A crisis in confidence -- Investigating existing ethnographic methods -- Is reflexivity necessary? -- The wrong way out: typology and idealism -- Reflexive realism: a new way of doing ethnography -- Measuring the "strength of belief" -- Toward reflexive ethnographic science
This paper describes a process evaluation of a 'wise' intervention that took place in six acute care units in two medical-surgical teaching hospitals in the United States during 2016–2017. 'Wise' interventions are short, inexpensive interventions that depend on triggering specific psychological mechanisms to achieve behaviour change. This study sought to increase the hand hygiene compliance (HHC) rates before entering a patient's room among nurses. The intervention centred on the use of threat to professional identity to prompt improved HHC. Through questionnaires administered to intervention participants and the implementation facilitator, together with independent observation of intervention delivery, we examined whether the steps in the Theory of Change occurred as expected. We found that aspects of the implementation—including mode of delivery, use of incentives, and how nurses were recruited and complied with the intervention—affected reach and likely effectiveness. While components of the intervention's mechanisms of impact—such as the element of surprise—were successful, they ultimately did not translate into performance of the target behaviour. Performance was also not affected by use of an implementation intention as repeated performance of HHC over years of being a nurse has likely already established well-ingrained practices. Context did have an effect; the safety culture of the units, the involvement of the Nurse Managers, the level of accountability for HHC in each unit, and the hospitals themselves all influenced levels of engagement. These conclusions should have implications for those interested in the applicability of 'wise' interventions and those seeking to improve HHC in hospitals.
Mass panics can arise in response to a variety of situations, such as the spread of pathogens, bank failures, or insecurities about economic supplies. Such panics can produce contagious behaviors such as fleeing social contacts, bank withdrawals, and panic buying. In such situations, the processing of external stimuli, mediated by the perceptions and biases of the individual, can reach a threshold point at which panic behaviors are triggered. Due to the human propensity to imitate the behavior of others in uncertain crisis situations, one individual's panic behavior can spread contagiously. This paper looks at the similarities among case studies of mass panic around the world and from these cases synthesizes a conceptual model to aid our understanding. Decision-makers can use this model to strengthen national resilience against panic-generated behaviors and ensure an orderly and successful public response to future biological, financial, or economic crises.
Background In circumstances where vaccine hesitancy is high, like in Tanzania in 2021, measures to control the spread of COVID-19 infection through non-pharmaceutical interventions, specifically mask-wearing, hand-washing and physical distancing, become crucial. This study was undertaken to inform the development of a context-adapted communication campaign to control COVID-19 in Tanzania. Focus of the Article The study examines the effectiveness of three different behaviour change campaign ads created as part of the same control effort, and two of them by the same creative process, with the same creative team, at roughly the same time, in altering behavioural propensities for relevant target behaviours, including the washing of hands, the wearing of masks and social distancing, and key participant attitudes, such as the sense of obligation to others. Research Question The main research question was: what are the effects of behaviour change campaign ads on propensities for engaging in COVID-19 target behaviours? We also examined behavioural attitudes and consumer appreciation of the ads (believability, likeability, relevance and surprise). The purpose of the study was to provide empirical evidence on the effectiveness of different messaging logics, in order to help improve future campaigns. Methods We designed a controlled survey experiment where participants were randomly assigned to receive one of the three campaign ads. These were called: the "Setting" campaign, which was designed using a theory-based Behaviour Centred Design (BCD) approach and produced with local partners; the "Password" campaign, which was the result of a substantial investment by a major international consortium; and the "Balance" campaign, a local adaption of "Password"; as well as an educational public service announcement, which served as an active control. An SMS survey was administered online to 2080 participants in Tanzania in 2022 to evaluate the potential effectiveness and consumer appreciation of the campaigns. Results The results showed that the most costly campaign, "Password", did not perform better than the other campaigns on any test. In particular, "Password" was not more effective than the theory-based "Setting" campaign on any single behavioural indicator or exposure variable. The "Setting" campaign was more effective than other ads on the expected qualities of appreciation (surprise, believability). However, the educational announcement achieved higher average response levels than all of the narrative-based treatments on measures of consumer appreciation, such as likeability, believability and relevance. Recommendations for Practice This study supported the proposition that a campaign specifically designed to elicit particular kinds of psychological responses could do so. It showed that a theory-based campaign, produced locally and at low cost, can compete on standard marketing values with high-quality creative processes and production values.
Poor peri-urban sanitation is a significant public health problem, likely to become more important as the world rapidly urbanizes. However, little is known about the role of consumer demand in increasing peri-urban sanitation quality, especially for tenants using shared sanitation as only their rental choices can be observed in the market. We analyzed data on existing housing markets collected between 9 Jun and 6 Jul 2017 using the Hedonic Pricing Method (HPM) to capture the percentage of rent attributable to sanitation quality (n = 933). We also conducted discrete choice experiments (DCEs) to obtain willingness to pay (WTP) estimates for specific sanitation components (n = 1087), and explored the implications by estimating the proportion of plots for which improved sanitation quality would generate a higher return on investment for landlords than building a place for an additional tenant to live. The HPM attributed 18% of rental prices to sanitation (∼US$8.10 per month), but parameters for several components were poorly specified due to collinearity and low overall prevalence of some products. DCEs revealed that tenants were willing to pay $2.20 more rent per month for flushing toilets on plots with running water and $3.39 more per month for solid toilet doors, though they were willing to pay little for simple hole covers and had negative WTP for adding locks to doors (-$1.04). Solid doors and flushing toilets had higher rent increase to cost ratios than other ways landlords commonly invested in their plots, especially as the number of tenant households on a plot increased. DCEs yielded estimates generally consistent with and better specified than HPM and may be useful to estimate demand in other settings. Interventions leveraging landlords' profit motives could lead to significant improvements in peri-urban sanitation quality, reduced diarrheal disease transmission, and increased well-being without subsidies or infrastructure investments by government or NGOs.
INTRODUCTION: There are gaps in global understanding about how to design and implement interventions to improve sanitation. This formative study provided insights for the subsequent redesign of a government-led national sanitation campaign targeting rural populations in Tanzania. METHODS: The Behaviour Centred Design approach was used to investigate the determinants of toilet building, improvement and use. Varied, novel, and interactive research tools were employed in fifty-five households in two regions of rural Tanzania. Results were analysed to articulate a Theory of Change, which then informed intervention design. RESULTS: Participants valued hard work, enterprise, and improving their lives over many years. They wanted better toilets but felt no urgency to act quickly. A common emotional motivator for improving toilets was to protect children from disease (Nurture) but this was insufficient to drive rapid change. Disgust with traditional toilets meant they were built at a distance from the house: an 'out of sight, out of mind' attitude. Other powerful motives included the desire to improve living conditions (Create), and to become a modern Tanzanian (Status), albeit without 'showing off'. Construction costs and water scarcity were the main stated barriers. Receiving information about realistic costs, support accessing materials, and visiting better latrines elsewhere were commonly reported reasons for improving latrines. CONCLUSIONS: The resulting Theory of Change recommended that the intervention should surprise people with a novel conversation about toilets, promote toilets as a means of conferring status, and introduce a perceived urgency to 'act now'. It should suggest that modest improvements would lead to a better life. Feelings of disgust and fear with poor quality toilets should be amplified, and barriers lessened through promoting transformational toilet improvements, and improving access to modern toilet products. This research provided considerable insight into sanitation behaviours in rural Tanzania, which informed creative intervention design.
While large-scale changes in population behaviour are required to reduce the transmission of the severe acute respiratory syndrome coronavirus 2 virus, the emergency context is not conducive to the sort of careful communications planning that would normally be required to meet such a task. Rapid strategic communications planning in a pandemic by governments is, however, possible and necessary. Steps include setting up a dedicated communications task force, mobilising partners and resources, developing a creative brief and theory of change and overseeing the creation, testing, roll out and revision of content. In this short guide, we argue that a minimum of strategic planning can be undertaken rapidly, and that good use can be made of simple principles of behaviour change, even during pandemics. Our aim here is to provide a blueprint that governments and their partners, especially in low-income settings, can follow to design, coordinate and resource national communications efforts to combat the COVID-19 pandemic immediately and for the longer term.
While large-scale changes in population behaviour are required to reduce the transmission of the severe acute respiratory syndrome coronavirus 2 virus, the emergency context is not conducive to the sort of careful communications planning that would normally be required to meet such a task. Rapid strategic communications planning in a pandemic by governments is, however, possible and necessary. Steps include setting up a dedicated communications task force, mobilising partners and resources, developing a creative brief and theory of change and overseeing the creation, testing, roll out and revision of content. In this short guide, we argue that a minimum of strategic planning can be undertaken rapidly, and that good use can be made of simple principles of behaviour change, even during pandemics. Our aim here is to provide a blueprint that governments and their partners, especially in low-income settings, can follow to design, coordinate and resource national communications efforts to combat the COVID-19 pandemic immediately and for the longer term.
This volume offers an integrative approach to the application of evolutionary theory in studies of cultural transmission and social evolution and reveals the enormous range of ways in which Darwinian ideas can lead to productive empirical research, the touchstone of any worthwhile theoretical perspective. While many recent works on cultural evolution adopt a specific theoretical framework, such as dual inheritance theory or human behavioral ecology, Pattern and Process in Cultural Evolution emphasizes empirical analysis and includes authors who employ a range of backgrounds and methods to address aspects of culture from an evolutionary perspective. Editor Stephen Shennan has assembled archaeologists, evolutionary theorists, and ethnographers, whose essays cover a broad range of time periods, localities, cultural groups, and artifacts
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