Methods and Approaches to Understanding Behaviour Change

"A behaviour change method is considered to be any process that has the potential to influence individuals and behaviour."

This Governance and Social Development Resource Centre (GSDRC) Helpdesk rapid review draws on academic and grey literature to present a broad overview of theories and models of behaviour and behaviour change. It highlights their adaptation and application to the field of international development through examples, and offers some insight into behaviour change initiatives in the Karamoja region of northeastern Uganda, in order inform further behaviour change activities in that area.

The report explains that "there are a large number of theories and approaches towards behavioural change derived from disciplines such as psychology, sociology, communication and political science. These theories focus on a number of different levels: the enabling environment; the community; the interpersonal; or the individual." It goes on to review different theories and models of behaviour change according to these different levels:

• For the enabling environmental level, which relates to the changes around policy and legislation, the report offers a brief outline of the following theories and approaches: media theories, social movement theories, social network and social support theory, social capital, ecological models, theories of complexity, theories of change, and behavioural economics.
• For the community level, the report gives an overview of: community organisation, the integrated model of communication for social change, the theory of social norms, the social convention theory, the theory of gender and power, a culture-centred approach, the positive deviance approach, the theory of organisational change, diffusion of innovations theory, the social marketing approach, and models of patient-centred communication functions.
• For the interpersonal level, the report offers an overview of the social learning theory/social cognitive theory, and theories of dialogue.
• For the individual level, the report offers brief descriptions of the following theories: hierarchy of effects model, the theory of self-determination, the theory of human motivation, the stages of change/transtheoretical model, the theory of planned behaviour, and the health belief model.

In addition, the report briefly outlines open theory models, specifically looking at the behaviour change wheel, which highlights how behaviour is part of an interrelated system.

Following the discussion on the difference theories, the report offers examples of behaviour change approaches and strategies in international development, specifically:

• The World Bank’s framework for affecting behaviour change, which relies on three principles: thinking automatically, thinking socially, and thinking with mental models.
• The United Nations Children’s Fund (UNICEF) Communication for Development (C4D) approach, which suggests that harmful cultural values, societal norms, and structural inequalities have to be taken into consideration for behaviours to change on a large scale.
• The United States Agency for International Development (USAID) C-Change Project, which was designed to provide support to USAID missions and their partners in designing, planning, implementing, and evaluating communication activities. This approach employs specific strategic approaches to achieve expected programme outcomes.
• FHI360's social and behaviour change communication approach - FHI 360 uses a socio-ecological lens to view the complex interplay between individual, interpersonal, community, and societal factors that affect behaviours. They select interactive, participatory strategies to ensure a holistic view of people’s desires, needs, and barriers and facilitators to change.
• Action Aid's Stepping Stones approach - this is a participatory training package that was designed to address HIV prevention in sub-Saharan Africa and increase the care of people living with HIV and AIDS (PLWHA) at the community level. It did so through promoting communication and relationship skills within households and communities and by enabling individuals and communities to find their own solutions.

The report offers the following selection of key findings emerging from the rapid review of theories and their application in international development:

• Evidence suggests that behaviour and behaviour change can be best understood when an open theory approach is adopted. This approach acknowledges that the translation of theoretical methods to specific contexts, populations, and cultures is complex.
• Information alone is insufficient to support behaviour change. Influencing healthy behaviours and creating a supportive social environment in a variety of contexts requires stimulation of learning and participation through regular dialogue with the affected community. This type of behaviour change communication and social mobilisation works best when actions, messages, and materials are strategically planned, managed, and monitored with the affected communities and supported by the necessary financial and human resources.
• Relationships with partners, families, and the community or society in which one lives can substantially determine how we behave.
• Behaviour change interventions need to take into account the specific psychological and social influences that guide decision making and behaviour in a particular setting. That means that the process of designing and implementing effective interventions needs to become a more iterative process of discovery, learning, and adaptation. What matters is not only which policy to implement but also how it is implemented.

The final section of the report looks at behaviour change in the context of Karamoja in Uganda. It shows that efforts to affect behavioural change within the context of Karamoja have focused on targeting interventions, principally around nutrition, health, and hygiene. The section discusses two programmes that are investigating behaviour change in the area: Concern’s Resiliency through Wealth, Agriculture and Nutrition in Karamoja (RWANU) programme, which commissioned Trials of Improved Practices (TIPs), a formative research method designed to test the feasibility and acceptability of practices at the household level that a programme plans to promote, which in this case was dietary diversity, hand washing, and designated defaecation. The second programme discussed is World Vision’s Northern Karamoja Growth, Health and Governance Program, which aimed to analyse existing barriers and enabling framework for prioritised Maternal Child Health and Nutrition/WASH behaviours. A barrier analysis survey methodology was conducted to inform the process, which is discussed in detail in the report.

(The GSDRC Research Helpdesk provides rapid syntheses of key literature and of expert thinking in response to specific questions on governance, social development, humanitarian, and conflict issues. The concise reports draw on a selection of the best recent literature available and on input from international experts.)