Abstract
BackgroundBehavior change interventions have been developed by drawing from many different theories using design processes of varying specificity. We describe the development of a behavior change intervention to improve on-site peri-urban sanitation quality in Lusaka, Zambia using the Behavior Centered Design (BCD) framework to explain the results of the process applied to improving the quality of shared peri-urban sanitation and compare them to similar interventions.MethodsWe used the BCD behavioral determinants model to synthesize the data from our literature review and formative research. Then, we partnered with creative professionals using a design process to develop a theory-driven on-site peri-urban sanitation intervention. Particular attention was paid to the implications of using BCD for intervention development on improving its effectiveness, increasing the contributions to knowledge for other behaviors and settings, and advancing the discipline of applied behavioral science.ResultsBased on findings from a literature review and formative research, we designed an intervention to encourage landlords to improve their toilets by making them more accessible, desirable, hygienic, and sustainable. The intervention involved landlords meeting in facilitated groups every 2 weeks with individual follow-up after each meeting. The meetings presented surprising “hidden camera”-style videos to reveal tenants’ perspectives, used participatory activities to help landlords reevaluate the benefits they would derive from improving sanitation on their plots, and provided practical guidance and mechanisms to facilitate the performance of construction and cleaning behaviors.ConclusionsUsing the BCD framework provided an easy-to-follow intervention design process. The resulting intervention is highly creative and multi-faceted, with each element having a theoretical role in an explicit theory of change. The development of this theory-driven intervention advances applied behavioral science by facilitating evaluation of each of the behavior change techniques and the overall delivery mechanism hypothesized to change the target behaviors. This informs the adaptation of these findings to improving on-site sanitation in other settings and the iterative development of the BCD model, which can be used to more effectively change other behaviors.
Highlights
Behavior change interventions have been developed by drawing from many different theories using design processes of varying specificity
We argue that the best way to advance applied behavioral science (ABS) is by developing theory-driven interventions
To Assess the state of knowledge about peri-urban sanitation intervention strategies, we conducted a systematized review of available literature on the drivers of on-site peri-urban sanitation improvement and included evidence from other settings as suggestive to supplement the limited research in peri-urban settings
Summary
Behavior change interventions have been developed by drawing from many different theories using design processes of varying specificity. We describe the development of a behavior change intervention to improve on-site peri-urban sanitation quality in Lusaka, Zambia using the Behavior Centered Design (BCD) framework to explain the results of the process applied to improving the quality of shared peri-urban sanitation and compare them to similar interventions. The problem of peri-urban sanitation Poor peri-urban sanitation is a large and growing public health problem, and the lack of strong evidence for how to improve it will make it difficult to meet the sustainable development goal (SDG) 6.2 of safely managed sanitation for all. About 4.5 billion people lack access to safely managed sanitation globally, and 29% of those live in urban areas [1]. Despite global progress in reducing open defecation, the prevalence of shared sanitation is increasing in many regions, and is common in peri-urban areas [4]. While the discussion of whether high-quality shared sanitation can be considered adequate is ongoing, it is clear that the quality of much shared sanitation so poor that it is unlikely to meet any established quality standard [5]
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