Phase 1: Identify potential behavioral factors

First, the exact behavior to be changed and the specific population group to be targeted are defined; we specify who exactly should change which behavior. Then, we collect information on behavioral and contextual factors that might influence the target behavior, for example by conducting short qualitative interviews with various stakeholders at different levels, including the target population. Following this, the potential behavioral and contextual factors that we have identified are arranged in the RANAS model of behavior change, which may involve adapting and extending the model. The RANAS model integrates leading theories of behavior change and findings of environmental and health psychology and thus uses scientific expertise built on decades of research. By using the RANAS model to classify and organize the potential behavioral and context factors, we ensure that no important behavioral factors are neglected. For more information about the RANAS model, see Methodological Fact Sheet 2.

Phase 2: Measure the identified potential factors and determine those steering the behavior

First, we develop a questionnaire to measure the behavior and the potential behavioral factors and a protocol to conduct observations of the target behavior. Template tools have been designed for both questionnaires and observation protocols, and these have to be adapted to the local conditions. A doer/non-doer analysis is conducted to identify the behavioral factors steering the target behavior. This means that the responses of people who perform the behavior (doers) are compared to the responses of those who do not (non-doers); a large difference in the responses between doers and non-doers shows that the behavioral factor in question critically steers the behavior and thus can be addressed through behavior change techniques (BCTs) to change the behavior.

Phase 3: Select corresponding BCTs and develop appropriate behavior change strategies

The BCTs that are thought to change the critical behavioral factors specified in step 2 are selected for application in the behavior change strategies. A catalog of BCTs has been compiled to achieve this. The catalog lists which BCTs are thought to change which behavioral factor, based on evidence from environmental and health psychology. The BCTs have to be adapted to the local context and combined with suitable communication channels, which constitute the mode of delivery of the BCTs. Together, the BCTs and the communication channels form a behavior change strategy.

Phase 4: Implement and evaluate the behavior change strategies

To verify the efficacy of these behavior change strategies and to optimize them, the strategies are evaluated with a before-after control (BAC) trial. This means that the behavior and the behavioral factors are measured with a questionnaire and with observations both before (step 2) and after implementing the strategies. Further, a control group has to be evaluated. This is to control for intervention-independent changes in behavior. The differences in behavior scores and in behavioral factor scores before and after the strategies’ implementation are calculated and compared to those of the control group. The behavior change strategies have been effective when the before-after differences in behavior and behavioral factors are larger for the population that received the strategies than for the control group. The strategies can be refined if needed. Otherwise, they can be applied directly at larger scales or in other, similar areas, backed up by the evidence that they are effective in changing behavior.

Phase 1: Specify behaviours, factors and context

First, the exact behaviours to be changed and the specific population group to be targeted are defined; we specify who exactly should change which behaviour. Then, we collect information on behavioural and contextual factors that might influence the target behaviour, for example by conducting short qualitative interviews or focus groups discussions with various stakeholders at different levels, including the target population. Following this, the potential behavioural and contextual factors that we have specified are used to adapt and extend the RANAS model of behaviour change. The RANAS model integrates leading theories of behaviour change and findings of environmental and health psychology and thus uses scientific expertise built on decades of research. By using it to classify and organize the potential behavioural and context factors, we ensure that no important factors are neglected. For more information about the RANAS model, see Method Fact Sheet 2.

Phase 2: Collect data on behaviours, factors and context

First, we develop a quantitative questionnaire to measure the behaviour and the specified behavioural factors and a protocol to conduct observations of the target behaviour. Template tools have been designed for both questionnaires and observation protocols. These have to be adapted to the local conditions, see Phase 1.

Phase 3: Conduct Doer/Non-doer analysis

A Doer/Non-Doer analysis is conducted to identify the behavioural factors steering the target behaviour. This means that the responses of people who perform the behaviour (doers) are compared to the responses of those who do not (non-doers); a large difference in the responses between doers and non-doers shows that the behavioural factor in question critically steers the behaviour and thus can be addressed through behaviour change techniques (BCTs) to change the behaviour.

Phase 4: Develop behaviour change campaign

The BCTs that are thought to change the critical behavioural factors specified in step 2 are selected for application in the behaviour change strategies. A catalogue of BCTs (see method fact sheet 4) has been compiled to achieve this. It lists which BCTs are thought to change which behavioural factor, based on evidence from environmental and health psychology. The BCTs have to be adapted to the local context and combined with suitable communication channels, which constitute the mode of delivery of the BCTs. Together, the BCTs and the communication channels form a behaviour change campaign strategy.

Phase 5: Realize behaviour change campaign

The developed behaviour change campaign strategy is realized by first training all implementers involved and making sure the interventions are executed the way they have been developed and planned. Detailed checklists that display the steps of the behaviour change campaign strategy will be used for implementation, monitoring and continued improvement.

Phase 6: Quantify change in behaviours and factors

To verify the efficacy of these behaviour change strategies and to optimize them, the strategies are evaluated with a before-after control (BAC) trial whenever possible. This means that the behaviour and the behavioural factors are measured with a questionnaire and with observations both before (step 2) and after implementing the strategies. Further, a control or comparison group should be evaluated. This is to control for intervention-independent changes in behaviour. The differences in behaviour scores and in behavioural factor scores before and after the strategies’ implementation are calculated and compared to those of the comparison group. The behaviour change strategies have been effective when the before-after differences in behaviour and behavioural factors are larger for the population that received the strategies than for the comparison group. The strategies can be refined if needed. Otherwise, they can be applied directly at larger scales or in other, similar areas, backed up by the evidence that they are effective in changing behaviour.

RANAS – We Understand Behaviour Change

Are you looking for any of the following?

We help you and your organization to understand the mindsets of your target population and transform this understanding into successful interventions.

Do you work in behaviour change and want to make your programs more effective?

Do you want to engage in scientific investigation or evaluation and monitoring on behaviour change?

Do you want to learn more on systematic behaviour change programming?

Services

Consultancy

With our consultancy and project management offers, we review your interventions or campaigns, or develop a new systematic behaviour change project based on the RANAS approach.

Network

Our User Platform contains online content created to help you learn about behaviour change and the RANAS approach.
Our forum and FAQs shall help you get in touch with other users and experts in behaviour change.

Academy

Through capacity building, trainings or workshops, we enable you to develop systematic behavior change campaigns based on the RANAS approach.

Research

We provide you with scientific knowledge about behaviour change.
We implement a research project for you or with you, to create innovative findings and insights in your field of work.
Through evaluations and monitoring, we identify strengths and weaknesses of your project and create recommendations for improvement

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Testimonials

Anne Babb

The RANAS Behavior Change Model opened my eyes further to name and categorize different behavioral factors, behavioral outcomes and contextual factors as a new insight that truly enhances our approach on behavior change at prevention activities and in recovery support. I am very inspired to learn more about this model and wish to share the learning with Blue Crosses worldwide.

Ranas Ltd. – We understand Behaviour Change

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Box 2.2: Advantages and disadvantages of data collection methods

Advantages	Disadvantages
Face-to-face interviews
– Engagement of participant is easier	– Highest social desirability bia
– Flexible reaction to participants needs and questions	– More time-consuming
No literacy required	–
– Interview length can flexibly be adapted (max. 60 minutes	–
Phone-based interviews
– Flexible planning of interviews	– No visual interaction with participant
– Flexible reaction to participants needs and questions	– Connectivity and reachability of participants
– No literacy required	– Potential social desirability bias
–	– Interview should not exceed 15 minutes
Internet-based interviews
– Less social desirablity bias	– No assistance in case of questions or problems
– Time-saving for data collection	–
– Literacy required	–
Paper-pencil vs. Electronic data collection
– No electronic devices needed	– No data-entry needed
– No dependency on electricity	– Data is instantly saved as it was entered into the data collection tool
– Data entry: very time-consuming, high chance of data entry errors	–

Box 1.12.: Allocation of the identified behavioural and contextual factors to the corresponding RANAS factor

Take the results from the qualitative interview data entry table and check for each question, whether you can identify any reoccurring pattern. For example, are there feelings which are named by several respondents? Which barriers are most frequently mentioned? Of you have conducted focus group discussions, you would already have this summary. Next, consider the following table and write the results next to the RANAS factor they correspond to. If there are results which do not match any of the RANAS factors, write them under “additional factors” at the bottom of the table. The following table contains some example results.

RANAS behavioural factors	Corresponding result from qualitative interviews or focus group discussions (Examples for HW)
Beliefs about Costs and Benefits	Handwashing with soap is time-consuming.
Feelings	Feeling clean after handwashing. Not liking scent of soap.
Others’ Behavior	It is a family custom to wash hands.
Others’ (Dis)Approval	Having been told to do so during childhood.
Barrier Planning	Lack of time to integrate handwashing into daily routines.

Box 1.11.: Example of data entry table

Enter each question in a separate row in columns 1 of your table. In the subsequent columns, enter the responses of your respondents. Use a separate column for each respondent.

Questions	Behavioural factor	Respondent /focus group 1	Respondent / focus group	…
How do you or others perform… (frequency, timings, place, materials)?	Behaviour
What do you dislike about…?	Feelings
What do you think are the advantages of …?	Benefits
Do you see any barriers/problems to perform …? Tell me about any situations when you do not (or are unable to) perform …?	Barrier planning
To whom would you like to listen to what he/she has to say about …?	Others disapprova

Box 1.9: Examples for questions used in a qualitative interview

Behavioural Factor	Questions
Behaviour	How do you or others perform… (frequency, timings, place, materials)
Feelings	What do you dislike about…?
Benefits	What do you think are the advantages of …?
Barrier planning	Do you see any barriers/problems to perform …? Tell me about any situations when you do not (or are unable to) perform …?
Others’ (dis)approval	To whom would you like to listen to what he/she has to say about …?

RANAS behaviour change techniques (BCTs)

Nadja Contzen and Hans-Joachim Mosler

Behaviour change techniques (BCTs) are the components of an intervention strategy designed to alter or redirect the processes that regulate behaviour. In other words, they change behaviour.

BCTs are observable, replicable, and irreducible, meaning that they cannot be divided into smaller sub-elements. Several BCTs can be combined, and they are brought to recipients through one or several communication channels, thus forming intervention strategies. BCTs are the what of an intervention strategy, whereas the communication channels are the how.

To be most effective, BCTs should correspond with the behavioural factors that were found to differ between doers and non-doers. While many of the BCTs address more than one behavioural factor, all but one have a predominant behavioural factor on which they operate (see the main behavioural factor listed in the left-hand column below). The exception is to exploit persuasive attributes, which means using the persuasive attributes of the information or testimonial source and of the message. Persuasive attributes include the competence, sympathy, credibility, famousness, and publicity of the source and the length and number of arguments of the message. As every BCT implies a specific source from which a specific message is sent, exploiting persuasive attributes can be applied in combination with every other BCT so as to increase impact. Each BCT is briefly described here.

Table: Behavioural factors and corresponding behaviour change techniques
Behavioural factors	Behaviour change techniques
Information BCTs – Risk factors
Factual knowledge	1. Present facts: present information about the circumstances and possibilities of suffering from a risk and about the relationship between a behaviour and the risk.
Factual knowledge	2. Present scenarios: present situations in the everyday life of the participant, showing how a behaviour leads to suffering damage from a risk.
Vulnerability	3. Inform about and assess personal risk: present qualitative and quantitative assessments individually for each person in such a way that the person realizes that she or he is at risk.
Severity	4. Arouse fear: use threatening information that stresses the severity of suffering damage from a risk.
Persuasive BCTs – Attitude factors
Beliefs about costs and benefits	5. Inform about and assess costs and benefits: provide information about costs and benefits of a behaviour and conduct a cost-benefit analysis.
	6. Use subsequent reward: reward the person each time she/he has performed the desired[1] behaviour or achieved the behavioural outcome.
	7. Self-Incentive: Prompt to plan to reward oneself in future if there has been effort and progress in performing the desired behaviour.
	8. Inform about and assess social and environmental consequences: Provide information about social and environmental consequences of performing the desired / undesired behaviour. Prompt imagining and comparing of future outcomes of changed versus unchanged behaviours.
Behavioural factors	Behaviour change techniques
Feelings	9. Describe feelings about performing and about consequences of the behaviour: present the performance and the consequences of a desired behaviour as pleasant and joyful and its omission or an undesired behaviour as unpleasant and aversive.
	10. Prompt anticipated regret: bring people to imagine the concerns and regret they would feel after performing the undesired behaviour.
Norm BCTs – Norm factors
Others’ behaviour	11. Inform about others’ behaviour: point out that a desired behaviour is already adapted by (a majority of) other persons. Increase visibility of others’ desired behaviour displayed through environmental clues.
	12. Prompt to talk to others: invite participants to talk to others about performing the desired behaviour in question.
	13. Prompt public pledging: let people commit to the desired behaviour and make their commitment public, thus showing to others that there are people who perform the behaviour.
	14. Social comparison: Facilitate observation of others in order to evaluate one’s own performance
Others’ (dis)approval	15. Inform about others’ approval / disapproval: point out that important others support the desired behaviour or disapprove of the undesired behaviour.
	16. Prompt to resist social pressure: In case there is social pressure against the desired behaviour, ask participants to anticipate and prepare for negative comments from others or for pressures towards the undesired behaviour.
Personal norms	17. Provide a positive group identity and use in-group terms: describe people already engaged in the desired behaviour in an attractive way, to increase the attractiveness of the behaviour itself. Use terms which evoke a feeling of belonging to this desirable group.
	18. Prompt identification as role model: ask participants to set a good example (e.g. for children) by engaging in the desired behaviour so as to influence others’ behaviours by one’s own behaviour.
	19. Highlight conflict: Make the conflict between the undesired behaviour and the participant’s personal norms and values visible.
	20. Set normative nudges: Activate participants’ personal norms in the moment of the behavioural decision through symbols of values in the person’s environment.
	21. Highlight alignment: Make the alignment of personal norms with other benefits of the desired behaviour visible.
Infrastructural, skill and ability BCTs – Ability factors
Action knowledge	22. Demonstrate behavioural options: Inform about behavioural options. Inform the participant about existing alternatives to the undesired behaviour.
	23. Provide instruction: convey know-how in order to improve a person’s knowledge about how to perform the respective behaviour.
Confidence in ability	24. Demonstrate and model behaviour: demonstrate the desired behaviour and prompt participants to pay attention to others’ performing the behaviour and its consequences in their everyday life.
	25. Prompt guided practice: train participants in behaviour enactment by giving instructions, demonstrating the desired behaviour, and letting him/her practice; and give feedback about the correctness of the performance of the behaviour.
	26. Prompt behavioural practice: prompt participants to practice the desired behaviour in their daily life.
Behavioural factors	Behaviour change techniques
	27. Organize social support: prompt participants to seek practical, informational, or emotional support from others and/or to initiate social support groups. Advise on and arrange social support for performance of the desired behaviour.
	28. Set graded tasks/goals: prompt participants to learn difficult behaviours, including several tasks, step by step.
Confidence in continuation	29. Reattribute past successes and failures: prompt participants to attribute failures to a temporary lack of skill or adverse circumstances instead of to his/her deficiency and successes as personal achievements. 30. Use arguments to bolster self-efficacy: convince participants that they will be able to perform and maintain the desired behaviour.
Confidence in recovering	31. Prompt coping with relapse: tell participants that lapses are normal when adopting a new behaviour and, though discouraging, not a sign of failure.
Planning & relapse prevention BCTs – Self-regulation factors
Action planning	32. Prompt specific planning: stimulate participants to formulate when, where, and how she/he plans to execute the behaviour.
Action control	33. Prompt (self)-monitoring of behaviour: invite the participant to regularly record the actual behaviour performance (e.g. correctness, frequency and duration).
Action control	34. Provide feedback on performance: give participants feedback on their behaviour performance.
	35. Highlight discrepancy between set goal and actual behaviour: request the participant to evaluate the actual behaviour performance in relation to the set behavioural goal.
Barrier planning	36. Prompt coping with barriers: ask participants to identify barriers to behaviour change and plan solutions to those barriers.
Barrier planning	37. Restructure the social and physical environment: prompt participants to remove social and physical bolsters of the undesired behaviour to interrupt habits.
Remembering	38. Use memory aids and environmental prompts: prompt participants to install memory aids or to exploit environmental cues so as to help to remember the new behaviour and to trigger it in the right situation.
Commitment	39. Prompt goal setting: invite participants to formulate a behavioural goal or intention.
Commitment	40. Prompt to agree on a behavioural contract: invite the participant to agree to a behavioural contract to strengthen her/his commitment to a set goal.

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RANAS behaviour factors

Nadja Contzen and Hans-Joachim Mosler

Behavioral factors are perceptions, thoughts, feelings, and beliefs which influence the practice of a behavior. Together, they characterize the mindset of a person with regard to that behavior. Different behavioral factors will most critically regulate different behaviors in different populations and contexts. To select the most effective behavior change techniques, we recommend surveying all the potential behavioral factors and conducting a doer/non-doer analysis to specify which behavioral factors are most critical. These are the factors to be addressed through behavior change techniques. Here, we first define all potential behavioral factors and then present example questions for each factor for chlorinating drinking water.

Table 1: Definitions of behavioural factors
Behavioural factor	Definition
Risk factors: represent a person’s understanding and awareness of the health risk.
Factual knowledge	A person’s knowledge about a disease’s causes and (personal) consequences and its preventive measures or about the (health) impact of environmental issues.
Vulnerability	A person’s estimate about the general probability to contract a disease and the subjective awareness of the personal risk of contraction.
Severity	A person’s assessment of the seriousness of an infection and of the significance of the disease’s consequences.
Attitude factors: represent a person’s positive or negative stance towards a behaviour.
Beliefs about costs and benefits	A person’s beliefs about monetary and non-monetary costs (time, effort etc.) and benefits (lower medical costs, improved health) of a behaviour, including social benefits (higher status, appreciation by others).
Feelings	A person’s emotions (joy, pride, disgust etc.) which arise when thinking of a behaviour or its consequences or when practicing the behaviour.
Norm factors: represent the perceived social pressure towards a behaviour.
Others’ behaviour	A person’s observation and awareness of others’ behaviour, his or her perceptions as to which behaviours are typically practiced by others.
Others’ (dis)approval	A person’s perceptions as to which behaviours are typically approved or disapproved by relatives, friends, or neighbours. This includes the awareness of institutional norms, i.e. the dos and don’ts expressed by recognized authorities such as village, tribe, or religious leaders, and other institutions.
Personal importance	A person’s beliefs about what she or he should do or should not do.
Ability factors: represent a person’s confidence in her or his ability to practice a behaviour.
Action knowledge	A person’s knowledge of how to execute the behaviour
Confidence in ability	A person’s perceived ability to organize and execute the courses of action required to practice a behaviour.
Confidence in continuation	A person’s perceived ability to continue to practice a behaviour which includes the person’s confidence in being able to deal with barriers that arise.
Confidence in recovering	A person’s perceived ability to recover from setbacks, to continue the behaviour after disruptions.

Self-regulation factors: represent a person’s attempts to plan and self-monitor a behaviour and to manage conflicting goals and distracting cues.
Action planning	The extent of a person’s attempts to plan a behaviour’s execution, including the when, where, and how of the behaviour.
Action control	The extent of a person’s attempts to self-monitor a behaviour by continuously evaluating and correcting the ongoing behaviour toward a behavioural goal.
Barrier planning	The extent of a person’s attempts to plan to overcome barriers which would impede the behaviour.
Remembering	A person’s perceived ease of remembering to practice the new behaviour in key situations.
Commitment	The obligation a person feels to practice a behaviour.

Table 2: Example questions to measure behavioural factors
Behavioural factor	Question example	Response scale
Factual knowledge	I will present you some potential causes of diarrhoea. Could you please tell me for each whether it is a cause or not? 1. Water contaminated by bacteria 2. Mosquito bite 3. Spicy food 4. Raw water	A = Yes; B = No. Each correct answer is awarded with one point.
Vulnerability	How high do you feel is the risk that you contract diarrhoea?	0 = No risk; 1 = A little risk; 2 = A risk; 3 = Quite a risk; 4 = A high risk
Severity	Imagine you contracted diarrhoea, how severe would be the impact on your daily life?	0 = Not severe; 1 = A little severe; 2 = Severe; 3 = Quite severe; 4 = Very severe
Beliefs about costs and benefits (effort)	How effortful do you think is it to chlorinate all your drinking water?	0 = Not effortful; 1 = A little effortful; 2 = Effortful; 3 = Quite effortful; 4 = Very effortful
Beliefs about costs and benefits (time)	How time-consuming do you think is it to chlorinate all your drinking water?	0 = Not time-consuming; 1 = A little time-consuming; 2 = Time-consuming; 3 = Quite time-consuming; 4 = Very time-consuming
Beliefs about costs and benefits (health)	How certain are you that chlorinating all your drinking water prevents you from getting diarrhoea?	0 = Not certain; 1 = A little certain; 2 = Certain; 3 = Quite certain; 4 = Very certain
Feelings (behaviour)	How much do you like to chlorinate all your drinking water?	0 = Don’t like it; 1 = Like it a little; 2 = Like it; 3 = Quite like it; 4 = Like it a lot
Feelings (taste)	How much do you like the taste of chlorinated water?	0 = Don’t like it; 1 = Like it a little; 2 = Like it; 3 = Quite like it; 4 = Like it a lot
Others’ behaviour	How many people in your community chlorinate all their drinking water?	0 = (Almost) nobody; 1 = Some of them; 2 = Half of them; 3 = Most of them; 4 = (Almost) all of them
Others’ (dis)approval	People who are important to you, how much do they approve to chlorinate all drinking water?	0 = Disapprove a lot; 1 = Disapprove; 2 = Neither approve nor disapprove; 3 = Approve; 4 = Approve a lot
Personal importance	How strongly do you feel an obligation to yourself to chlorinate all your drinking water?	0 = Not obliged; 1 = A little obliged; 2 = Obliged; 3 = Quite obliged; 4 = Very obliged
Behavioural factor	Question example	Response scale
Action knowledge	How are 20 Litres of drinking water correctly chlorinated?	No answer options are provided. Each mentioned critical step of chlorination is awarded with one point: A = Filter turbid water; B = Add [2 caps] of chlorine to the water; C = Wait for [30] minutes; D = For turbid water, add [two caps] of chlorine to the water. Note: correct amount of chlorine and time depends on used product.
Confidence in ability	How confident are you that you can chlorinate your drinking water?	0 = Not confident; 1 = A little confident; 2 = Confident; 3 = Quite confident; 4 = Very confident
Confidence in continuation	How confident are you that you can continuously chlorinate all your drinking water even though you have to spend a substantial amount of money on chlorine?	0 = Not confident; 1 = A little confident; 2 = Confident; 3 = Quite confident; 4 = Very confident
Confidence in recovering	Imagine you have stopped chlorinating your drinking water for several days, for example because there was no chlorine available. How confident are you that you would start chlorinating all your drinking water again?	0 = Not confident; 1 = A little confident; 2 = Confident; 3 = Quite confident; 4 = Very confident
Action planning	Do you have a plan when during the course of your day to chlorinate your drinking water? If yes: Could you please specify the point in time?	No answer options are provided. Answers will be classified into “specific plans” (e.g. after breakfast; at 9am) and “unspecific/no plans” (e.g. in the morning).
Action control	How much do you pay attention to chlorinating all your drinking water?	0 = Pay no attention; 1 = Pay a little attention; 2 = Pay attention; 3 = Quite pay attention; 4 = Pay much attention
Barrier planning	Do you have a plan how you can treat all your drinking water even if there is no chlorine at home?	No answer options are provided. Answers will be classified into “correct plan” (e.g. I’ll boil the water) and “incorrect/no plan” (e.g. I’ll drink raw water).
Remembering/ forgetting	How often does it happen that you forget to chlorinate your drinking water?	0 = (Almost) never (0%); 1 = Seldom (25%); 2 = Sometimes (50%); 3 = Often (75%); 4 = (Almost) always (100%)
Commitment	How important is it for you to chlorinate all your drinking water?	0 = Not important; 1 = A little important; 2 = Important; 3 = Quite important; 4 = Very important

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Tool 1.7: Definitions of behavioural factors

Definitions of behavioural factors
RANAS behavioural factors	Definitions	Examples of typical thoughts
Risk factors, representing a person’s understanding and awareness of the health risk
Health Knowledge	A person’s knowledge about a disease’s causes, personal consequences, and preventive measures.	“If I drink raw water I might get diarrhea”.
Vulnerability	A person’s estimation of the general probability of contracting a disease and subjective awareness of the personal risk of contraction.	“The risk that I get diarrhea is high”.
Severity	A person’s assessment of the seriousness of an infection and the significance of the disease’s consequences.	“If I get diarrhea I cannot go to the market to sell my products, so I lose money”.
Attitude factors, representing a person’s positive or negative stance towards a behavior
Beliefs about Costs and Benefits	A person’s beliefs about the monetary and non-monetary costs (time, effort etc.) and benefits (lower medical costs, improved health) of a behavior, including social benefits (higher status, appreciation by others).	“Fetching water at the safe source is time-consuming”.
Feelings	A person’s emotions (joy, pride, disgust etc.) when thinking of a behavior or its consequences or when practicing the behavior.	“I like to wash hands with soap”.
Norm factors, representing the perceived social pressure towards a behavior
Others’ Behavior	A person’s observation and awareness of others’ behavior, his or her perceptions of which behaviors are typically practiced by others.	“Nearly all community members use a latrine for defecation”.
Others’ (Dis)Approval	A person’s perceptions of which behaviors are typically approved or disapproved of by relatives, friends, and neighbors. This includes awareness of institutional norms, i.e. the dos and don’ts expressed by recognized authorities such as village, tribe, and religious leaders or other institutions.	“My relatives approve when I chlorinate my drinking water”.
Personal Importance	A person’s beliefs about what she or he should do or should not do.	“I feel personally obliged to wash hands with soap before I feed my baby”.

Definitions of behavioural factors (continued)
RANAS behavioural factors	Definitions	Examples of typical thoughts
Ability factors, representing a person’s confidence in her or his ability to practice a behavior
How-to-do Knowledge	A person’s knowledge of how to execute the behavior.	“When I chlorinate my drinking water, I have to leave the water to stand for at least 30 minutes before drinking it”.
Confidence in Performance	A person’s perceived ability to organize and execute the courses of action required to practice a behavior.	“I am confident in my ability to use the water filter correctly”.
Confidence in Continuation	A person’s perceived ability to continue to practice a behavior, which includes the person’s confidence in being able to deal with barriers that arise.	“I am confident that I can find the time and money to regularly buy all drinking water at the safe source”.
Confidence in Recovering	A person’s perceived ability to recover from setbacks, to continue the behavior after disruptions.	“I am confident in my ability to restart using the latrine for defecation even after it was broken for several weeks”.
Self-regulation factors, representing a person’s attempts to plan and self-monitor a behavior and to manage conflicting goals and distracting cues
Action Planning	The extent of a person’s attempts to plan a behavior’s execution, including the when, where, and how of the behavior.	“I plan to refill the water filter every evening before going to sleep”.
Action Control	The extent of a person’s attempts to self-monitor a behavior by continuously evaluating and correcting the ongoing behavior toward a behavioral goal.	“Yesterday I arrived late at the borehole and it was already closed; so today I really have to remember to go in time!”
Barrier Planning	The extent of a person’s attempts to plan to overcome barriers which would impede the behavior.	“If I don’t have enough soap at home I won’t be able to wash my hands regularly. Therefore I keep a stock of two soaps in the cupboard and refill it as necessary every market day”.
Remembering	A person’s perceived ease of remembering to practice the new behavior in key situations.	“Every evening before going to sleep I drink a cup of water and thus remember to refill the water filter”.
Commitment	The compulsion a person feels to practice a behavior.	“I am committed to drinking only chlorinated water”.

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Box 2.2: Box: Formulating meaningful response options

Requirements	Examples	Explanations
The grades should be of a consistent breadth.	Example with a consistent breadth: 1 ¨ Never 2 ¨ Seldom 3 Sometimes 4 ¨ Often 5 ¨ Always Example with inconsistent breadth: 1 ¨ Never 2 ¨ Sometimes 3 ¨ Often 4 ¨ Very often 5 ¨ Always	Only with a consistent breadth can we calculate mean values in Step 2.3. In the lower example, the breadth between grade 0 and 1 is larger, and between 2, 3 and 4 smaller than between 1 and 2.
The scale at best contains 5 grades.	Example with 3 grades: 1 ¨ Never 2¨ Often 3 ¨ Always Example with 5 grades: 1 ¨ Never 2 ¨ Seldom 3 ¨ Sometimes 4 ¨ Often 5 ¨ Always	With less than 5 grades, the rating scale is not able to differentiate adequately between participants. With more than 5 grades, participants tend to be overwhelmed by the number of response options and the degree of differentiation.

Box 2.2: Box: Formulating meaningful response options

Requirements

Examples

Explanations

Precise

“At what time of the day do you usually go to fetch water?”

¨ Morning
¨ Afternoon
¨ Evening The answer options of the first question are very broad. Therefore, we cannot gain much information.
¨ Irregularly

“At what time of the day do you usually go to fetch water?”

¨ Morning, before preparing breakfast
¨ Morning, before eating breakfast
¨ Morning, after breakfast
¨ Morning, before preparing lunch
¨ Noon, before eating lunch
¨ Afternoon, after lunch
¨ Afternoon, before preparing dinner
¨ Evening, before eating dinner
¨ Evening, after dinner
¨ Evening, before going to sleep 11 ¨ Irregularly

The answer options of the first question are very broad. Therefore, we cannot gain much information.

For the second question, the answer options are much more specific, and we gain a clear picture about when a person fetches water. Note. Depending on the context, people may not be used to thinking in hours. Therefore, specifying the time (e.g. at 9am) may be difficult for them. Often it is more appropriate to ask about tasks which they do before or after.

Box 2.2: Advantages and disadvantages of data collection methods

Requirements	Explanations	Examples
Simple	Formulate the question as simple and straightforward as possible.	yes: “How much do you think that washing hands with soap before eating is time-consuming or not time-consuming?” no: “How much do you think that if you wash your hands with soap before you eat that this consumes much time or consumes not much time?”
Short	While the meaning of the first two questions is essentially the same, the first includes additional aspects or information which is not necessary but lengthens the question. If you have to ask a long, complex question (see third and fourth questions), to increase comprehension try to break it into several sentences (as in the fourth question).	no: “How much do you think that it may be disgusting or not disgusting if you drink untreated water which you had fetched from an unsafe water source?” yes: “How disgusting is drinking untreated water to you?” no: “How confident or unconfident are you to start washing hands with soap before handling food again after you had stopped to wash hands for several days, for example because there was no water or soap for handwashing?” yes: “Imagine you have stopped washing hands with soap before handling food for several days, for example because there was no water or soap for handwashing. How confident are you to start washing hands with soap and water before handling food again?”
Concrete	With the first question, we only gain information on whether the participant washes hands or not. However, no information is gained with regard to the handwashing agent or with regard to the key time. With the second question, we gain information on whether hands are washed with a specific agent at a specific key time.	no: “Do you wash your hands?” yes: “Do you wash your hands with soap and water before eating?”
Unidimensional, without “and” or “or”	The question contains two separate ratings, one regarding the temperature and one regarding the color of the water. A response may represent a weighting of the two aspects or the rating of that one aspect which is more important to the participant.	no: “How much do you like the temperature and the color of the water?”
Without expressions unfamiliar to the target population	Depending on the sample, participants may or may not be familiar with the term abdominal typhus. In the latter case, the disease would first have to be explained to the participant.	no: “Have you ever suffered from abdominal typhus?”
Not suggestive	The first question implies that drinking untreated water is disgusting. The second question (1) emphasizes the subjectivity of the rating, and (2) leaves open whether it is disgusting or not.	no: “Do you agree that drinking untreated water is disgusting?” Yes: “How much do you think that drinking untreated water is disgusting?”
Careful regarding sensitive topics	Often the question is not so much whether it is possible to talk about a sensitive topic at all but rather which words are appropriate to use. Which topics are sensitive and which words are appropriate depend on the specific local context. In one context, for example, it is more appropriate to ask about “defecation”, while in another the appropriate word may be “pooping”.	“Where do you go to defecate?” “Where do you go to poop?”
In line with the response options	While the question is formulated as a yes-no question, the response option is a rating scale.	no: “Do you like the temperature of the water?” 1 ¨ Not at all 2 ¨ A little 3 ¨ Quite 4 ¨ Much 5 ¨ Very much

Box 2.2: Advantages and disadvantages of data collection methods

Open questions

Description

Examples

Further information

The interviewer reads the question.
The participant answers in his/her own words.
The interviewer writes down the answer(s).

For multiple-response questions:

If the participant keeps silent after a response, the interviewer asks ‘Anything else?’ Only when the participant responds ‘No’, the interviewer proceeds to the next question.

Single-response question: What is the single most important reason to collect your drinking and cooking water at the arsenic safe well?

Multiple-response question: What are the advantages of collecting your drinking and cooking water at the arsenic safe well?

Advantages:

We get the participant’s own answers.
Allows exploration of the range of possible topics arising from an issue, including those that we had not anticipated.

Disadvantages:

Time-consuming for the participant and the interviewer.
Answers are difficult to code and compare.
Time-consuming for the data processing, as the responses have to be categorized.
Open multiple-response questions: Difficult to analyse.

Open questions with given response options

Description

Examples

Further information

The interviewer reads the question.
The participant answers in his/her own words.
Based on the answer(s), the interviewer selects the corresponding response option(s).

For multiple-response questions:

If the participant keeps silent after a response, the interviewer asks ‘Anything else?’ Only when the participant responds ‘No’, the interviewer proceeds to the next question.

Single-response question: What is the single most important reason to collect your drinking and cooking water at the arsenic safe well?

1 ¨ Taste

2 ¨ Distance

88 ¨ Other……………….

Multiple-response question: What are the advantages of collecting your drinking and cooking water at the arsenic safe well?

1 ¨ Taste

2 ¨ Distance

88 ¨ Other……………….

Advantage compared to the previous format: Responses are pre-categorized to facilitate data gathering, entry, and processing.
Prerequisite: knowledge about the most common responses.Disadvantage of open multiple-response questions: Difficult to analyse.

Open questions

Description

Examples

Further information

The interviewer reads the question and the response options.
The participant chooses a response option.
The interviewer ticks the chosen response option.

Unipolar: How much do you think that collecting all your drinking and cooking water at the arsenic safe well is tiring or not tiring?

1 ¨ Not tiring 2 ¨ A little tiring 3 ¨ Quite tiring 4 ¨ Tiring 5 ¨ Very tiring

Advantages:

Precise and explicit responses
Easy and quick to gather
Easy to compare and analyse
Easy to report

Disadvantages: unknown responses or aspects are not detectable.

Table: Example questions to measure behavioral outcomes
Behavioral outcome	Example question	Response scale
Behavior (frequency)	How much of your household’s organic waste do you compost?	0 = Almost none; 1 = Less than half; 2 = About half; 3 = More than half; 4 = Almost all
Intention	How strongly do you intend to compost your organic waste?	0 = Not strongly; 1 = A little strongly; 2 = Strongly; 3 = Quite strongly; 4 = Very strongly
Habit (automaticity)	How much do you feel that you compost your organic waste automatically?	0 = Not automatically; 1 = A little automatically; 2 = Automatically; 3 = Quite automatically; 4 = Very automatically

Factor	Item / Question	mean value	difference	interpretation	decision
Behavior: chlorination	How much of your household’s drinking water do you chlorinate?	Doer: 93% Non-Doer: 54%	40%	Doers chlorinate 93% of their drinking water on average, whereas non-doers only chlorinate 54% of their drinking water.	selected for the intervention
health knowledge	I will present you some potential causes of diarrhea. Could you please tell me for each whether it is a cause of diarrhea or not?	Doer: 2.4 Non-Doer: 2.3	0,1	Doers and non-doers do not differ strongly in health knowledge.	not selected for the intervention
other’s behavior	How many people of your community chlorinate all their drinking water?	Doer: 3.1 Non-Doer: 1.6	1,5	Doers perceive more that others in their surrounding also chlorinate their drinking water.	selected for the intervention
action control	How keenly do you try to chlorinate all your drinking water?	Doer: 2.7 Non-Doer: 1.3	1,4	Doers more keenly try to chlorinate all their drinking water.	selected for the intervention
reason 1: good mother	What are your reasons to chlorinate your drinking water?	Doer: 70% Non-Doer: 30%	40%	70% of the doers mention that a reason why they chlorinate their drinking water is because they want to be a good mother, only 30% of the non-doers say so.	selected for the intervention
reason 2: cheap	What are your reasons to chlorinate your drinking water?	Doer: 50% Non-Doer: 50%	0%	Doers and non-doers do not differ on the frequency of mentioning the reason for chlorination that it is cheap.	not selected for the intervention
respondents age	How old are you?	Doer: 42.8 Non-Doer: 28.5	14,3	Doers are on average older than non-doers.	considered in the intervention
monthly income	What is the monthly income of your household?	Doer: 3015 Non-Doer: 2892	123	Doers and non-doers do not strongly differ on their monthly income.	not considered in the intervention

What you need
a	Infection diagram in one piece
b	Infection diagram as puzzle
c	Infection prevention pictograms
d	Template to note feelings

How to do the activity		Notes: Acceptability	Notes: Feasibility
Step 1	Approach the household and engage in an informal conversation to find out if there are children below 5 years in the household.
Step 2	Find out who is the primary caregivers (participant) and request 15 minutes of his/her time.
Step 3	Engage the participant in an informal conversation and lead the topic towards hand hygiene.
Step 4	Ask the participant if he/she would like to learn more about hand hygiene.

RANAS factor block	RANAS factor	RANAS BCT
Risks	Health knowledge	BCT 1: Present facts

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Phase 4: Outputs

Working on the content, it will be available soon.

Box 1.6.: Focus group discussions: Group processes and pressure and how to minimize their influence

Keep in mind that group processes and social pressure can substantially impair focus group discussion outcomes. Distorting influences may be:

Tips to minimize group processes and social pressure in focus group discussions:

Box 2.2.1: Guideline on data collection scheduling

Box 2.2.1: Two approaches to questionnaire translation

Employ translators

Translate together with the data collectors during training

Box 3.1.: Data cleaning

Box 2.1.2 General rules for arranging the questions in a questionnaire

Box 2.2: Advantages and disadvantages of data collection methods

Box 2.1: Comparing RANAS surveys to KAP surveys

Box 1.12.: Allocation of the identified behavioural and contextual factors to the corresponding RANAS factor

Box 1.11.: Example of data entry table

Box1.10. Ethical Issues

Personal privacy:

Informed consent:

Voluntary participation:

Confidentiality:

No promises:

Box 1.9: Examples for questions used in a qualitative interview

Box 1.8.: Conducting individual qualitative interviews

Preparations:

Introduction and consent:

Procedure:

Box 1.7. Conducting focus group discussions

Preparations:

Introduction and consent:

Procedure

Box 1.5. Examples of potential target groups

Box 2.2.2: Selection of data collectors

Requirements:

Advantages of appointing health promoters as data collectors:

Disadvantages of appointing health promoters as data collectors:

Box 1.4. Example descriptions of the behaviour ‘to use a latrine’ and ‘to wash hands with soap’

The behaviour of using a latrine implies the following actions:

The behaviour of handwashing implies the following actions:

Box 1.3.: Examples for spot check question

Box 1.2 Examples for questions to key informant interviews

Box 1.1

Examples of behaviours related to safe drinking water consumption:

Examples of behaviours related to sanitation:

Examples of behaviours related to handwashing with soap:

Examples of other behaviours related to health and the environment:

Picture of BCTs

BCT 1: Present facts

Catalog of behavior change techniques (BCTs

ESI 3.1 to A practical guide using the RANAS approach Version 1.0, August 2016

ESI 3.1: Catalog of behavior change techniques (BCTs)

Information BCTs – Risk factors

Factor: Health knowledge

Factor: Vulnerability

Factor: Severity

Phase 4:  Outputs

Phase 3:  Outputs

Example 3A : Doer/non-doer analysis example for chlorinating drinking water

Phase 2:  Outputs

Phase 5:  Outputs

Phase 1:  Outputs

Phase 6:  Outputs

Phase 5:  Tools

Phase 5:  Tools

Phase 3:  Tools

Phase 2:  Tools