New tactics to nudge habit change for open defecation behavior

Open defecation remains a critical global health challenge, affecting almost 1 billion people around the world and contributing significantly to the estimated 842,000 people who die each year because of poor sanitation, hygiene practices, and unsafe water supplies [1].
 
Most behavior change approaches and frameworks for addressing open defecation have focused on relatively conscious, “reflective”  drivers of behavior, including people’s emotions (such as pride or shame), rational knowledge (e.g., of germ theory), social norms, and explicit action plans (such as commitments to change). Using the framework popularized by renowned social psychologist Daniel Kahneman [2], these factors can be described as “System 2” drivers of behavior i.e., relatively conscious and motivational factors. It is now well established, however, that human behavior can also be heavily influenced by “System 1” drivers i.e., relatively automatic, cue-driven factors [3].
 
In a newly released working paper by the World Bank Water Global Practice’s Water and Sanitation Program (WSP) “Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science”, we draw on basic scientific findings from psychology, cognitive science, and behavioral economics to propose a framework of eight “System 1” principles to support the initiation and maintenance of open defecation behavior change. In doing so, the new working paper builds from the general framework advanced in the World Bank Group’s 2015 World Development Report “Mind, Society, and Behavior”, which emphasized three core insights from behavioral science, namely that people think automatically, think socially and think using mental models.
 
The eight principles were developed drawing on field research insights and consultations with global sanitation and hygiene experts and leading academic behavioral scientists.  To illustrate, three of the “System 1” principles are to:

• Leverage context change to drive the new behavior of toilet use by capitalizing on seasonal migration patterns or by promoting sanitation to expecting first-time parents who are undergoing major life changes.
• Piggyback on existing behaviors and cues such as by installing communal toilets in areas that are typically used by people who defecate in the open as part of their routine morning walks.
• Find ways to connect ending open defecation to locally meaningful rituals, such as marriage (e.g., “no toilet, no bride” campaigns).

The eight principles proposed are meant to augment, not replace, approaches based on System 2 thinking such as community-led total sanitation. We think of them as booster kits. As mentioned above, a core insight from the behavioral sciences [2] is that human behavior is the product of both System 2 and System 1 thinking. Thus, the most challenging behavior change problems will invariably require a set of tactics targeting both Systems and working in unison.
 
As practitioners and program managers explore folding these ideas into existing or planned interventions, we encourage the use, where feasible, of randomized control trials (RCTs), the robust measurement of outcome data, and the capturing of successes and failures alike. In particular, we encourage the sharing of new ways to translate, tailor, and “bring to life” these basic science principles as makes sense in specific environments, cultures and sub-populations. Drawing on insights from these principles will generate new kinds of interventions in the mission for ending open defecation by 2030.
 
[1] UN. (2015) The Millennium Development Goal Report 2015. United Nations, New York, NY.
[2] Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux.
[3] Marteau, T. M., Hollands, G. J., & Fletcher, P. C. (2012). Changing human behavior to prevent disease: the importance of targeting automatic processes. Science, 337, 1492-1495.; Wood, W., & Neal, D. T., (in press). Habit-based behavior change interventions. Behavioral Science and Policy.

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