What is the role of habits and nudges in behavior change interventions?

Did you know that as much as 50% of our daily activity is argued to be driven by habits - habits that are actually established from our childhood? Our daily actions can be said to run in auto-pilot mode with only limited conscious thoughts. Habits can be described as "automatic reactions to particular cues", but there is a lack of further understanding of what these cues actually are, especially when talking about WASH-related behaviors like handwashing.

These so-called cues can also be referred to as nudges, which are about simple cues in one's environment, while habits are learned and usually frequent behavioral responses to cues or nudges. Nudges are based on the idea that because behavior is not entirely based on conscious choices, these choices can be guided. There is a term, originally coming from the field of behavioral economics, referring to these guidance practices as choice architecture. It involves practices seeking to change the way options are presented to the people in focus, the final intention being to influence their choices. One of the main aspects of nudges is that people start to behave or change their undesired behavior without putting much thought into the change. Nudges have been perceived as effective methods also since they require no actual change in people's values in order to create change.

It is important to understand that nudges do not provide any incentives, new knowledge, or information. So for instance, in a hygiene promotion context, the educational and informational posters are not nudges. There are good examples regarding handwashing nudges, like the "watchful eyes" as a part of a project called "Super Amma" in India, where pictures of eyes were situated above the handwashing facilities, or footpath nudges, that were first tested in schools in Bangladesh. This involved also painting the latrines and other parts of the toilet area with bright colors. In the case of Bangladesh, the researches noticed found that the simple nudge intervention of five months was actually as effective as high-intensity interventions that require substantially more resources. In India, the women were found to be 10% more likely to wash their hands when the eyes were applied, compared to no intervention.

WATCHFUL EYES, © BALAJI GOPALAN FROM

CENTRE OF GRAVITY.

The same kind of nudges was used in Vietnamese schools, making around 30% more students wash their hands compared to the pre-nudge situation. An organization called Splash found that after adding mirrors above the handwashing stations in schools in Nepal, students preferred using sinks that had mirrors above them, even when these sinks were located in less convenient places than the ones without mirrors. The fact that these nudges created some changes does not mean that they make the same in other settings, but many researches on similar kinds of nudge-based interventions at least provide compelling examples for how to apply nudges.

FOOTPATH NUDGE © KAMAL HOSSAIN, SAVE THE CHILDREN

What does it require to develop nudges?

Many times not much really, as the examples above show it can be only a small amount of paint or some stickers. Many times small things matter. Of course, sometimes there is a need to develop infrastructure, for instance in the case of handwashing interventions, where adequate handwashing stations (usually with soap or an alternative for it) is needed before there it makes any sense to create further nudges.

How to choose the right nudges?

Most importantly you need to know your "audience", i.e. the final beneficiaries. You need to understand their routines and habits. Global Handwashing partnership suggests to consider these following questions, initially created to help in the development of handwashing nudges, but these can be applied in many other areas and topics as well:

1. What needs to be in place for users to wash their hands? Are soap and water available?

2. What will the users do immediately before or after handwashing? Commons answers may be cooking or using the toilet.

3. Where do users typically look or move toward at critical handwashing times, like when exiting the toilet or preparing to eat?

4. What types of colors, messages, or other elements would be eye‐catching and engaging to your user? For example, painted nudges should be in a color that clearly stands out from the color of the surface they are painted on.

The hard evidence linked to the use of nudges and their relationship to behavior change still remains quite limited. The Global Handwashing Partnership is encouraging anyone using nudges in their own interventions to document the reports and share 'with them.

If you are interested in diving more deeply into scientific findings on ways to "nudge" people towards positive and desired behaviors, take a look at the World Development Report: Mind, Society and Behavior. The approaches presented in the report from 2015 have shown to be highly potential in shifting diverse behaviors such as parental caregiving practices, corruption, or household savings.

Sources used:

• The Global Handwash Partnership: https://globalhandwashing.org/step-two-behavior-initation/ and https://globalhandwashing.org/wp-content/uploads/2017/11/Using-Nudges-to-Encourage-Handwashing-with-Soap.pdf

• Research paper by Curtis et al. (2009) Planned, motivated and habitual hygiene behavior: an eleven country review: https://academic.oup.com/her/article/24/4/655/569523

• The World Development Report: http://documents1.worldbank.org/curated/en/905011467990970572/pdf/104328-WP-PUBLIC-OD-Habit-and-Nudging-Catalyst-Behavioral-Sciences-022916.pdf