Interactive Guideline

Introduction: The RANAS approach to systematic behaviour change

The problems humanity is facing, whether we talk about public health issues or the manyfold environmental problems, lay grounded in human behaviour. Unhealthy and unsustainable lifestyles and habits seem hard to overcome, but there is a science dedicated to doing exactly that: behaviour change.

Studies have shown that technologies alone do not necessarily lead to better health or environmental outcomes. There are always humans involved in using technologies and humans often behave in unpredictable ways. We all have seen in our projects that only because a technology is provided, people do not necessarily use it. We all know from ourselves that just because we want to do something, we don’t necessarily do it. Even if we fear negative consequences, something else may be more important. Or even if we did something one day, it doesn’t mean we will always do it.

The RANAS approach to systematic behaviour change is based on the principle that human behaviour depends on various behavioural factors that can be identified and targeted with behaviour change interventions and thus, behaviour can be changed.

Which behaviours, for example?

Your organization has the task to avoid littering in a community, but despite information signs littering is not decreasing significantly. Or your organization promotes handwashing intensively, because of an imminent pandemic but even so only a small proportion of the population washes their hands with soap. Or your organization has installed lots of safe wells, but you notice that these wells are rarely used despite awareness-raising campaigns about the health effects of drinking safe water. Most likely, your promotion activities have somehow failed to change the mindset of your people. For behaviour to change, people’s mindsets must change, because all behaviour is based on processes in people’s minds: knowledge is activated, beliefs and emotions rise to the fore, and an intention to perform a particular behaviour emerges, eventually resulting in observable behaviour.

Studies have shown that technologies alone do not necessarily lead to better health or environmental outcomes. There are always humans involved in using technologies and humans often behave in unpredictable ways. We all have seen in our projects that only because a technology is provided, people do not necessarily use it. We all know from ourselves that just because we want to do something, we don’t necessarily do it. Even if we fear negative consequences, something else may be more important. Or even if we did something one day, it doesn’t mean we will always do it.

The RANAS approach to systematic behaviour change is based on the principle that human behaviour depends on various behavioural factors that can be identified and targeted with behaviour change interventions and thus, behaviour can be changed.

How can behaviour change be induced?

There are various methods for promoting behaviour change. Many organizations raise awareness of health and environmental risks and increase knowledge. However, risk awareness and knowledge are just two among a multitude of behaviour-steering factors. The RANAS model of behaviour change integrates leading theories of behaviour change and decades of research of environmental and health psychology. By using the RANAS model to classify and organize the potential behavioural and context factors, we ensure that no important behavioural factors are neglected. The RANAS model ultimately serves as the basis for developing a behaviour change campaign that is evidence-based and effective.

This manual has the goal to make practitioners familiar with the multitude of behaviour-steering factors that have been elaborated within the social sciences and how to develop campaigns that change a behaviour of their interest within a community they work with.

Studies have shown that technologies alone do not necessarily lead to better health or environmental outcomes. There are always humans involved in using technologies and humans often behave in unpredictable ways. We all have seen in our projects that only because a technology is provided, people do not necessarily use it. We all know from ourselves that just because we want to do something, we don’t necessarily do it. Even if we fear negative consequences, something else may be more important. Or even if we did something one day, it doesn’t mean we will always do it.

The RANAS approach to systematic behaviour change is based on the principle that human behaviour depends on various behavioural factors that can be identified and targeted with behaviour change interventions and thus, behaviour can be changed.

What is systematic behaviour change?

We propose a systematic behaviour change methodology, the RANAS approach, that (1) specifies potentially relevant factors for behaviour change based on theories of psychology; (2) measures behavioural factors in a valid way; (3) determines behavioural factors that are relevant for behaviour change; (4) enables the selection of behaviour change techniques based on evidence; (5) supports effective and impactful behaviour change campaign implementation; and (6) evaluates the techniques’ effectiveness in changing behaviour and the mechanisms of behaviour change. These elements ensure that your behaviour change campaign is based on a systematic methodology, each phase of the methodology is reproducible and therefore subject to analysis and learning, and your behaviour change shows more impact and efficiency.

This manual has the goal to make practitioners familiar with the multitude of behaviour-steering factors that have been elaborated within the social sciences and how to develop campaigns that change a behaviour of their interest within a community they work with.

Studies have shown that technologies alone do not necessarily lead to better health or environmental outcomes. There are always humans involved in using technologies and humans often behave in unpredictable ways. We all have seen in our projects that only because a technology is provided, people do not necessarily use it. We all know from ourselves that just because we want to do something, we don’t necessarily do it. Even if we fear negative consequences, something else may be more important. Or even if we did something one day, it doesn’t mean we will always do it.

The RANAS approach to systematic behaviour change is based on the principle that human behaviour depends on various behavioural factors that can be identified and targeted with behaviour change interventions and thus, behaviour can be changed.

Purpose of this guideline and how to use it

The purpose of this guideline is to help practitioners design an effective behaviour change campaign. The methodology is explained step by step describing key actions, necessary skills and resources as well as typical challenges and solutions.

The guideline includes many TOOLS to be used and adapted by practitioners. Additional information can be found in separately marked BOXES. The entire process of designing, implementing and evaluating a behaviour change campaign is illustrated by a CASE STUDY of a handwashing campaign in Zimbabwe.

Phase 1: RanasEXPLORE
Specify behaviours, behavioural factors, and context

Summary

We first decide how the project design will look like (step 1.1 Define project design); we then define the exact behaviour to be changed and the specific population group to be targeted – we specify who exactly should change which behaviour (step 1.2 Define target behaviours and target audience). Then, we collect information on the behavioural factors that might influence the target behaviour in the specific population, for example by conducting qualitative interviews (step 1.3 Explore relevant psychosocial and contextual factors). Thereby, we gain a first impression of the behavioural factors that potentially determine the target behaviour in the specific population and context. In the following, the potential behavioural factors that we have identified are included in the RANAS model (step 1.4 Complement the RANAS factors); this means adapting and extending the RANAS model to the local context.

The steps of this phase are:

1.1 Define project design

1.2 Define target behaviours and target population

1.3 Explore behavioural and contextual factors

1.4 Specify the RANAS behavioural factors

Step 1.1: Define project design

When planning a project, you have to define if and how reliably you want to evaluate change in behaviour and behavioural factors. Such evaluation allows to continuously improve the campaign and scale it up. The method you chose for the evaluation already requires attention when starting the project, because the project design depends on it. We recommend three options to evaluate changes and your first key action will be to choose the one which is most appropriate for your project.

Key Actions

Option 1: Phased implementation with before-after measurement and independent comparison group

The most reliable method to evaluate your behaviour change campaign is by comparing changes in people’s behaviour and behavioural factors in areas where you implemented the campaign (campaign group) to areas where you will implement the campaign later (comparison group). Practically, this means that, first, you measure behaviour and behavioural factors in the entire project area (baseline survey), second, implement the campaign in only one half of the project area, third, measure behaviour and behavioural factors again in the entire project area (follow-up survey), and fourth, implement the campaign in the other half of the project area. This means that at the time of the follow-up survey, only half of the project area has received the campaign. Using baseline and follow-up data, you can compute the changes in behaviour and behavioural factors for each of the

two areas and compare them. This method allows for the strong conclusion that the differences between groups that you measure are due to the RANAS campaign (and not due to changes in context). We recommend to use this method whenever possible.

Option 2: Regular implementation with before-after measurement and a natural comparison group

However, resources, time and other considerations may not always allow to have a real comparison group as described above. In this case, your behaviour change campaign can be evaluated using a “natural comparison group”. To do so, conduct the baseline survey, implement your campaign in the entire project area and conduct the follow-up survey. In the follow-up survey, you include a “campaign check”. This means that for each participant you determine whether they have received the campaign or not. Individuals who have received the campaign or most parts of it are the campaign group. Individuals who have not received the campaign or only limited parts of it are the comparison group. You can then compute the changes in behaviour and behavioural factors for each of the two groups and compare the changes. This method provides some evidence that differences between the groups are due to your campaign. However, it is possible that specific people tend to participate more readily in your campaign than others, such as those already aware of the topic. This can bias your results.

Option 3: Regular implementation with before-after measurement without comparison group.

The easiest but most unreliable method is to measure behaviour change before and after the intervention in the campaign group only. To do so, you conduct the baseline survey, implement your campaign in the entire project area and conduct the follow-up survey without using the campaign check. This method may be used in stable contexts and in cases where the time between baseline and follow-up is short. However even then, regulations, seasonality, or socio-economic conditions may have changed at the same time and you cannot disentangle the effects of these context changes from the effects of your campaign. We recommend this method only if none of the others are feasible.

Summarizing, we have the following project designs to evaluate behaviour change:

1. Phased implementation with before-after measurement and independent comparison group,

2. Implementation with before-after measurement and a natural comparison group,

3. Implementation with before-after measurement without comparison group.

Ethical considerations in campaign planning

To adhere to good ethical standards, a comparison group as mentioned in this guideline, should also receive a campaign. To be able to nevertheless receive the necessary data and findings of a comparison group, we can give the campaign to the comparison group after the implementation of the campaign and the endline evaluation (time-shifted campaign). If a time-shifted campaign is not possible, for example when working in an emergency, the comparison group could receive a standard campaign, or different campaign groups could be compared which have received different aspects of the campaign. The participating communities should be consulted to make the respective decisions conjointly or with the respective input.

Outputs

  • Project design

Step 1.2: Define target behaviours and the target population

In this step, we will define the specific behaviour to be changed and the specific population group to be targeted. In other words, we specify who exactly should change which behaviour.

Key Actions

Define the target behaviour

It is important to precisely define what behaviours need to be targeted by the behaviour change campaign. Taken the example of safe water consumption, one needs to define within the local context whether the campaign should target where drinking water is collected, how it is stored at home, if it needs to be treated at point of use etc. The more precisely a target behaviour is identified and described, the more effective a campaign can be designed. Box 1.1 gives more examples of behaviours relevant for health and the environment.

Often one behaviour depends on other behaviours. To stop open defecation, first a latrine has to be constructed and kept clean. For handwashing to occur, soap and water first have to be available. For safe water to be consumed, it may be necessary to first disinfect the water and then store it safely. For proper waste management, separate bins and separated recollection needs to be organized and available.

In order to select the appropriate target behaviour, it is useful to answer certain key questions:

– Which behaviours would community members like to change in their community?

– What are existing government programs and policies recommending?

– What is the current disease burden?

– Which environmental problems is the community exposed to or contributing to?

– What are ongoing activities by other actors in the community?

– Which behaviours are frequently practiced in the community?

– Which behaviours are only rarely practiced?

– Is the required infrastructure available?

Conduct key informant interviews

Even if your project team is familiar with the preferences of community members and can give responses to the key questions above, it makes sense to check your assumptions and collect additional information. For this select 5 to 10 key informants, who are individuals who you believe have an in-depth knowledge of the target community and project context. Key informants include members of the target group and decision makers. You may also select few key informants only and then ask those who else they would recommend you to interview. Box 1.2. provides examples for questions to key informant interviews, which you can adapt. This list is not exhaustive.

Conduct key informant interviews

It makes only sense to target a behaviour for which the required infrastructure is present but which is not yet practiced consistently in the target community. Promoting latrine use, for example, does neither make sense if there are no accessible latrines nor if everybody is already using latrines for defecation. If you do not have reliable data about the prevalence of a behaviour and availability of infrastructure you need to collect them. We recommend to conduct spot check observations (see the following Box 1.3.: Examples for spot check questions) in 50 to 100 randomly selected households.

Describe all the components of the target behaviour

If you have successfully identified your target behaviour, you need to specify it further. A behaviour is a sequence of actions; an action is an observable single act. To define a behaviour comprehensively, we have to describe all the actions involved. Box 1.4. gives two example descriptions ‘to use a latrine’ and ‘to wash hands with soap’.

Select the target group

Next, we need to define the population group to be targeted. Some behaviours have different main actors while other behaviours should be practiced by everyone. Fetching water, for example, often is the task of girls or mothers while latrine construction usually falls to the domain of the male head of household. Handwashing or latrine use, on the other hand, should be practiced by everyone. But even in those cases, the behaviour of a particular group of people may have a greater influence on the household’s or population’s health, either directly (e.g. handwashing before cooking by primary caregivers) or indirectly by influencing others’ behaviour (e.g. teachers or natural leaders as role models).

Therefore, the specific group to be targeted by an intervention typically depends on the behaviour to be changed. Different interventions may be necessary for different target groups, see Box 1.5. Examples of potential target groups.

In order to select the appropriate target group, it is useful to answer certain key questions:

  • Who are the persons to practice the target behaviour?
  • Whose behaviour has the greatest influence on the family’s health or on the environment?
  • Whose influence on other people’s behaviour is highest (who are potential role models)?
  • Who are the persons most at risk if the behaviour is not practiced?

Key resources

  • Pre-existing information on behavioural status quo in the target population
  • Tool for spot check observations: See Box 1.3. for examples for spot check questions
  • Tool for Key Informant Interviews: See Box 1.2. for examples for questions to key informant interviews

Outputs

  • The behaviour(s) to be changed is/are defined.
  • The target population(s) is/are defined.
  • The project context is explored

Step 1.3: Explore behavioural and contextual factors

The step describes how to collect information on behavioural and contextual factors in order to adapt the RANAS model to the project context. Behavioural factors are elements in the mindset of a person, such as knowledge, beliefs, and emotions which can be motivators or barriers for behaviour performance. The chapter Introduction provides an overview about the RANAS behavioural and context factors. Because every population is unique, behavioural factors beyond those contained in the RANAS model may be relevant in a specific population. In addition, some behavioural factors of the RANAS model are very generic, such as “feelings” or “barriers” and need to be specified.

Contextual factors, in contrast, are conditions outside of a person’s mindset that may facilitate or hinder a behaviour, such as existing water infrastructure or information provided at a health centre. We have started to explore these factors already during the previous step through spot-check observations and key information interviews. In this step, we will complete these insights through interviews with members of the target population.

Key Actions
Conduct individual qualitative interviews or focus group discussions

There are different ways of collecting data in this step. Focus group discussions are widely used, because they are time-efficient and allow discussion between participants. However, they bear the risk that the group processes and social pressure (Box 1.6.) hinder participants from expressing their opinions and beliefs freely. The following Box (1.7.) provides general instructions on conducting focus group discussions.

Individual qualitative interviews have the advantages that they focus on one participant at a time only, they allow to gather data in a more private setting and the course of the data collection can be adapted to the participant’s individual responses. Although they are more time consuming, we recommend to conduct individual qualitative interviews if possible. Box 1.8. provides general instructions on how to conduct individual qualitative interviews.

We recommend that you prepare a question guide (see Box 1.9. Examples for questions used in a qualitative interview) in advance, although the course of the interview or focus group discussion does not have to strictly follow the question guide. The guide helps to ensure that all the relevant topics are addressed. Irrespective of which tool you use, collect data from approximately 20 participants. If you chose focus groups, the size of each group should not exceed 10 participants.

Data quality obtained from both tools is highly dependent on the skills of the data collectors. So, ideally, the project team conducts the interviews themselves instead of hiring and training interviewers. If you require additional data collectors, select (Box 2.2.2. Selection of data collectors, phase RanasMEASURE) and train (Box 2.2.3 Exemplary outline for training data collectors, phase RanasMEASURE) them carefully, including about ethical issues (see Box 1.10. Ethical issues).

Enter the data

It is not necessary to prepare a full transcript of an interview or a group discussion. Instead, it is sufficient to note down a short summary to each qualitative question into a table (see Box 1.11. Example of data entry table). The table will be used in the next step 1.4, Specify the RANAS behavioural factors.

Key resources
  • Results from the previous step 1.2: Define target behaviour(s) and target population(s).
  • Box 1.5: Conducting focus group discussions
  • Box 1.6: Conducting qualitative individual interviews
  • Tool: Question guide (see Box 1.9. for Examples for questions used in a qualitative interview)
  • Tool Data entry table (see Box 1.11. for an Example of a data entry table)
  • Skilled and trained data collectors (see Box 2.2.2. Selection of data collectors and Box 2.2.3 Exemplary outline for training data collectors, from phase RanasMEASURE)
Outputs
  • Potential motivators and barriers to the target behaviour in your specific target population

Step 1.4: Specify the RANAS behavioural factors

In this step, we use the data collected in the previous step to adapt the RANAS model to the local project context. The resulting adapted RANAS model is thus both context specific and based on existing scientific evidence provided by the RANAS model. We will later use the adapted RANAS model to develop our quantitative questionnaire.

Key Actions
Get familiar with the RANAS behavioural factors

To match the factors identified in Step 1.3 to the RANAS behavioural factors, we first have to gain familiarity with the RANAS behavioural factors. Tool 1.7 provides definitions of behavioural factors along with examples of typical thoughts related to each factor.

Specify existing factors and include additional factors

Once we are familiar with all the RANAS behavioural factors, we summarize the results from our individual qualitative interviews and focus group discussion and allocate them to the corresponding RANAS factor (see Box 1.12. for an example of allocation of the identified behavioural and context factors to the corresponding RANAS factors). For example, the responses to the question “What are your positive feelings towards …?“ reveals which specific feelings may be relevant for the target behaviour in the specific population and should be noted under the RANAS factor feelings in the attitude factor block. The results from this type of analysis are later used to define the questions that measure the RANAS factors with the quantitative survey (see phase 2: RanasMEASURE).

Key resources
  • The RANAS model presented in the Introduction
  • Results from Step 1.3: Data entry table (see Box 1.11. for an Example of a data entry table)
  • Tool 1.7: Definitions of behavioural factors
  • Box 1.12.: Allocation of the identified behavioural and contextual factors to the corresponding RANAS factors
Outputs
  • The behavioural factors of the RANAS model are adapted to the local context and can be used to adapt questions in the quantitative questionnaire (see phase 2: RanasMEASURE).

Phase 2: RanasMEASURE
Collect data on behaviours, behavioural factors, and context

Summary

In the previous phase 1, RanasEXPLORE, we have learned about the different behavioural and contextual factors that form part of the RANAS model for behaviour change. The chapter also discussed the importance of carefully selecting the target behaviour and deciding for a project design that fits your context and resources. It also introduced the different steps to conduct qualitative interviews to explore the behavioural factors potentially steering the target behaviour and finally provided guidance on how to adapt the behavioural factors of the Ranas model to your project context.

In phase 2, RanasMEASURE, we will build on the findings from RanasEXPLORE to develop the tools needed for a quantitative baseline survey and discuss what needs to be considered when planning the survey. The first step 2.1 is to develop a questionnaire measuring the behaviour and the behavioural factors, which have now been adapted to the specific context. The information we gained from RanasEXPLORE will guide the development of the quantitative questionnaire. If required, we develop a protocol of structured observations of the target behaviour. In the second step 2.2, the questionnaire and observations are implemented in a baseline survey. The results of phase 2, RanasMEASURE, are quantitative data on behaviours, behavioural factors, and context for the specific target audience.

The steps of this phase are:

2.1. Develop a questionnaire and a behaviour observation protocol

2.2. Conduct a baseline survey

Step 2.1 Develop a questionnaire and a behaviour observation protocol

Summary

In this step, we develop a survey tool to measure the target behaviour and the behavioural factors. To measure the behaviour, we have three options: direct observations, spot checks, and self-reports (i.e. questionnaires). For the behavioural factors, we have only one option: self-reports measured with the help of a questionnaire. The same is true for some of the contextual factors (e.g. a respondent’s age) while others are observable or measurable by spot checks (e.g. distance of the water source). To prepare the survey tools, the first step is to consult the outputs from phase 1, RanasEXPLORE. There, we defined the target behaviour, target population as well as the behavioural and contextual factors we want to measure.

Beware that the development of the questionnaire is a crucial step: it requires rigor, time, knowledge and skills. It may be advisable to seek assistance from a RANAS expert for this essential step, even if you have experience in using KAP – knowledge, attitude, practice – surveys as a thorough understanding of the RANAS model is required (Box: Comparing RANAS surveys to KAP surveys).

Key Actions
Select mode of data collection

There are different ways to conduct interviews: face-to-face, via phone call or online. If the survey includes a direct conversation with the participant, the answers can either be recorded using paper-pencil or electronically. Direct interaction (face-to-face or phone-based) has the advantage of being more direct and adaptable to the needs of the participant. Whereas internet-based surveys reduce social desirability and are time-saving but participants need to be literate. It is advisable to think through all possible advantages and disadvantages before selecting on mode of data collection (Box: Advantages and disadvantages of data collection methods).

Introduction and consent

The questionnaire starts with an introduction that briefly explains the general purpose of the survey to the household. It outlines the importance of the respondent’s participation, a statement guaranteeing confidentiality, and a section obtaining informed consent (Tool: Example introduction and consent form). It includes information on how participants can hand in complaints regarding the survey. To guide the participant through the interview, we include instructions and information wherever necessary during the interview

Development of behavioural, psychosocial and contextual questions

To measure the behaviour as well as each behavioural and contextual factor, we formulate at least one and often several questions. Different question formats (Box) can be used: open questions with or without predefined response options, or closed questions with uni- or bipolar rating scales. Formulating meaningful questions and response options is very important and possible pitfalls are manifold. It is essential to follow some basic rules for formulating questions, response options and rating scales (3 Boxes). One option to make rating questions easier to be answered by participants is the use of a visual scale (Box).

Further, the questions have to be comprehensible to the target population. Therefore, it is essential that people familiar with the local languages are involved in the questionnaire development. If the questions cannot be developed directly in the local language (e.g. because the focal person of the project does not speak the local language), we have to translate them in the next step (see Step 2.2 baseline survey).

The sample questionnaire (Tool) presents questions to measure behaviour, all RANAS behavioural factors and some contextual factors for water treatment with chlorine. Please bear in mind that these are sample questions and it is not a ready-to-use questionnaire. The questions have 1) to be adapted to the specific behaviour and population group (Step 1.2) and 2) to be adapted and extended based on the specific local conditions (Step 1.3). In most cases, you will need additional questions to the sample questions . In particular, more contextual factors have to be considered in most cases.

Behaviour observation protocol

The questionnaire measures behaviour by self-reports. A more reliable and valid way, however, is to use direct observations and spot checks (Box 1.3 in phase 1). For example, observe where a person goes to defecate, whether a person washes hands with soap after defecation, or how much litter can be found in the streets. Direct observations are usually very time-consuming and thus costly. However, they are more objective than self-reports. In other words, there is always a trade-off between having a more precise measure (direct observation) and practicality (self-reports). We recommend to complement self-reports with at least short spot-check observations.

Spot checks measure the behaviour indirectly; they measure proxy indicators of the behaviour (e.g. soap and water at the handwashing station to measure handwashing) and outputs of the behaviour (e.g. PET bottles in the sun to measure solar water disinfection, SODIS). Therefore, they are somewhat less precise than direct observations. However, they are very quickly and easily collected and thus very cost effective. Examples of spot checks include the water level in the water filter to measure water filtering, cleanliness of hands to measure handwashing, the amount of correctly separated garbage in different garbage containers to measure waste separation, and cleanliness of latrines to measure toilet cleaning.

For both direct observations and spot checks, we prepare a protocol that includes specific instructions on what and how to observe as well as a checklist to record the observations (Tool: Example Observation Protocol, Tool: Example Spot Check Observation). Usually, spot checks can be included in the same document as the questionnaire; for direct observations, it is advisable to prepare a separate manual.

Arranging questions in a meaningful order

Once all the questions have been formulated, we compile the questionnaire by arranging all the questions into a meaningful sequence. Box 2.1.2 (General rules for arranging the questions in a questionnaire) provides some rules for arranging the questions. If an observation protocol is used, it usually makes sense to place this in the end of the questionnaire after the interview questions.

To assist the interviewer, we can also include hints on question types, household selection or definition of terms used in the questions.

Translate the questionnaire and observation protocols into the local language

Unless the questionnaire has been prepared in the local language, we have to translate it, taking into account the specific vocabulary and dialect of the target population. The translation is vital; simply providing data collectors with the original, untranslated questionnaire and letting them each translate the questions individually is not an option. In such a scenario, each data collector would ask the questions slightly differently and perhaps even change the wording from interview to interview. To be able to compare the data for analysis, all the data collectors have to ask the questions identically; therefore, we need a translated questionnaire.

We have two options for the translation; we can hire a translator, or we can translate the questionnaire together with the data collectors during training. Box 2.2.1 provides more information on the two approaches.

Key resources and information
  • Results from Step 1.2: the specified target behaviour and population group
  • Results from Step 1.3: the list of psychosocial and contextual factors adapted to the local context
  • Knowledge and experience in questionnaire design
  • Sample questions, see Tool 2.1.1: Sample questionnaire
  • Locally knowledgeable person
Outputs

Survey tool that includes a structured questionnaire and, optionally, an observation protocol. With these, we can ensure that we collect the same types of information from all participants in the same way.

Step 2.2: Conduct a baseline survey

Introduction

After the questionnaire and observation protocols are finalized, the next step is to conduct the baseline survey. With this survey, we will gain a more detailed understanding of the situation in the population. This data will be used for the doer and non-doer analysis in RanasANALYZE (phase 3), before we then derive the behaviour change techniques in RanasDESIGN (phase 4). It is important to survey a relatively large and representative sample of the population to receive a clear picture of the frequency of the behaviour and the psychosocial factors. The sample of individuals selected in this step will be surveyed again in RanasEVALUATE after the intervention. Thus, we can follow their changes in behaviour and psychosocial factors over time.

The key actions presented here do not all need to be executed sequentially; some can occur in parallel and, depending on the mode of data collection, some can be omitted.

Key Actions
Define the sample size and the sample selection procedure

Whenever the target population is too large to be surveyed in its entirety, we have to select a part of the population and survey this sample. To receive a high-quality sample, two aspects are relevant: first, the sample size and second, the selection procedure. Box 2.2.1: Instructions for sample size calculation and sample selection procedure gives instructions based on both aspects.

Schedule the data collection, define the number of data collectors to be employed and supervisors to be appointed

When the sample size and sample selection procedure has been defined, we can schedule the data collection and define the number of data collectors to be employed. It is necessary to know the approximate daily capacity of a data collector. Guideline figures on usual capacity of data collectors are provided in Box 2.2.1 (Guideline on data collection scheduling). For a team of 10 data collectors, you need at least one local supervisor, who organizes the data collection and supervises the team. A local supervisor should have the same mother tongue as the target population and be familiar with local customs and social protocols.

Employ data collectors

The next key task is to select and employ data collectors. Box 2.2.2: Selection of data collectors provides some information on the requirements for data collectors and the advantages and disadvantages of appointing health promoters as data collectors. We recommend employing one or two additional data collectors; they serve as stand-ins during data collection.

Organize the data collection

A visit to all the communities to be surveyed is essential to inform them about the upcoming data collection, to meet the relevant authorities, and to receive their consent and support. In some contexts, it may be helpful to ask for a letter of support from the authorities to be distributed to the data collectors. In case of phone-based or internet data collections, this action can be omitted. Under certain circumstances, ethical clearance might have to be sought.

Provision of the questionnaire

We need to prepare the questionnaire for data collection, either program it for use on electronic devices when used online or print the questionnaire for paper-pencil data collection.

Programming the questionnaire for electronic data collection needs some preparation and skills. Common tools are free services like KOBO collect or ODK collect or paid services like Survey CTO. A detailed instruction for programming and saving electronic data using KOBO collect can be found on the UNHCR webpage under this link.

Train the data collectors

The collection of data with reliable quality requires intensive training of the data collectors in which all supervisors take an active part. Note that this is a crucial step; it might be advisable to seek assistance from an expert for this, especially when applying the RANAS approach for the first time.

The duration of the training depends on the length of the questionnaire and the mode of data collection and lasts between 3 and 5 days. The training includes a pretest day in the field. It lasts longer when the survey instruments contain direct observations and when the questionnaire is translated jointly with the data collectors. Box 2.2.3 provides an exemplary outline for training data collectors.

It may be helpful to ask the team to complete a short evaluation form and/or exam every evening to detect any difficulties in understanding the training content. Use role-plays to ensure that data collectors get used to the tool and handle participants respectfully at all times. Role plays also help to develop strategies to ask difficult or sensitive questions.

In case the training cannot be realized face-to-face, it can also be provided using an online communication platform (e.g., zoom or teams). In this case, plan for more breaks and stretch the training over more time, if possible. Box 2.2.4 lists some recommendations on remote/online trainings. All organizational aspects for the training are listed in Box 2.2.2: Instructions for the organization of the data collector training.

Pretest of the survey instruments

The training ends with a pretest day in the field or remote in case of phone- or internet-based data collection. It is conducted with participants which are not part of the actual baseline sample but which share the key characteristics of the study participants (e.g. their situation is also rural). The pretest day has two goals. First, it is an important exercise for the data collectors. Second, we can test the survey instruments: the questionnaire, the spot checks, and the direct observation manual. We can verify whether the interview partners understand all the questions, whether all questions are answerable, and whether the questions are correctly and completely understood by the population. We can also check whether the spot checks and the direct observation manual are applicable and correspond to the situation in the field. Feedback from the data collectors is essential to achieve the second goal; we need their experience to optimize the survey instruments.

Revise the survey instruments

In nearly all cases, the survey instruments have to be revised after the pretest day. Plan at least one or two days to update the questionnaire, including the observation protocols. Bear in mind that when you change questions, the new formulations have to be translated as well, then programmed and we need to make sure the interviewers work with the latest version of the questionnaire.

Conduct the data collection

During data collection, it is essential that the data collectors are accompanied every day by one or, depending on the team size, several local supervisors. The tasks of the supervisors are outlined in Box 2.2.3: Instructions for the supervisors during data collection. If data collectors are not supervised, data quality may suffer; survey instruments may be (1) incorrectly completed due to misunderstandings, (2) left incomplete due to an error, resulting in missing data, or (3) falsely completed due to cheating. Only through adequate supervision can we guarantee to collect data of high quality.

Key resources and information
Outputs

Survey data from a sample of the target population group.

Phase 3: RanasANALYZE
Conduct Doer/Non-Doer analysis

Introduction

In phase 2, RanasMEASURE, we discussed the development of a quantitative questionnaire and observation tools based on the findings of phase 1, RanasEXPLORE. In a second step, how to conduct the data collection.

In this phase 3, RanasANALYZE, we will learn how to process the obtained data from the baseline survey and how to determine those behavioural factors that steer the target behaviour. Based on this information, the according behaviour change techniques will be selected and the campaign designed in phase 4.

The steps of this phase are:

3.1. Prepare the dataset for analysis

3.2. Defining differences between Doers and Non-Doers (The Doer/Non-Doer analysis)

Step 3.1: Prepare the dataset for analysis

Introduction

For preparing the dataset, the data gathered in the survey is entered into a data file, cleaned, and processed.

Key Actions
Clean and process collected data

After data collection, the dataset needs to be prepared for data analysis. In case of electronic data collection, the dataset can be downloaded and imported into Excel. When all data is imported, we have to process it. Cleaning the data is the first step. Missing or erroneous values need to be identified and corrected (see Box 3.1. Data cleaning for details). To further process the data, we need to identify the behaviour-question which can be used to determine doers and non-doers, code open answers into categories and recode multiple answer options into yes/no answers to each answer option (see Box 3.2. Data entry and division of the sample into doers and non-doers for a visual explanation using an example data set). Finally, data entry needs to be done by hand in case data is collected by paper-pencil. In an excel table, each row represents one participant, each column is one question, and each cell thus equals the response of one person to one question (see Box 3.3. Data entry for data collected by paper-pencil for more details).

Delete personal information

In order to keep the interview data anonymous, we need to delete any personal data from the data file. If you have not done so already, assign every respondent one ID number. Then copy the ID number together with any personal information on the individual (name, phone number, nicknames) to an extra file. Delete the personal information from the datafile. Only selected individuals should have access to the file containing ID number and personal information.

Combining responses for data analysis

Sometimes, it is necessary to combine the responses to some questions or to some question-parts before analyzing the data, thus building scales.

  • Calculating the mean value of the responses to all questions measuring self-reported handwashing at different key times for each participant gives a self-reported handwashing score.
  • To sum the responses to the questions on health knowledge for each participant creates a health knowledge score.

Step 3.2: Conduct the Doer- / Non-Doer analysis

Introduction

After having prepared the dataset, we conduct a doer/non-doer analysis. A doer/non-doer analysis compares the responses of people who do a behaviour (doers) to the responses of those who do not (non-doers). A large difference between doers and non-doers in responses to a question about a behavioural factor indicates that this factor is critical, meaning that it steers the target behaviour. Small or no differences mean that these factors are not relevant for the behaviour in question, thus no resources need to be spent to address them. A doer/non-doer analysis involves three steps. First, the sample is divided into doers and non-doers. Second, mean scores are calculated separately for doers and non-doers. Third, the mean scores are compared. Following, these three steps are explained in more detail.

Key Actions
Select questionnaire items for the definition of doers and non-doers of the target behaviour

There are different possibilities to decide which participants classify as doers and which as non-doers. This decision can either be made based on questions related to the target behaviour (e.g., The last time you defecated; did you use a toilet, or did you defecate in the open?) or questions that are part of the observation protocol (e.g., does the toilet look used?). In case the target behaviour is not yet performed by the target audience, it is also possible to use the intention to perform the target behaviour as the item to classify doers and non-doers (i.e., intenders and non-intenders). For example: In a community, where no toilets exist and people practice open defecation, no doers exist. Therefore, it is possible to use the intention to use a toilet instead of the actual behaviour “toilet use”. Each of these mentioned options has different advantages and disadvantages in terms of social desirability, bias, variance and reliability (see Box 3.4. Advantages and disadvantages of items for the definition of doers and non-doers for a more complete list).

Divide the sample into doers and non-doers of the target behaviour

If the behaviour was assessed by a dual response question the distinction of doers and non-doers is simple. For example, the question: The last time you defecated, did you use a toilet, or did you defecate in the open? leads to one group which used a toilet (doers) and a second group which defecated in the open (non-doers). However, for most behaviours, there is no predefined value or cut-off point at which to divide the sample into doers and non-doers. Instead, a cut-off point has to be determined based on the data. For this decision the following rules of thumb are proposed:

  • The first choice is to define people as doers that perform the behaviour in 100% of the occasions. For avoiding arsenic contaminated drinking water, for example, only people classify as doers that collect 100% of their drinking water from safe water sources. People who consume less than 100% arsenic-free water are considered non-doers.
  • However, for sound data analysis, none of the two groups of doers and non-doers should contain less than 30% of the sample or less than 30 cases. If classifying doers as people performing the target behaviour in 100% of the occasions leads to less than 30% doers (or less than 30 cases), we need to decide for a more meaningful cut-off point.
  • For handwashing, for example, we can also decide to categorize only people who wash their hands at 100% of key events as doers, and all who wash their hands less than 100% as non-doers. However, 100% handwashing might be an unrealistic cut-off point for many populations. Therefore, a more reasonable cut-off point might be 90% handwashing prior to and after key events. In this case, people who wash hands at 90% of key events and more are doers; people who wash hands at less than 90% are non-doers.

When we have defined a cut-off point, we divide the sample into doers and non-doers. In most cases, we divide the sample into doers and non-doers based on one measure; however, it is also possible to combine several measures.

Sort the dataset according to doers and non-doers:

Sort your data according to your main behavioural outcome variable (column B1, Behaviour: Chlorination, measured in % of household’s chlorinated water). In more detail, the following steps need to be performed:

  • Select the whole table; selecting your data only partially will distort your data dramatically as only some columns will get sorted and others remain (!), make sure to choose the option “expand the selection” if requested.
  • Make sure you have selected the option “my data has headers” within the sort command; so that your variable names will always remain in the first row
  • Now sort your data according to the item that you will use to divide doers and non-doers; this could be a binomial (yes/no) or a linear measure (how much?)

For formatting cells, using colours under “cell styles” or use the “conditional formatting” options to highlight your groups. Example 3.A. Doer/non-doer analysis example for chlorinating drinking water shows visually, and in more detail how to perform this step.

Calculate the mean scores of each behavioural factor separately for doers and non-doers

For each behavioural factor (i.e. for each question), the mean score in the responses is calculated separately for doers and non-doers. Calculation and interpretation of mean scores is quite straightforward for questions with rating scales or about factors such as age; it simply means the average of responses. For yes/no questions, the mean score equals the percentage of yes responses and should be displayed in Excel as a percentage. For open multiple-response questions, we treat every response option as a separate yes/no question; ‘yes’ means that that response was mentioned and ‘no’ means that that response was not mentioned. Example 3.A. Doer/non-doer analysis example for chlorinating drinking water provides more details and visuals on how to calculate means for doers and non-doers.

Compare the mean scores between doers and non-doers to identify the behaviour-steering factors

Next, we compare the mean scores of doers and non-doers for each behavioural factor. We calculate the differences between mean scores for doers and non-doers by subtracting the means of the non-doers from the means of the doers. The critical behavioural factors are those with the largest differences between doers and non-doers. These are thus selected to be targeted with the respective BCTs. Please see Example 3.A. Doer/non-doer analysis example for chlorinating drinking water for more details on how to compare the mean scores between doers and non-doers for different kinds of question formats. The following Box 3.5.: Interpretation of results demonstrates how to use the comparison results for interpretation and campaign planning.

Analyse contextual factors
We can analyse the data that we collected about contextual factors in the same way as we analyse the data about the behavioural factors. For the interpretation of the results, however, we have to distinguish two types of contextual factors. The first type of contextual factors is those that can be changed by a behaviour change campaign, such as the availability of chlorine for water disinfection or tippy taps for handwashing (physical context) or the social cohesion within a village or neighbourhood (social context). If we find a meaningful difference between doers and non-doers for such a contextual factor, we will select a BCT to change it in the subsequent RanasDESIGN phase. The second type of contextual factors are those that cannot be changed by a behaviour change campaign, such as the age of a respondent, the household income, or the level of education (all three are personal context factors). If we find differences between doers and non-doers in such a contextual factor this often means that we have identified a vulnerable sub-group of our target group. For example, if we find that those households that chlorinate their drinking water have a higher income, this also means that low-income households chlorinate their drinking water less. Consequently, low-income households are currently more at risk of contracting a communicable disease and require specific attention when designing the behaviour change campaign. In such a case, we recommend conducting a second doer non-doer analyses which includes only individuals from that vulnerable sub-group. For example, if we have found a relevant difference in household income between doers and non-doers in our first analysis, we should now conduct a second analysis and compare doers and non-doers on the behavioural factors in this sub-group that only includes low-income households. This allows us to identify the behavioural factors which are specifically relevant to them. By selecting BCTs according to these behavioural factors, we make sure that our campaign is tailored to the mindset of this especially vulnerable group.
Key resources and information
  • Data as collected during phase 2 RanasMEASURE

  • Skilled and trained data entry personnel.

  • Skilled and trained data analysis personnel.

Outputs

The behavioural factors steering the target behaviour are determined. These are the factors that we want to tackle through our campaign.

Phase 4

Summary

The steps of this phase are:

2.1. Develop a questionnaire and a behaviour observation protocol

2.2. Conduct a baseline survey

Step 4.1: ........

Coming soon…

Step 4.2: Develop campaign instructions and material

Key actions

Develop campaign instructions

The campaign strategy, that we have developed in the previous step, contains all relevant elements for the behaviour change campaign. We now have to develop the exact content and flow of the campaign activities by developing step-by-step campaign instructions. For example, we may have decided in the campaign strategy that we want to implement BCT 13 Prompt public pledging during a household visit and use a sticker as sign of a household’s pledge to separate their waste. To give another example, we may have decided to implement BCT 9 Describe feelings about performing and about consequences of the behaviour through a mindfulness exercise. In the campaign instructions, we now have to develop a rough script how the household visit should be implemented. The campaign instructions have several purposes: The first purpose is to provide clear and concise guidance for the implementation of the campaign. This is important so that the activities are implemented in the same way when working in a team. The second purpose is to define the parameters for monitoring the campaign implementation. The campaign instructions will serve as checklist for both, the promoters and their supervisors. When developing the campaign instructions, we should be alert that everything we write has to be grounded in the BCTs and corresponding activities that we outlined in our campaign strategy. A common challenge is to fall back into old habits of risk communication. This can be overcome by checking that each activity focuses exclusively on the selected BCTs and corresponding activities that we have outlined in the campaign strategy. Tool 4.4 provides an example for a campaign instruction that you can adapt. There is space to tick each step once it has been implemented.

Design campaign materials

Some behaviour change interventions will require use of materials, such as a pre-recorded radio spot or a visualisation of the target behaviour’s benefits on a flyer or a poster. To come back to our previous example of BCT 13 Prompt public pledging, we need a sticker, visible to everyone that is the public sign of the household’s pledge. No matter which materials we use, we need to make sure our materials are in line with the relevant BCTs. Further, it is important to tailor the materials to the local context and culture. For example, in one context a sticker at the door of a house may be a good commitment sign whereas in another context a flag on the roof of a house may be better. We can also revise and adapt materials which are already in use to save resources, see Box 4.5. We can adapt and create those materials ourselves, or we partner with a creative agency who designs and produces the materials. If engaging with a creative agency, we recommend working with a local agency, because they know best how to elicit attention in the target group and how people can be appealed to. A common challenge when working with creative agencies is to make sure that the materials they produce are in line with the campaign strategy and BCTs. We recommend informing the agency in detail about the RANAS steps that have led to the campaign strategy including the results of the doer and non-doer analysis. We also suggest to develop first drafts for the materials without the agency and to discuss these in detail with the agency. Box 5.5 provides some examples of past campaign materials.

Pilot campaign

When we have a first version of the campaign instructions and required materiel, we have to pilot them. Piloting means that we conduct the campaign in a small sample of 5 to 10 participants to learn which activities and materials are ready for implementation and which activities and materials need further revision. We should focus the pilot on two guiding questions: 1) Are the activities and materials practicable for the implementing staff and 2) are the activities and materials acceptable to the target population. If we can answer both questions for all activities and materiel with “Yes” we are ready for the next phase, that is RanasIMPLEMENT. If not, we have to go back and revise the campaign instructions and materials. In case we find that, in general, a communication channel or BCT are not practicable or not acceptable we need to go back to the campaign strategy and adapt it. Several iterations of piloting and revisions may be necessary. The pilot should be conducted by members of the team who have already been involved in the previous RANAS phases and that will continue to work for the project during the implementation. We do not recommend working with external promoters for the piloting.

Before starting the piloting, inform the participants that they are part of a pilot and get their informed consent to participate and to provide feedback afterwards. During the pilot observe the reactions of the participants and your experience of implementing the activities and document them in Tool 4.5, which is an extension of the campaign instructions. After the pilot, we have to gather the feedback from both implementers and participants. We can use short qualitative interviews or focus group discussions to do so. Tools X and Y provide instructions on how to apply these methods. We can use the following questions: What did you like/dislike? Which activities were easy/difficult for you? What could be improved? Do you have any general feedback/comments? Please add the key findings to the corresponding activity and step in Tool 4.5 so the tool contains all information which you have gathered during the pilot. Once you have gathered and documented all information, you can make the required revisions of the campaign instructions directly in the tool.

Key resources

  • Campaign strategy from step 1

Outputs

Campaign manual with details regarding activities and implementation planning.

Phase 5: RanasIMPLEMENT
Realize the behaviour change campaign

Introduction

So far, we have seen how to prepare a behaviour change project (phase 1, RanasEXPLORE) and how to analyse and understand behaviour. For that, we have done an in-depth qualitative analysis and a quantitative analysis of the situation and the context, the behaviour(s) in question and their influencing factors (phase 2, RanasMEASURE). Based on this and comparing doers with non-doers (phase 3, RanasANALYZE), we chose BCTs to change the most influential factors, thus creating a campaign strategy and manual (phase 4, RanasDESIGN).

In this chapter, we will see how to prepare the implementation of the campaign (step 5.1.: prepare to implement campaign) based on the campaign strategy. With the help of these preparations, the behaviour change campaign will be implemented (Step 5.2: Implement and monitor behaviour change campaign), and we will see how to monitor the campaign implementation (Step 5.2: Implement and monitor behaviour change campaign). The same checklists used for training (step 5.1: Prepare to implement campaign) and implementation (Step 5.2: Implement and monitor behaviour change campaign) will also serve for monitoring and thus quality control. The supervisors record whether each activity is put into practice the way it was planned.

The steps of this phase are:

5.1. Prepare to implement campaign

5.2. Implement and monitor behaviour change campaig

Step 5.1: Prepare to implement campaign

Introduction

In this step, all the preparations for the actual implementation of the campaign will take place. For this, we first need to establish which project community or group will receive which campaign strategies. Wherever possible, previous results and planned campaign strategies should be discussed with the participating communities or their representatives. Based on these decisions and the campaign strategy and respective instructions, checklists should be created which detail activities and messages for each campaign strategy. Personnel needs to be trained in the created campaign strategies, as well as in community involvement and sensitivity, with the help of the checklists. Then, a monitoring system should be put into place, for which the same checklists can serve as tools.

Key Actions
Assign the strategies to project communities or project groups

First of all, one needs to decide which project communities or groups receive which behaviour change strategies. Depending on the decisions from phase 1 (RanasEXPLORE), this might mean that a certain group receives a standard campaign or that there will be different phases to the campaign, where certain groups receive the campaign later. This makes a comparison of the effects of the campaign possible. Additionally, certain communication channels and strategies will be more adequate for certain groups, for example because they indicated that they find certain communication channels more trustworthy or because these channels are the only ones available in a certain region or because the group requires a certain kind of strategy (e.g. a food vendor support group receives cooking and food preparation hygiene classes, a mother’s group receives information about breastfeeding). Both the assignment of the strategies to different areas or groups and the decision for communication channels should be discussed with the community or chosen representatives. Focus group discussions or community meetings can serve for this kind of involvement and community participation at this point (see phase 1, RanasEXPLORE for instructions).

Prepare checklists

The first key action here is to create checklists for each activity and communication channel, which can give step-by-step guidance to the implementers and promoters. The more detailed the steps of what needs to be done in which order, the easier it will be for the implementing person (e.g. the promoter) to follow these instructions (the following Box 5.1. provides a model checklist).

A checklist should detail each activity and the respective message, step by step.

The supervisors need to be trained in the use of the checklist and regular visits to the different activities should be planned. The checklists can be uploaded into a digital data collection system like Kobocollect (www.kobotoolbox.org) or, if filled in manually, the data needs to be transferred into a table to be able to analyse it.

Choose promoters

It is recommendable to choose independent promoters, i.e. different promoters to the interviewers, so that interviewees are later not under the pressure of answering in the way that the promoter who now interviews them wants to hear – in line with what they have been taught. Thus, the pressure to answer in a socially desirable way will be reduced by either choosing different teams of persons for interviewers and promoters or by switching the areas (or interviewees) between interviewing and promotion.

Also, choose promoters who have a profound knowledge about and familiarity with the target area. If, on the other hand, promoters are already active in the regions, clarify how to integrate the new activities into the existing ones and what differentiates this project from previous ones. See Box 2.2.2. Selection of data collectors for more details.

Training of personnel

We recommend holding a training for the project implementers and promoters, especially if interpersonal communication (e.g. through community meetings or household visits) has been chosen as a communication channel in the project at hand. The promoter training should be planned with a presentation which is based on the campaign manual and the checklists. The content of the training should be as follows:

  • Information about the project
    •  Goals of the project and difference of goals versus outputs, steps leading up to this point, results of the baseline data collection,
    • how the campaign was based on these baseline results,
    • Knowledge about the general health or environmental topic at hand and the related behaviours,
  • RANAS information:
    • behaviour change and behavioural factors,
    • RANAS model,
    • steps of the campaign,
    • chosen BCTs, which factors they tackle and with which messages,
    • how this behaviour change project is different to mere health messaging or “business as usual”,
  • Preparation:
    • promoter’s exact roles and responsibilities,
    • logistics
    • monitoring and supervision,
    • materials to be used,
    • checklists.
  • Ethical issues
    • Be Mindful of Personal Privacy
    • Obtain Informed Consent
    • Embrace Voluntary Participation
    • Remain Confidential
    • Don’t Promise Anything

See Box 1.10. Ethical issues from phase 1, RanasEXPLORE for more details.

A promoter training should last between one and two days and should include role-playing with feedback and a pre-test with persons outside of the project, as well as discussions with and participation of all team members. As much as possible, the promoters as well as the participating communities should be integrated in the detail planning of the implementation, because they have important cultural insights and experiences. Before closing of the training, it should be verified that the promoters understood all of the above points of content. Please see Box 2.2.3. Exemplary outline for training data collectors for more details about how to train data collectors.

Prepare other communication channels

Communication channels which do not require interpersonal communication (e.g. radiospots, posters, leaflets) do not require a promoter training as such, but the implementing persons should have the same knowledge about behaviour change, community engagement and the planned campaign as described above (content of training). Additionally, each communication channel should be prepared according to the campaign materials (e.g. it needs to be decided, how many of which kinds of materials will be disseminated, and the mode and place of dissemination).

Prepare monitoring

Thorough monitoring of the campaign implementation is very important because the best campaign will not be effective if not implemented correctly. Especially for experienced promotors it may be difficult to apply new kinds of strategies. There is always a danger to revert to promoting health risk awareness or to point out common consequences of environmental deterioration, which has been done many times before, even if analysis has shown that this strategy is not effective in that case. Thorough monitoring can prevent this reversion and ensure that the campaign is implemented in all its planned aspects. To prepare this monitoring, the checklists can be adapted (so that each time an activity is being observed or supervised, each activity step can be checked off), and it needs to be planned how the collected data will be recorded and analysed (please see the next step, “Step 5.2: Implement and monitor behaviour change campaign” for more details). Out of the group of trained promoters, a number of supervisors can be chosen who partake in implementing the campaign, but also record monitoring data with the help of the checklists. Good supervisors stand out from the group through leadership skills, natural authority, a good understanding of the issues at hand and the planned campaign and/or outstanding social skills. Thus, the prepared checklists can be used to support supervisors as well as promoters and to monitor the campaign. Please see the next step (5.2. implement and monitor behaviour change campaign) for more details about the implementation of monitoring.

Key resources and information
  • The developed campaign strategy with activities and instructions

  • Checklists for implementation which were prepared in this project

  • Staff which will be trained for implementation

  • A trainer who understands the RANAS process, the campaign strategy, and the checklists thoroughly

  • Presentation slides based on the campaign strategy

  • Developed behaviour change materials

Tools and examples
  • Example for a campaign strategy: (link 1: Tool from Phase 4)

  • Box 5.1.: Model checklist

Outputs

Checklists with step-by-step instructions for each activity.

Implementers / promoters who understand the campaign and their exact tasks.

Step 5.2: Implement and monitor behaviour change campaign

Introduction

This step is all about implementation and monitoring of the planned behaviour change campaign. This is the culmination of everything that we have done so far. Following, details are given about how to roll out the planned activities and how to systematize analysis and feedback.

Key Actions
Implementation

To implement the campaign, we need to roll out the planned activities according to the campaign strategy and the checklists.

Supervisors should be assigned to groups of promoters and the checklists given to both, with a schedule of randomized and non-announced visitations of supervisors to the planned activities. The checklists can be used for monitoring; this will be explained in the next section. It is recommendable to plan for an extended time of implementation, as one-time-experiences or communication have shown to have less impact than repeated ones. Follow-up visits, monitoring and evaluation will show which effects the current campaign has and for how much longer it should be implemented.

A successful implementation should consider the following:

  • Every promoter should receive a printed manual and checklist.
  • It is important to find out the appropriate times for household visits, to ensure that the target group is available. Appointments might be necessary.
  • Before starting to work in a community, leaders and/or officials of the area should be contacted, to ensure a good introduction into the community. Ideally, the community has already been participating in the whole process leading up to this point.
  • Regular meetings between groups of promoters and supervisors should be held (e.g., at the end of each day), to give feedback and ensure exchange of experiences and early solution of problems.
  • There should be a feedback system in place which ensures that the recipients of the campaign can be heard, and the campaign can be adapted to possible problems. Depending on the local context, this can take the form of a sort of letter box with paper provided and a pen attached, or contact details specifically for complaints.
  • Regular revision of the collected monitoring data through checklists is important to detect campaign problems early on and to give feedback to promoters.
  • Take pictures or videos of each type of promotion activity, they serve well in reports, advertisement for the project, and to detect possible errors in implementation.
  • When taking pictures or videos, permission to publish needs to be given by all participants.
Monitoring

Monitoring is a continuous systematic collection of data on specific indicators to gain insight into the impact and effectiveness of an ongoing campaign. It serves to know whether the targeted objectives and intermediate goals are achieved and allows for adjustments during progress.

We recommend using the already developed checklists and to have a supervisor visit ongoing campaign activities like household visits or community meetings and to compare the implemented activities with the requirements of the checklist. A simple check or yes/no on each step listed will then provide quantitative measurements about the quality of the campaign and how well the promoters are adhering to the instructions. Additionally, immediate feedback can be given to the promoters this way. This in turn allows for continuous improvement of the campaign implementation.

To avoid errors when inserting data from checklists to data sheets (e.g. Excel), use a digital system (e.g. Kobocollect) to collect data with the help of the digitalized checklists. This will directly produce a data sheet. Alternatively, if this is not possible, have two people work together on the transfer of written to digital data (see Box 3.3. Data entry for data collected by paper-pencil, phase 3, RanasANALYZE, for more detail).

For good community engagement, it is important to create a system of how to receive feedback and criticism from the participating persons and communities. For example, an Email-address and telephone number of a responsible person of the implementing organisation. Determine how to integrate such feedback and criticism into the existing project.

Analysis and feedbac

Simple percentages of checks (= proper implementation) for each step of the checklist tell us how well each activity is being implemented. This means, the checklists need to be transferred on a daily basis into a prepared data feed, where the number of correctly implemented steps is inserted by date. The total number of implemented activities should also be inserted. This way correctly implemented steps divided by total possible steps gives a percentage of correctly implemented steps. The higher this percentage is, the better. Feedback should be given on steps which are fulfilled less than 100%, reminding the implementers of these steps and if necessary, explaining them again or discussing possible difficulties. It is recommendable to hold a feedback meeting with all implementers at the end of the first day and give detailed feedback on which steps need to be improved and how. Then, depending on the frequency of campaigning, regularly and with a higher frequency, and, once a percentage of 90% or higher of correctly implemented steps can be observed, with less frequency.

Key resources and information
  • Trained implementers, promoters and supervisors

  • Activity checklists based on the developed campaign strategy from phase 4, RanasDESIGN

  • The behaviour change materials from phase 4, RanasDESIGN

  • Data sheet to insert checklist data

Tools and examples
  • Example for a campaign strategy: (link 1: Tool from Phase 4)

  • Box 5.1.: Model checklist

  • Tool: 20220314_Method fact sheet 4 Behaviour change techniques

Outputs

Data about the quality of the campaign implementation (percentages of fulfilment of activities).

Behaviour change campaign implemented as planned.

Goals which are outlined in the campaign manual are reached.

Phase 6: RanasEVALUATE
Quantify change in behaviour and behavioural factors

Introduction

In the previous phases, we have seen how to set the parameters of the project (phase 1: RanasEXPLORE), how to analyse the target population’s behaviour, context and behaviour-influencing factors (phase 2: RanasMEASURE and phase 3: RanasANALYSE). The results of the explorative phase and the baseline survey have been used to choose behaviour change techniques and these build the basis for a campaign strategy (phase 4: RanasDESIGN). With the help of the campaign strategy and intervention checklists, the campaign has been implemented and monitored (phase 5: RanasIMPLEMENT).

After having implemented the developed behaviour change campaign, most projects evaluate whether the targeted behavioural factors and behaviours have changed as anticipated. In some projects, a before and after measurement is not possible, in which case this phase does not fully apply. To measure short-term effects, a constant monitoring can be put into place for direct feedback and improvement (phase 5, RanasIMPLEMENT). To measure long-term effects, the follow-up survey should be conducted 6, 12, 18, or even 24 months after campaign implementation. For this evaluation, a follow-up questionnaire has to be developed (step 6.1.), the follow-up survey(s) have to be implemented (step 6.2.) and the data has to be used to quantify the change that has taken place (step 6.3.). Finally, the findings of the evaluation are used to improve the existing campaign, scale it up to a bigger target population and / or to plan future behaviour change campaigns (step 6.4.). Evaluation is important for accountability and learning because it examines the achieved outcomes, the efficiency and the wider impact on people’s lives and allows to find recommendations to improve the project itself and to improve future policy and practices.

The steps of this phase are:

6.1. Develop follow-up questionnaire

6.2. Conduct follow-up survey(s)

6.3. Quantify change

6.4. Integrate findings

Step 6.1: Develop follow-up questionnaire

Introduction

In order to evaluate the impact of the campaign, first a follow-up or endline questionnaire needs to be developed. Key actions for doing so include the planning of the evaluation and, based on that planning and the baseline questionnaire, the actual creation of the questionnaire

Key Actions
Planning of evaluation

An evaluation is done by comparing behaviour and behavioural factors as they were before the campaign (baseline, see phase 2: RanasMEASURE) with how they are after it: A before and after comparison shedding further light on the impact of the behaviour change intervention. Optimally, in phase 1 (RanasEXPLORE, see step 1.1) the decision was made for project design Option 1 ” Phased implementation with before-after measurement and independent comparison group” (for the other options, see the following Box 6.1. Evaluation option if a BAC is not possible). This option includes a before-after measurement in two separate groups (a campaign and comparison group with time-shifted application of the campaign in the comparison group; see phase 1 RanasEXPLORE, step 1.1. Define project design, for the different project design options). For evaluating, one can decide between conducting a midline and an endline evaluation survey, or just an endline. The advantage of also conducting a midline evaluation is that there is still time to improve on the existing campaign. Thus, depending on the project design that has been decided during phase 1, RanasEXPLORE, one or several follow-up surveys have to be developed now, as part of the evaluation phase.

Creating the follow-up questionnaire(s)

A follow-up questionnaire consists of the same observations of and questions about the relevant behaviour(s) and behavioural factors as the baseline (see phase 2, RanasMEASURE, for how to create a baseline survey).

In addition, the follow-up questionnaire contains a separate part called “campaign check”: To evaluate a campaign, it is important to know how many members of the target group received which parts of the campaign and how it was perceived. For example, some people participated in community meetings while others only received household visits, and some may have had both. To improve participants’ recall, it is useful to show some materials used during the campaign implementation. Some generic campaign check items can be found in the following Box 6.2. Examples for campaign check items.

Key resources and information
  • Baseline questionnaire, see phase 2 RanasMEASURE
  • Follow-up questionnaire with campaign check
  • Optimally a digital platform like Kobocollect
  • Knowledge and experience in questionnaire design
  • Someone who knows how to program or format the questionnaire
  • Locally knowledgeable person(s)
Tools and examples
Outputs

A developed and programmed or formatted follow-up questionnaire ready to be used.

Step 6.2: Prepare and conduct follow-up survey(s)

Introduction

In order to conduct one or several follow-up surveys, data collectors are necessary. Once these are chosen, they need to be trained before they can start collecting data by applying the developed follow-up questionnaire.

Key Actions
Choosing data collectors

Ideally, data collectors should not be the same person as the implementers, because interviewees are very likely to answer in what they perceive is the desired way, according to what the implementer told them about the behaviour, if he or she is the same person who told them what to do in the first place. Thus, if there is only one team available, a cross pattern can be planned where those persons from the target population who came into contact with a certain implementer, are being interviewed by a different person.

Train data collectors and collect data.

Very similar to phase 2, RanasMEASURE, the data collectors need to be trained. Please review Box 2.2.3. Exemplary outline for training data collectors to plan and implement a data collector training.

Conduct evaluation survey

Ideally, the same persons who were interviewed for the baseline should be interviewed during follow-up, using the follow-up questionnaire(s) developed. Household or identification numbers, photos of the households, mobile phone numbers and even GPS coordinates collected during the baseline survey are helpful to identify the same participants. For more information on how to conduct data collection, please see phase 2 (RanasMEASURE)

Key resources and information
  • Well trained data collectors

  • Lists to identify participants of baseline

  • Follow-up survey, in digital format and smartphones or tablets, or paper/pencil

Tools and examples
  • Box 2.2.3. Exemplary outline for training data collectors

  • Example: Endline questionnaire (TBD, maybe example from Zimbabwe)

Outputs

Data sheet from collected follow-up survey

Step 6.3: Quantify change

Introduction

In order to quantify the change in behaviour and the behavioural factors in the target group, the collected data needs to be entered, cleaned and processed (please see phase 3, RanasANALYZE, for details). Then, mean scores are being calculated for the different groups and times. These mean scores are then compared, and the results interpreted.

Key Actions
Enter, clean and process the data

First, data sheets from the follow-up survey are downloaded, entered into a calculation program, cleaned and processed (similar to what was done in phase 3, RanasANALYZE). Then, we need to unite the data sheets from baseline and follow-up survey by cases/persons, so that each person’s data is united in one line. Example 6.A. (Example for quantifying change) presents the entered and processed follow-up data of one sample. There, you can see that we applied two groups to test our intervention strategy, a comparison group and a campaign group.

Calculate mean scores at baseline and at follow-up separately for the comparison and the intervention group

We calculate the mean scores at baseline and at follow-up. We do that (1) for the behaviour measure by which we divided our sample into doers and non-doers and (2) for each behavioural factor. Where we have applied a comparison and a campaign group, the mean scores are calculated separately for each group. In Example 6.A. (Example for quantifying change), you can see a screenshot for both operations.

Calculate change scores from baseline to follow-up separately for the comparison and the intervention group

To assess whether and by how much the behaviour and the behavioural factors changed from baseline to follow-up, we calculate the change scores. Change scores are simply the mean scores at baseline subtracted from the mean scores at follow-up. Again, we do this separately for comparison and campaign group. The bigger the change score, the bigger were the changes in behaviour(s) or behavioural factors.

Compare change scores between comparison and campaign group

Where we have applied a comparison and a campaign group, we also want to compare the change scores between these groups. To do this, we subtract the change scores in the comparison group from the change scores in the intervention group. Based on these difference scores, we can verify whether our campaign strategy was indeed effective: whether behaviour changed more positively in the campaign group than in the comparison group. We also inspect the difference scores for the behavioural factors to see whether the behavioural factors that we targeted in our campaign changed as we wanted. A bigger change score in the campaign group than the comparison group shows that the campaign worked as intended.

Statistical comparisons, e.g. by t-test, are a good way to analyse whether the campaign created statistically significant bigger changes than the comparison group. If this is not possible, an easy way to identify the difference between the campaign and the comparison group is to subtract the means of one group from those of the other and identify any difference which is bigger than 10% of the answer scale. Meaning, for variables with 5-point likert-scale answers (e.g. 5 = I like it very much to 1 = I don’t like it), differences bigger than 0,5 are meaningful whereas for binary answers (e.g. 1 = yes, 0 = no), differences bigger than 0,1 are meaningful.

If we had used several campaign groups, each receiving a different intervention strategy, we would also calculate difference scores between these campaign groups. From these scores, we could assess which of the campaign strategies was most effective.

Interpret results

The bigger that difference between before and after, the more the behaviour or the behavioural factor has changed. However, this effect also depends on how high the behavioural performance was in the beginning (e.g. if 90% of the target population were showing the behaviour at baseline, there is a maximum of 10% which the behaviour can increase) and it can depend on other things happening in the area (e.g. elections, strikes, a natural disaster or a pandemic will have its own influence on behaviour). Therefore, the matching of these before-after differences with a comparison group are used to give a clear insight into the actual effect of the campaign. We expect to see the desired behaviour and influencing factors increase in the campaign group and stay approximately the same in the comparison group. The behaviour change strategies have been effective when the before-after differences in behaviour and behavioural factors are larger for the campaign group than for the comparison group. This way, we prove that the observable effect is due to the implemented campaign. We also inspect the difference scores for the behavioural factors to see whether the behavioural factors that we targeted with our campaign changed as we wanted. If we had used several campaign groups, each receiving a different intervention strategy, we would also calculate difference scores between these groups. From these scores, we could assess which of the campaign strategies was most effective.

Key resources and information
  • Data sheets from baseline and follow-up surveys

  • Someone who can unite the baseline and follow-up surveys in one data sheet

  • Someone to calculate the before-and-after differences, as well as those between campaign and comparison group

  • Someone to interpret and write up the results

Tools and examples
  • Example 6.A.: Example for quantifying change

  • Example: before-and-after comparison trial calculations (Zimba example?)

  • Example: Interpretation of results (Zimba example?)

Outputs

Data results and a report summarizing the findings.

Information about the effectiveness of the campaign.

Recommendations about how to improve the campaign.

Step 6.4: Integrate findings

Introduction

Integrating the findings is an important part of the process because interventions can be improved or upscaled that way. Ethical considerations and appropriate community engagement should be considered here, as throughout the whole process.

Key Actions
Improving campaigns

The work is not finished when the data has been analysed. We see it as an ongoing process and want to use the insights from the analysis to further improve and adapt our campaigns. To be able to follow this up with improved campaign strategies, we need to continue collecting data in future and linking it optimally to our monitoring and evaluation system. Based on the data analysis and its interpretation, we know how effective certain campaign strategies are and which behavioural factors they changed how much. Comparing these changes with the planned behaviour change techniques, we can identify which techniques worked better and which behavioural factors could change even more. Thus, recommendations can be given about how to improve certain BCTs and in this way improve the effectiveness of the campaign. These recommendations should be discussed with the participating communities and further campaign implementation planned conjointly.

Upscaling

When we see that a campaign was successful, meaning that the target behaviour changed in the desired manner, we can think about scaling up the campaign to a bigger target area or to other, similar areas, backed up by the evidence that they are effective in changing behaviour. However, one has to keep in mind that the campaign was designed and proved effective for a specific target group under specific circumstances and will lose their effectiveness if applied to different contexts without going through the adaptation process which we have seen throughout the RANAS approach. Thus, it is good to think about and discuss what the differences between regions might be when it comes to those behaviours, because there are always at least some differences. If necessary, additional qualitative and/or quantitative questions can be asked, and answers analysed. Upscaling campaigns should be adapted accordingly to identified differences.

Ethical considerations in campaign planning

Like mentioned in phase 1, RanasEXPLORE: To adhere to good ethical standards, a comparison group as mentioned in this guideline, should also receive a campaign. To be able to nevertheless receive the necessary data and findings of a comparison group, we can give the campaign to the comparison group after the implementation of the campaign and the endline evaluation (time-shifted campaign). If a time-shifted campaign is not possible, for example when working in an emergency, the comparison group could receive a standard campaign, or different campaign groups could be compared which have received different aspects of the campaign. The participating communities should be consulted to make the respective decisions conjointly or with the respective input.

Key resources and information
  • Evaluation data, analysis and evaluation report
  • Recommendations developed based on data
Tools and examples

Example of an evaluation report (Zimba example?)

Outputs

Improved campaign.

Upscaled campaign.