A step-by-step process >
III. Design
During the design stage, the results from formative research are transformed into a detailed implementation plan by first developing a behaviour-change strategy, based on the results of formative research in the analysis phase and then building an implementation and monitoring plan for delivering and managing the strategy in practice.
The design phase is commonly the weak link in the chain of developing a behaviour-change intervention. Formative research may produce clear insights about behaviours, the people who practice them and the drivers and barriers to change, but these insights are often not used to produce original and effective ideas for implementing behaviour-change. To help overcome this, the contents of this section are supported by a proposed set of participatory activities that managers can facilitate to help their team improve the design process.
a) Strategy development
The behaviour-change strategy should identify the following:
- What behaviour(s) are aimed to be changed by the intervention;
- Who are the people who will be targeted by the intervention (the people practising the behaviours, the people who influence them);
- Other key stakeholders who will be involved in the intervention, including programme staff, implementing partners, public and commercial actors etc.;
- The SMART objectives for behaviour change:
- Specifying the behaviours, who practices them and what amount of change is expected;
- Identifying how change will be measured;
- Making sure the change objectives are appropriate to people’s need, preferences and capacities;
- That they are realistic in terms of time and resources available, and the constraints of the context;
- That they are defined in terms of time;
- The behavioural factors / determinants that will be the focus of the strategy i.e. the barriers, enablers and motivators that will be addressed;
- Strategies for influencing the behavioural determinants. For example, if people’s perceptions about the high cost of soap were identified as a barrier to using soap for handwashing, this could be addressed by making soap cheaper, or by creating the perception that using soap can actually help save money by reducing health-care costs. Achieving each of these objectives would require quite different activities. In the DBC approach, these objectives are called Bridges to Activities.
- Behaviour-change activities that will be carried out in order to achieve the change objectives.
HOW TO DEVELOP THE STRATEGY?
We have developed a process that can be used for developing a behaviour-change strategy with a project team and with the participation of people from the population concerned by the intervention. It involves 7 steps with a series of participatory workshop sessions that can be facilitated by a project manager.
WHAT OTHER RESOURCES ARE AVAILABLE?
Here are some suggestions of resources where you can find more detail on behaviour-change activities, and advice for choosing and developing them.
They are presented according to the design challenge you may have.
To set a goal for behaviour change (a bridge to activities)
Task 12 in the DBC training manual provides guidance and exercises on how to define the bridges to activities based the analysis of behaviour determinants. There are many examples of bridges to activities on pages 246 to 248 of the manual.
To find behaviour-change techniques and activities to match determinants
Examples of behaviour-change activities related to different determinants for AAH’s different intervention sectors. They can be used for inspiring ideas. Avoid just copying them into your strategy.
- BC Guide table of activities by determinant – FSL
- BC Guide table of activities by determinant – Health & Nutrition
- BC Guide table of activities by determinant – WASH
The RANAS catalogue of behaviour-change techniques (BCTs) presents 36 different generic behaviour-change techniques that have been shown to influence the 17 different behavioural factors / determinants on which the RANAS approach is based. For example, BCT 10 prompt public commitment is a way to demonstrate that there are people performing the desired behaviour and thereby encourage others to do the same and BCT 21 Organize social support is one of eight BCTs designed to increase people’s confidence in their ability to perform a behaviour. BCTs in RANAS are similar to Bridges to Activities in the DBC approach, in that they are strategies for influencing a behavioural determinant. Each BCT is illustrated with activity examples from the WASH sector, but the same principles could be applied to any behaviour.
Table 7 on page 40 of the Behaviour Centred Design Manual provides a list of many different behaviour-change components according to different influences on behaviour that can be used in an intervention.
To generate other ideas for novel behaviour-change activities
The Design Kit (a product of HCD), provides a range of human-centred design methods such as brainstorming, creating concepts out of ideas, and co-creating, that can be very useful at the design stage. Single methods can be chosen according to the particular design challenges faced, or they can be combined to make a design process. Another useful resource for human-centred design is the Stanford School Design Thinking Bootleg, a set of activity card to help facilitate a creative and participatory design process.
The Behaviour Centred Design Manual (Chapter 4) also provides step-by-step guidance on the creative process for selecting and designing behaviour change campaigns, as well as an example of a creative brief (pages 66-68) and tips for finding and hiring a creative agency for developing communications materials (page 70).
For information on interpersonal activities for assisting behaviour change
Action Against Hunger’s ABC Manual Part 2 (pages 54-71) presents a wide range of activities that can be used at community, group, family and individual levels to promote and accompany behaviour and social change. Among them, you will find behaviour simulation and rehearsal, counselling, motivational interviews, home visits and family support.
In the document Care Groups: A Reference Guide for Practitioners you can find guidance on how to develop peer-support sessions and a curriculum of topics for behaviour change following the adult learning cycle, and how to conduct supportive supervision of care-group volunteers and promoters.
See the resource Make Me a Change Agent: A Multisectoral SBC Resource to guide community workers and field staff on how to develop specific type of behaviour-change activity (home visit, testimonies, storytelling etc.) and training resources to build the skills of your team.
To develop communications campaigns for behaviour change
If messages and communications are to be used for behaviour change, then a specific process is required with the involvement of specialists to produce messages and communications that are relevant to the behaviours and the people involved, and that produce measurable behaviour change.
The SBCC I-Kit can help managers and teams go through the essential steps and tasks in the process, and identify what input is required from communications specialists, and how to manage their contribution. A key task is to write a creative brief for a specialist service provider such as a communications company or a local radio station. See the Compass How-to Guide: How to Write a Creative Brief for detailed guidance on this.
If you want to develop communications materials yourself, you can find ideas at the Compass How-to Guide: How to Develop SBCC Creative Materials.
Develop the behaviour change strategy.
b) Implementation planning
IMPLEMENTATION PLAN
The implementation plan for behaviour-change activities should include the following elements:
- Standing Operating Procedures (SOPs) for the behaviour-change activities:
- The behaviour-change objective, identifying the priority group(s) and a measurable description of the behaviour(s) to be promoted;
- The different behaviour-change activities that will be carried out to achieve the behaviour-change objective;
- A detailed plan for each activity, describing who should be reached by it, how it will be carried out, what materials are needed, what competencies are required for delivering it, how long it will take and how many times it will be repeated;
- A list of staff required to carry out the activities, and any training required;
- Activity and resources plan:
- A timeline / Gantt chart for implementation showing when each behaviour-change activity will take place, resources allocated and who will be responsible for it.
The plan should include enough time for designing, testing and refining behaviour-change activities and conducting additional formative research if needed. It should also identify responsibility for essential support activities such as formative supervision of field staff, and monitoring.
If a standard behaviour-change methodology such as PHAST or CLTS is used then there’s no need to write the SOPs, as they already exist in the implementation manuals. In this case, it just requires a timeline for delivering each step of the process.
The implementation plan for the behaviour-change activities should be drawn up with reference to overall plan for the project it is part of. This is important for integrating behaviour change into the project as a whole, and identifying potential conflicts, dependencies and synergies with other components of the project.
MONITORING PLAN
The Design phase also includes development of the monitoring plan. This should be done according to the same procedures used in any other Action Against Hunger project intervention. Behaviour-change indicators should be built into the monitoring and evaluation plan for the project as a whole.
The behaviour-change indicators written in the monitoring plan will be specific to the behaviour(s) that the change intervention focuses on. They should be described carefully in the plan so that they can be measured objectively and reliably, and the plan should define who will measure the behaviour change and how.
To illustrate careful formulation of behaviour-change indicators, here are five examples from a list of eighteen behaviours important for maternal and child health interventions described on the Accelerator Behaviors website.
Build the implementation and monitoring plan.
| Behaviours | Indicators |
|---|---|
| Mothers initiate breastfeeding within one hour after delivery | Among last-born children born in the two years preceding the survey the percentage who started breastfeeding within 1 hour of birth |
| Caregivers feed adequate amounts of nutritious, age-appropriate foods to children from 6 to 24 months of age, while continuing to breastfeed | Percentage of breastfed children age 6-23 months fed four or more food groups and the minimum meal frequency |
| Pregnant women complete a full course of quality antenatal care (ANC) | Percentage of women who had a live birth in the three years preceding the survey who had 4+ antenatal care visits |
| Family members wash hands with soap under running water at 4 critical times [after defecation, after changing diapers, before food preparation and before eating] | Among households where place for handwashing was observed, percentage of households with soap and water. Soap includes soap or detergent in bar, liquid, powder or paste form. |
| Pregnant women and children sleep under an insecticide-treated net (ITN) | Percentage of pregnant women and children under age five who slept under an insecticide-treated net (ITN) the night before the survey |
A number of AAH core indicators relate to behaviour change and are required for all interventions. Here’s a summary, per sector of intervention:
| Sector | Core indicators related to behaviour change |
|---|---|
| Food Security and Livelihoods | • Minimum Dietary Diversity – Women • Household Dietary Diversity Score |
| WASH | • Change in presence of hand-washing enablers • Change in individual knowledge of key times for hand-washing • Change of access to improved water • Change in use of latrine/toilet • Change in hygienic disposal of child faeces |
| Nutrition and Health | • Proportion of discharges who defaulted • Proportion of the target population receiving and taking supplements with the correct dosage and frequency |
| Mental Health and Care Practices | • Changes in optimal breastfeeding practices by lactating mothers • Changes in quality interactions between caregivers and their children |
See the AAH Multi-sectoral Monitoring and Evaluation Guidelines and the Toolkits for each sector for detailed guidance, including the selection and measurement of these indicators.
The behaviour-change results indicators may not be measured very frequently, as this can be costly and time-consuming. As a minimum, in AAH projects, they should be measured a the beginning and the end of the intervention by doing KAP surveys.
Regular monitoring should focus on the following process indicators:
- The coverage of the behaviour-change activities (the percentage of the target audience reached by the activities as planned);
- The quality of activities delivered (as compared with the Standard Operating Procedures for the activities – using a quality checklist).
a) Strategy development
Develop the behaviour change strategy.
The behaviour-change strategy should identify the following:
- What behaviour(s) are aimed to be changed by the intervention;
- Who are the people who will be targeted by the intervention (the people practising the behaviours, the people who influence them);
- Other key stakeholders who will be involved in the intervention, including programme staff, implementing partners, public and commercial actors etc.;
- The SMART objectives for behaviour change:
- Specifying the behaviours, who practices them and what amount of change is expected;
- Identifying how change will be measured;
- Making sure the change objectives are appropriate to people’s need, preferences and capacities;
- That they are realistic in terms of time and resources available, and the constraints of the context;
- That they are defined in terms of time;
- The behavioural factors / determinants that will be the focus of the strategy i.e. the barriers, enablers and motivators that will be addressed;
- Strategies for influencing the behavioural determinants. For example, if people’s perceptions about the high cost of soap were identified as a barrier to using soap for handwashing, this could be addressed by making soap cheaper, or by creating the perception that using soap can actually help save money by reducing health-care costs. Achieving each of these objectives would require quite different activities. In the DBC approach, these objectives are called Bridges to Activities.
- Behaviour-change activities that will be carried out in order to achieve the change objectives.
HOW TO DEVELOP THE STRATEGY?
We have developed a process that can be used for developing a behaviour-change strategy with a project team and with the participation of people from the population concerned by the intervention. It involves 7 steps with a series of participatory workshop sessions that can be facilitated by a project manager.
WHAT OTHER RESOURCES ARE AVAILABLE?
Here are some suggestions of resources where you can find more detail on behaviour-change activities, and advice for choosing and developing them.
They are presented according to the design challenge you may have.
To set a goal for behaviour change (a bridge to activities)
Task 12 in the DBC training manual provides guidance and exercises on how to define the bridges to activities based the analysis of behaviour determinants. There are many examples of bridges to activities on pages 246 to 248 of the manual.
To find behaviour-change techniques and activities to match determinants
Examples of behaviour-change activities related to different determinants for AAH’s different intervention sectors. They can be used for inspiring ideas. Avoid just copying them into your strategy.
- BC Guide table of activities by determinant – FSL
- BC Guide table of activities by determinant – Health & Nutrition
- BC Guide table of activities by determinant – WASH
The RANAS catalogue of behaviour-change techniques (BCTs) presents 36 different generic behaviour-change techniques that have been shown to influence the 17 different behavioural factors / determinants on which the RANAS approach is based. For example, BCT 10 prompt public commitment is a way to demonstrate that there are people performing the desired behaviour and thereby encourage others to do the same and BCT 21 Organize social support is one of eight BCTs designed to increase people’s confidence in their ability to perform a behaviour. BCTs in RANAS are similar to Bridges to Activities in the DBC approach, in that they are strategies for influencing a behavioural determinant. Each BCT is illustrated with activity examples from the WASH sector, but the same principles could be applied to any behaviour.
Table 7 on page 40 of the Behaviour Centred Design Manual provides a list of many different behaviour-change components according to different influences on behaviour that can be used in an intervention.
To generate other ideas for novel behaviour-change activities
The Design Kit (a product of HCD), provides a range of human-centred design methods such as brainstorming, creating concepts out of ideas, and co-creating, that can be very useful at the design stage. Single methods can be chosen according to the particular design challenges faced, or they can be combined to make a design process. Another useful resource for human-centred design is the Stanford School Design Thinking Bootleg, a set of activity card to help facilitate a creative and participatory design process.
The Behaviour Centred Design Manual (Chapter 4) also provides step-by-step guidance on the creative process for selecting and designing behaviour change campaigns, as well as an example of a creative brief (pages 66-68) and tips for finding and hiring a creative agency for developing communications materials (page 70).
For information on interpersonal activities for assisting behaviour change
Action Against Hunger’s ABC Manual Part 2 (pages 54-71) presents a wide range of activities that can be used at community, group, family and individual levels to promote and accompany behaviour and social change. Among them, you will find behaviour simulation and rehearsal, counselling, motivational interviews, home visits and family support.
In the document Care Groups: A Reference Guide for Practitioners you can find guidance on how to develop peer-support sessions and a curriculum of topics for behaviour change following the adult learning cycle, and how to conduct supportive supervision of care-group volunteers and promoters.
See the resource Make Me a Change Agent: A Multisectoral SBC Resource to guide community workers and field staff on how to develop specific type of behaviour-change activity (home visit, testimonies, storytelling etc.) and training resources to build the skills of your team.
To develop communications campaigns for behaviour change
If messages and communications are to be used for behaviour change, then a specific process is required with the involvement of specialists to produce messages and communications that are relevant to the behaviours and the people involved, and that produce measurable behaviour change.
The SBCC I-Kit can help managers and teams go through the essential steps and tasks in the process, and identify what input is required from communications specialists, and how to manage their contribution. A key task is to write a creative brief for a specialist service provider such as a communications company or a local radio station. See the Compass How-to Guide: How to Write a Creative Brief for detailed guidance on this.
If you want to develop communications materials yourself, you can find ideas at the Compass How-to Guide: How to Develop SBCC Creative Materials.
b) Implementation planning
Build the implementation and monitoring plan.
IMPLEMENTATION PLAN
The implementation plan for behaviour-change activities should include the following elements:
- Standing Operating Procedures (SOPs) for the behaviour-change activities:
- The behaviour-change objective, identifying the priority group(s) and a measurable description of the behaviour(s) to be promoted;
- The different behaviour-change activities that will be carried out to achieve the behaviour-change objective;
- A detailed plan for each activity, describing who should be reached by it, how it will be carried out, what materials are needed, what competencies are required for delivering it, how long it will take and how many times it will be repeated;
- A list of staff required to carry out the activities, and any training required;
- Activity and resources plan:
- A timeline / Gantt chart for implementation showing when each behaviour-change activity will take place, resources allocated and who will be responsible for it.
The plan should include enough time for designing, testing and refining behaviour-change activities and conducting additional formative research if needed. It should also identify responsibility for essential support activities such as formative supervision of field staff, and monitoring.
If a standard behaviour-change methodology such as PHAST or CLTS is used then there’s no need to write the SOPs, as they already exist in the implementation manuals. In this case, it just requires a timeline for delivering each step of the process.
The implementation plan for the behaviour-change activities should be drawn up with reference to overall plan for the project it is part of. This is important for integrating behaviour change into the project as a whole, and identifying potential conflicts, dependencies and synergies with other components of the project.
MONITORING PLAN
The Design phase also includes development of the monitoring plan. This should be done according to the same procedures used in any other Action Against Hunger project intervention. Behaviour-change indicators should be built into the monitoring and evaluation plan for the project as a whole.
The behaviour-change indicators written in the monitoring plan will be specific to the behaviour(s) that the change intervention focuses on. They should be described carefully in the plan so that they can be measured objectively and reliably, and the plan should define who will measure the behaviour change and how.
To illustrate careful formulation of behaviour-change indicators, here are five examples from a list of eighteen behaviours important for maternal and child health interventions described on the Accelerator Behaviors website.
| Behaviours | Indicators |
|---|---|
| Mothers initiate breastfeeding within one hour after delivery | Among last-born children born in the two years preceding the survey the percentage who started breastfeeding within 1 hour of birth |
| Caregivers feed adequate amounts of nutritious, age-appropriate foods to children from 6 to 24 months of age, while continuing to breastfeed | Percentage of breastfed children age 6-23 months fed four or more food groups and the minimum meal frequency |
| Pregnant women complete a full course of quality antenatal care (ANC) | Percentage of women who had a live birth in the three years preceding the survey who had 4+ antenatal care visits |
| Family members wash hands with soap under running water at 4 critical times [after defecation, after changing diapers, before food preparation and before eating] | Among households where place for handwashing was observed, percentage of households with soap and water. Soap includes soap or detergent in bar, liquid, powder or paste form. |
| Pregnant women and children sleep under an insecticide-treated net (ITN) | Percentage of pregnant women and children under age five who slept under an insecticide-treated net (ITN) the night before the survey |
A number of AAH core indicators relate to behaviour change and are required for all interventions. Here’s a summary, per sector of intervention:
| Sector | Core indicators related to behaviour change |
|---|---|
| Food Security and Livelihoods | • Minimum Dietary Diversity – Women • Household Dietary Diversity Score |
| WASH | • Change in presence of hand-washing enablers • Change in individual knowledge of key times for hand-washing • Change of access to improved water • Change in use of latrine/toilet • Change in hygienic disposal of child faeces |
| Nutrition and Health | • Proportion of discharges who defaulted • Proportion of the target population receiving and taking supplements with the correct dosage and frequency |
| Mental Health and Care Practices | • Changes in optimal breastfeeding practices by lactating mothers • Changes in quality interactions between caregivers and their children |
See the AAH Multi-sectoral Monitoring and Evaluation Guidelines and the Toolkits for each sector for detailed guidance, including the selection and measurement of these indicators.
The behaviour-change results indicators may not be measured very frequently, as this can be costly and time-consuming. As a minimum, in AAH projects, they should be measured a the beginning and the end of the intervention by doing KAP surveys.
Regular monitoring should focus on the following process indicators:
- The coverage of the behaviour-change activities (the percentage of the target audience reached by the activities as planned);
- The quality of activities delivered (as compared with the Standard Operating Procedures for the activities – using a quality checklist).
