Transcript Introducing FOAM

Introducing FOAM:
Focus, Opportunity, Ability, Motivation
A draft behavior
change model for
HW programs
Dakar, May 29, 2007
Overview of Presentation
 Background
 Behavior change models
 The Hanoi Workshop
 Next steps
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Background
 Many tools available (eg. Handwashing Handbook)
 All stress audience-centered programming
 Lack of holistic model to explain all factors influencing HW
 Global Scaling Up HW Project presents an opportunity
 Learning objective
 Common framework
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What is a BC Model
 Diagram that represents the various
“determinants” of behavior change
 “Determinants” are internal or external factors that
influence an individual to perform a behavior
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Advantages of a BC Model
 Provides a common language
 Identifies critical linkages
 Informs M&E
 Enables evidence-based and comprehensive
programming
 Can be adapted across populations
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Foundations of BC Models
 Draw on disciplines such as public health,
marketing, communication, advertising, business,
social psychology and consumer behavior
 Foundations include Health Belief Model, Theory
of Reasoned Action and The Stages of Change
which have been studied extensively
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Two Examples of BC Models
 WB’s BC continuum
 PSI’s PERForM
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World Bank BC Continuum
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PSI’s PERFORM
HEALTH STATUS
QUALITY OF LIFE
USE
RISK -REDUCING BEHAVIOR
AT RISK
OPPORTUNITY
Availability
Brand
Attributes
ABILITY
Brand Appeal
Knowledge
Quality of Care
Social Norm
MOTIVATION
Belief
Attitudes
Social Support
Intention
Self Efficacy
Subjective
Norm
Locus of
Control
Outcome
Expectation
Threat
Willingness to
Pay
POPULATION CHARACTERISTICS
SOCIAL MARKETING INTERVENTION
PRODUCT
PLACE
PRICE
PROMOTION
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Examples of PERForM
Applications in Cambodia
 Data:
 2003 sero-surveillance: 42% new HIV/AIDS cases from
husband to wife
 Formative research: low condom use with trusted
partner due to 1) low perceived risk and 2) low social
support – confirmed later through TRaC survey
 Number One: widely available (over 95% of brothels)
and affordable but associated with commercial sex
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Examples of PERForM
Applications in Cambodia (2)
 Program responses:
 launch of OK Condom
 “Klahan” (Be brave) BCC campaign
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OK Condom
 Marketing strategy:
 Different product launched with family planning positioning in
2004
 Differentiated distribution channels from Number One condom
 Advertising and promotion includes mass media and
sponsorships
 Key results:
 Total condom sales in Cambodia grew from 20 million in 2004
to over 25 million in 2006
 OK Condom’s share at 10% of total sales
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Klahan BCC Campaign
 Aimed at building social support and improving
personal risk perception among trusting couples
 Integrates mass media (8 TV and radio spots),
mobile video units, website and outreach through
NGO peer-educator networks
 Key determinants and exposure tracked through
TRaC annual surveys
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Spots
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Generic Vs Branded
 Generic (BCC) campaigns aim to change
knowledge, attitudes and beliefs related to
intended behavior and/or build “primary” demand
for product category
 Branded build “secondary” demand for product
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Generic Vs Branded (2)
 PSI generally does not put product brand on
“generic” or BCC campaigns:
 Enhances credibility
 Facilitates stakeholder buy-in
 Facilitates use by partners
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PERForM and M&E
 TRaC = annual targeted KAP-type surveys
 Compares those who perform the desired
behavior to those who do not
 Identifies key determinants correlated to desired
behavior
 Establishes dashboards, allows for monitoring
and campaign impact evaluation
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The Hanoi Workshop
 Held April 24-27, 2007
 Participants included HW Coordinators,
GoV/MoH and Global team
 Facilitated by a communication consultant
 Key objective: develop a global behavior change
model for the “Scaling up HW Behavior Change”
project
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Process
1.
2.
3.
4.
5.
6.
Agreement on expectations and parameters
Review of existing frameworks
Overview of research and theories on change
Country/regional presentations
Identification of relevant determinants for HW
Decision to group determinants under
opportunity, ability and motivation
7. Development of draft BC model FOAM
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F in FOAM
 Focus:
desired behavior (consistent
HW at critical times)
target populations
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OAM
 Opportunity: institutional or
structural factors that influence an
individual’s chance to perform a
behavior
 Ability: individual’s skills and
proficiency to perform a behavior
 Motivation: drives, wishes, urges, or
desires that influence an individual
to perform a behavior
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Focus
Opportunity
Ability
Access/availability
Knowledge
Product attributes
Social Support
Social norms
Motivation
Attitudes & beliefs
Expectations
Threat
Intention
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Opportunity
Availability/access: ease of obtaining the
cluster of goods and services needed for the
behavior
Can I get water/soap when I need it?
How far to go to get it?
Is there water and soap when I wash hands?
What is the price?
Can I buy it when I need it?
Am I able to make the decision to buy soap?
Who makes the decision to buy soap?
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Opportunity (2)
Product attributes: perceived or actual
characteristics of goods and services
Does soap smell good?
Does water look clean?
Is the color (soap or water) nice?
Is it anti-bacterial?
Is the soap agent I have at home
appropriate for all critical times?
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Opportunity (3)
Social norms: behavioral standards which
exist in the community for an individual to
follow
Are people around me washing their
hands with soap?
Who around me is washing hands?
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Ability
Knowledge: true facts accumulated
through learning about objects, actions,
and events
Do I know why HW is important?
Do I know that washing with water is not
good enough?
Do I know when to do it?
Do I know that germs that are invisible
can make me or my child sick?
Do I know that HW can prevent my child
from getting diarrheal disease and ARIs?
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Ability (2)
Social support: Physical, emotional, or
informational assistance an individual or
community gives or receives for a
behavior
Has anyone talked to me about HW?
Has anyone helped me to HW?
Has anyone made me feel good about
HW or rewarded me?
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Motivation
 Attitudes and beliefs: perceptions or mental
positions about a product or behavior.
Evaluations or assessment of a product or
behavior which may or may not be true.
 Do I believe that HW is necessary?
 Do I believe that HW improve my child’s health?
 Do I think that all soaps the same and equally
effective?
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Motivation (2)
 Expectations: what an individual thinks will
happen as a result of performing the behavior.
 Will washing my hands reduce my child’s
immunity?
 What will others think of me if I HW? How
much do I care what they think (subjective
norms)?
 What do I think could happen if I HW? What if I
do not HW?
 Does God/fate decide whether my child will
suffer from diarrhea or ARI (locus of control)?
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Motivation (3)
Threat: perceived danger or harm
associated with performing or not
performing the behavior
How likely is my child to get diarrhea or
ARI (susceptibility)?
How dangerous is diarrhea or ARI for
my child (severity)?
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Motivation (4)
Intention: individual’s plan to perform or
facilitate the behavior
Am I planning to install a HW station?
Next time I go to the toilet/feed my baby
am I going to washing your hands with
soap?
How much am I willing pay?
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From Model to Practice
 FOAM can be integrated into existing tools and
frameworks
 Enables full marketing mix vision
 Informs monitoring/MIS
 Informs the formulation of communication
objectives in the advertising brief
 FOAM Operational Matrix (FOM) can be used for
planning purposes
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Enabling Environment
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Population Characteristics and HWWS Behavior
Focus
Opportunity
Ability
Motivation
2
Research
Key determinants
3
Communication
Strategy
Program Objectives
Concept &
Message
development
Marketing mix
Product
Price
Place
4
Channel
Choice
Promotion
Advocacy
development
Implementation
Monitoring and evaluation
5
6
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FOAM Operational
Matrix (FOM) from VN
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Next Steps
 Feedback from PPPHW BCC sub-working group and SC
 Country-level validation/training workshops
 Vietnam workshop tentatively planned early July
 Tanzania FOAM workshop planned for mid July
 Identification of key determinants to be tracked in
household surveys based on formative research
 Inclusion of FOAM communication objectives in advertising
agency briefs and spot formative research
 Training or TA on application of FOAM for HWTM
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