Midstream Players Determine Population-Level Behavior Change: Social Marketing Research to Increase Demand for Lead-Free Components in Pitcher Pumps in Madagascar.

Mahmooda Khaliq,James R Mihelcic,Adaline M Buerck,Lova Rakotoarisoa,Luke John Paul Barrett,Silvia Sommariva,Rinah Rakotondrazaka

doi:10.3390/ijerph18147297

Abstract

Lead (Pb) exposure through water contamination is an important issue at the intersection of public health and water, sanitation, and hygiene (WASH). Behavior-change programs designed to address this pressing problem rarely take a behavioral-science-informed approach, nor do they consider the role of intermediate players who often influence and support behavior change. Social marketing segments the population and focuses on the consumer/user throughout program development and implementation. To illustrate the social marketing process, this cross-sectional, qualitative design study investigates the use of Pb in the construction and maintenance of household pitcher pumps for potable water in Madagascar. A sample of 18 technicians were interviewed on their current practices, motivators, barriers, and communication channels for knowledge exchange. The results reveal the importance of peers, those considered experts or “market mavens”, and the need for information on the dangers of Pb as an outdated practice for any future intervention. This study advances the notion of a design shift within engineering WASH projects, whereby social/behavioral approaches are used to consider the needs, concerns, and current behaviors of the consumer. We also advocate for engaging intermediate players who often influence behavior change in the rollout of an engineering innovation.

Highlights

Lead (Pb) exposure through water contamination is a key issue at the intersection of public health and water, sanitation, and hygiene (WASH) [1]
A recent report found that around one in three children globally have blood lead levels (BLL) above 5 micrograms per deciliter [2], a level considered to be a prompt for action, though there is no safe level of Pb for the body; even low BLLs (~1–2 μg/dL) can affect children’s cognitive and social development [3]
Rather than focus on the end-user, whose health is compromised by Pb exposure, the midstream approach focuses on behavior change among intermediate players who

Summary

Introduction

Lead (Pb) exposure through water contamination is a key issue at the intersection of public health and water, sanitation, and hygiene (WASH) [1]. The same report identifies pipe replacements as one key long-term solution to eliminating exposure from water sources and suggests that behavior-change interventions should target both the general population and occupationally exposed workers to limit exposure [2]. The present study extends these lines of inquiry to the development of a midstream behavioral intervention to address the problem of Pb in drinking water in the port city of Toamasina, Madagascar. Rather than focus on the end-user, whose health is compromised by Pb exposure, the midstream approach focuses on behavior change among intermediate players (e.g., pump technicians in Toamasina) who 4.0/).

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Conclusion