Department Environmental Social Sciences

Environmental and Health Psychology (former group page)

Research of this cluster targets at understanding how psychological interventions change opinions, behavioral determinants, and behaviors and how these individual changes affect phenomena on the population level. Based on this understanding, intervention techniques and campaigns can be developed that are more efficient, robust, and have a longer lasting effect.

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Teaching Material

Webinar by Prof. Mosler, on Systematic Behaviour Change using the RANAS approach

Hygiene promotion in Humanitarian Contexts using a Systematic Approch to Behavior Change

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Using the RANAS approach

Systematic Behavior Change in Water, Sanitation and Hygiene

Main Document

Case Studies

Electronic Supplementary Information

General Information

Research topics and methods

Psychological topics

  • Effects and effectiveness of behavior change techniques: Psychological determinants of behavior; corresponding behavior change techniques; etc.
  • Situational effects on behavior: Prospective memory; habit development; social norms; etc.
  • Communication and ‘thinking’: Message production, persuasion, and risk communication; mental models and decision making of ‘common people’; information selection and interpretation; etc.
  • Interaction processes in populations and media effects: Cooperation and collective actions; diffusion of innovations; behavior caused disease spreading; opinion dynamics; etc.

Water-research topic

Water consumption and drinking water
  • Use of household water-treatment systems in developing countries: SODIS; As- and F-mitigation techniques; etc.
  • Safe storage and handling of water in developing countries
  • Consumption of and opinions related to tap-water in developed countries: Consumption of tap vs. bottled water; micro-pollutants in tap-water; etc.
  • Consumption of and opinions related to consumption of virtual water in developed countries
Sanitation / hygiene and wastewater
  • Acquisition, use, and maintenance of latrines in developing countries
  • Promotion of hand-washing and other hygiene-related behaviors (e.g., protection against flies)
  • General hygiene personal norm
  • Behaviors and opinions related to waste-water: Use of urine-bags after X-ray treatment; opinions on waste-water policies; conscious use of chemicals at home; etc.
Aquatic ecosystems and ground water
  • Behaviors affecting aquatic ecosystems and ground water: Irrigation behavior and use of chemicals by farmers; relocation of boats infected with invasive dreissenids; fish-stocking behavior; etc.
  • Opinions related to aquatic ecosystems and ground water: Subjective value of certain aquatic systems (e.g., for recreation); opinions on policies regarding aquatic ecosystems and ground-water reserves; etc.

Methods

Data gathering
  • Household surveys (cross-sectional, longitudinal, and time-series)
  • Surveys with experimental manipulations and Internet-based experiments
  • Campaigns and field experiments
  • Behavior observation and recording of conversations
Statistical analyses
  • Multivariate statistical modeling (e.g., regression analyses, also non-linear)
  • Mediator-moderator analyses (covariance-based and case-based)
  • Multi-level analyses

Psychological behavior change campaigns

Activities and Topics

The group dealing with behavior change campaigns compiles and applies psychological models and methods to planning and evaluating behavior change campaigns mainly in the water, sanitation, and hygiene sector and also mainly in developing countries. There are three main activities:

  • Planning, implementing, and evaluating campaigns:
    This activity comprises a) conducting qualitative formative research, b) a representative baseline survey on the target behavior and its psychological determinants, c) developing, designing, and pretesting of behavior change strategies, d) implementation at scale of behavior change strategies, and e) evaluation and monitoring of the effects of behavior change strategies on the behavior and it’s determinants.
  • Empirical investigation on effects of behavior change techniques:
    In this activity tests are conducted to secure the intended effect of behavior change techniques on psychological determinants. The result will be a systematic about which behavior change techniques can be used to change which behavioral determinant. This activity will entail more sophisticated, more parsimonious behavior change strategies with more enduring effects on behavior.
  • Selecting and combining components of psychological models:
    Well proven behavioral models from environmental, health, and social psychology are compiled to show practitioners which behavioral determinants have to be taken into account to explain behavior. Currently the group uses the RANAS Model (R(isk), A(ttitudes), N(orms), A(bilities), and S(elf-Regulation) of Mosler (2012, A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. International Journal of Environmental Health Research, 1-19.)

Methods

  • Data gathering with representative observations and surveys:
    Surveys in form of face-to-face interviews with formalized questionnaires are conducted. The sample size depends on the size of the targeted population and the sample is drawn randomly. Intensive interviewer training is needed to capacitate the interviewers to inquire psychological factors.
  • Field experiments:
    To measure the effects and effectiveness of behavior change techniques, different techniques are applied to groups and a control group is left unaffected. This is conducted in a naturalistic setting where people act in their normal daily life, by this we assure a maximum of validity of these experiments. To measure changes in behavior as well as in behavioral factors a panel survey is conducted, meaning that the same persons are interviewed in a baseline, mid-term, and in a final survey. To measure sustainable change an additional post-interventional survey should be conducted 6 or 12 months after the intervention.
  • Doer – Non-Doer data analysis:
    To determine which behavioral factors are most influential on the behavior one has to compare the non-performers and performers of the behavior. Therefore we simply calculate the mean for each behavioral factor for both groups (non-performers and performers). The biggest difference in the means between the two groups indicates which behavioral factors are most important for the performance of the behavior. Note that for this step, it is important that all variables are on the same scale (e.g. reaching from 0 to 4). For a more reliable statistical calculation regression analysis should be computed, which is more valid but requires some skills in statistics (for a short description see Mosler, 2012).

Teaching

Current modules

Jennifer Inauen teaches Module G1 (Health Behavior Change) in the Psychology Master’s program at the Distance Learning University of Switzerland:

http://fernuni.ch/psychologie/master/

Completed Projects

Monitoring and Evaluation of a Large Scale Hand-washing Campaign in India

The Great WASH Yatra
A user-driven sanitation (UDS) project in Kampala’s urban slums aimed to increase shared toilet users’ cleaning behavior.

Shared toilet cleaning in Uganda
This project aimed at improving the effectiveness of an information intervention to promote the use of existing safe water options with theory-based and evidence-based behaviour change techniques.

Promoting arsenic-safe water consumption in Bangladesh
The present study designed and evaluated several promotion strategies for solar water disinfection (SODIS), based on results from a baseline survey.

Long-term use of solar water disinfection in Zimbabwe
Altering subjective perceptions of facts like prices or walking distances can change behavior even without changing objective circumstances.

Community fluoride filter in Ethiopia
A handwashing promotion project in the Borena Zone of southern Ethiopia aimed to increase handwashing rates in communities through systematic behavior change strategies.

Changing handwashing behavior in southern Ethiopia
This project aimed to investigate factors explaining the (regular) use of safe water kiosks in three Kenyan communities.

Explaining the use of safe water kiosks in Kenya
This project in post-earthquake Haiti aimed to evaluate the impact of public health promotions and cholera response on handwashing rates.

Handwashing behavior in post-earthquake Haiti
The aim of this study is to develop and deliver effective behavior change strategies promoting hygiene practices towards the prevention of cholera and diarrheal diseases.

WaSH interventions for cholera prevention in the Lake Chad Basin
The global aim of the study is the identification of evidence based behavior change techniques concerning water consumption, sanitation and hygiene practices.

WaSH situation for rural families in Burundi
The goal of the project is to design, implement and evaluate Behaviour Change Campaigns on Hand Washing

Handwashing Campaigns in Burundi and Zimbabwe
The objective of this study is to find out the relevant socio-psychological factors of behavior intentions related to the prevention of an Ebola outbreak and hand washing with soap in vulnerable areas

Ebola prevention activities in The Gambia and Guinea-Bissau
The objective of this study is to gain information about the current situation with regard to the population’s knowledge about Ebola to take action towards the promotion of prevention behaviors.

Ebola prevention in Guinea-Bissau
This study aims at developing and testing evidence-based behavior change strategies to alter purchasing and use of sanitation facilities as well as handwashing practices in two main suburbs of Dakar.

Sanitation and Hygiene Situation in periurban regions in Senegal

Group members

Team

Group Leaders

Team

Publications

2019

The role of social identification for achieving an open-defecation free environment: a cluster-randomized, controlled trial of community-led total sanitation in Ghana

Unsafe sanitation practices are a major source of environmental pollution and are a leading cause of death in countries of the Global South. One of the most successful campaigns to eradicate open defecation is "Community-Led Total Sanitation" (CLTS). It aims at shifting social norms towards safe sanitation practices. However, the effectiveness of CLTS is heterogeneous. Based on social identity theory, we expect CLTS to be most effective in communities with stronger social identification, because in these communities individuals should rather follow social norms. We conducted a cluster-randomized controlled trial with 3,216 households in 132 communities in Ghana, comparing CLTS to a control arm. Self-reported open defecation rates and social identification were assessed pre-post. Generalized Estimating Equations showed that CLTS achieved lower open defecation rates compared to controls. This effect was significantly stronger for communities with stronger average social identification. The results confirm the assumptions of social identity theory. They imply that pre-existing social identification needs to be considered for planning CLTS, and strengthened beforehand if needed.
Harter, M.; Contzen, N.; Inauen, J. (2019) The role of social identification for achieving an open-defecation free environment: a cluster-randomized, controlled trial of community-led total sanitation in Ghana, Journal of Environmental Psychology, 66, 101360 (8 pp.), doi:10.1016/j.jenvp.2019.101360, Institutional Repository

The link between mental health and safe drinking water behaviors in a vulnerable population in rural Malawi

Background: Mental disorders, particularly depression and post-traumatic stress disorder, are common long-term psychological outcomes in emergency contexts arising from conflicts, natural disasters, and other challenging environmental conditions. In emergencies, people suffer not only from the lack of external resources such as drinking water and food but also from poor mental health. Mental disorders can substantially impair daily activities in vulnerable individuals. However, water, sanitation, and hygiene (WASH) behaviors are daily activities that require effort, time, and strong internal motivation. Therefore, questions arise: whether there is a relationship between mental health and safe water behaviors, and if so, whether the motivational drivers of these behaviors are affected by mental health.
Methods: Our cross-sectional study conducted face-to-face interviews with 638 households in rural Malawi. We used a quantitative questionnaire based on the risks, attitudes, norms, abilities, and self-regulation (RANAS) approach to measure motivational psychosocial factors. Mental health was assessed using the validated Chichewa version of the Self-Reporting Questionnaire (SRQ-20). Results. Almost a third of the respondents reported poor mental health. We found significant negative association between mental health and self-reported safe water collection (p = .01, r = −.104) but not between safe water transportation and storage behavior. The moderation analysis revealed significant interaction effects of mental health with some psychosocial factors and therefore on WASH behaviors. Poor mental health changed the influence of three psychosocial factors—perceived others’ behavior, commitment, and remembering—on safe drinking water collection behavior. The influence on water transportation and storage behavior of the perceived severity of contracting a disease, the belief that transporting and storing water requires substantial effort, and others’ approval depended on the mental health condition of the respondent.
Conclusions: These results imply that populations with a significant proportion of individuals with poor mental health will benefit from interventions to mitigate mental health before or parallel to behavioral change interventions for WASH. Specific population-level interventions have been shown to have a positive effect on mental well-being, and they have been successfully applied at scale. This research is especially relevant in emergency contexts, as it indicates that mental health measures before any WASH interventions will make them more effective.
Slekiene, J.; Mosler, H.-J. (2019) The link between mental health and safe drinking water behaviors in a vulnerable population in rural Malawi, BMC Psychology, 7, 44 (14 pp.), doi:10.1186/s40359-019-0320-1, Institutional Repository

Toward complementary food hygiene practices among child caregivers in rural Malawi

Despite being preventable, foodborne diseases remain a global health challenge. Poor food hygiene practices such as improper handling of kitchen utensils are among the major causes of diarrhea transmission. A formative study was conducted in Malawi to inform an intervention design to promote complementary food hygiene practices. An assessment of contextual and psychosocial factors for behavior change was conducted using Risk, Attitude, Norms, Ability, and Self-regulation model. We conducted 323 household surveys with caregivers of children aged 6 to 24 months. Analysis of variance was used to estimate difference between doers and non-doers of three targeted behaviors: washing utensils with soap, keeping utensils on a raised place, and handwashing with soap. Analysis of variance analyses revealed that literacy level, ownership of animals, and presence of handwashing facility and dish racks were contextual factors predicting storage of utensils on an elevated place and handwashing frequencies. Psychosocial factors, such as time spent to wash utensils with soap, distance to the handwashing facility, and cost for soap, had an influence on washing utensils and handwashing practices. Perceived vulnerability determined effective handwashing and storage of utensils. Perceived social norms and ability estimates were favorable for the three targeted behaviors. Promotion of already existing targeted beneficial behaviors should be encouraged among caregivers. Risk perceptions on storage of utensils and handwashing practices should be increased with motivational exercises such as paint games. Caregivers’ technical know-how of local dish rack and tippy tap construction is essential.
Chidziwisano, K.; Slekiene, J.; Kumwenda, S.; Mosler, H.-J.; Morse, T. (2019) Toward complementary food hygiene practices among child caregivers in rural Malawi, American Journal of Tropical Medicine and Hygiene, 101(2), 294-303, doi:10.4269/ajtmh.18-0639, Institutional Repository

The impact of various promotional activities on Ebola prevention behaviors and psychosocial factors predicting Ebola prevention behaviors in the Gambia evaluation of Ebola prevention promotions

The outbreak of the Ebola virus disease (EVD) from 2014 to 2016 is over. However, several outbreaks of contagious diseases have already arisen and will recur. This paper aims to evaluate the effectiveness of EVD prevention promotions in the Gambia and to assess the psychosocial factors that steer three behaviors: handwashing with soap, calling the Ebola Hotline, and not touching a person who might be suffering from EVD. In 2015, data were gathered from 498 primary care providers. The questionnaire was based on psychosocial factors from the risks, attitudes, norms, abilities, and self-regulation (RANAS) model. Three promotional activities were significantly associated with psychosocial factors of handwashing and, thus, with increased handwashing behavior: the home visit, posters, and info sheets. Norm factors, especially the perception of what other people do, had a great impact on handwashing with soap and on calling the Ebola Hotline. The perceived certainty that a behavior will prevent a disease was a predictor for all three protection behaviors. Commitment to the behavior emerged as especially relevant for the intention to call the Ebola Hotline and for not touching a person who might be suffering from EVD. Health behavior change programs should rely on evidence to target the right psychosocial factors and to maximize their effects on prevention behaviors, especially in emergency contexts.
Gamma, A. E.; Slekiene, J.; Mosler, H.-J. (2019) The impact of various promotional activities on Ebola prevention behaviors and psychosocial factors predicting Ebola prevention behaviors in the Gambia evaluation of Ebola prevention promotions, International Journal of Environmental Research and Public Health, 16(11), 2020 (18 pp.), doi:10.3390/ijerph16112020, Institutional Repository

Factors associated with levels of latrine completion and consequent latrine use in Northern Ghana

Open defecation is still a major health problem in developing countries. While enormous empirical research exists on latrine coverage, little is known about households' latrine construction and usage behaviours. Using field observation and survey data collected from 1523 households in 132 communities in northern Ghana after 16 months of implementation of Community Led Total Sanitation (CLTS), this paper assessed the factors associated with latrine completion and latrine use. The survey tool was structured to conform to the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) model. In the analysis, we classified households into three based on their latrine completion level, and conducted descriptive statistics for statistical correlation in level of latrine construction and latrine use behaviour. The findings suggest that open defecation among households reduces as latrine construction approaches completion. Although the study did not find socio-demographic differences of household to be significantly associated with level of latrine completion, we found that social context is a significant determinant of households' latrine completion decisions. The study therefore emphasises the need for continuous sensitisation and social marketing to ensure latrine completion by households at lower levels of construction, and the sustained use of latrines by households.
Nunbogu, A. M.; Harter, M.; Mosler, H.-J. (2019) Factors associated with levels of latrine completion and consequent latrine use in Northern Ghana, International Journal of Environmental Research and Public Health, 16(6), 920 (18 pp.), doi:10.3390/ijerph16060920, Institutional Repository

Role of implementation factors for the success of community-led total sanitation on latrine coverage. A case study from rural Ghana

Community-led total sanitation (CLTS) is an approach to improving sanitation to combat open defecation (OD). OD is a health threat to children under five. CLTS promotes the construction of latrines with the goal of declaring communities open defecation free. However, which factors of the implementation process are most important for the success has yet to be ascertained. The analysed sample comprised of 94 communities in rural Ghana, where CLTS was implemented and factors describing the implementation process of CLTS were assessed. Additionally, monitoring data from the implementation process were used. Multiple regression analysis revealed that latrine coverage was significantly related to attendance at the CLTS meeting, the number of supportive community leaders, the expectation of participants of receiving an incentive, and the number of follow-up visits. Implementers of CLTS should direct their attention to the processes following the community meeting. The success of CLTS can be improved by investing in follow-up visits, the support of local leaders, and the careful application of incentives.
Harter, M.; Lilje, J.; Mosler, H.-J. (2019) Role of implementation factors for the success of community-led total sanitation on latrine coverage. A case study from rural Ghana, Environmental Science and Technology, 53, 5466-5472, doi:10.1021/acs.est.9b01055, Institutional Repository

2018

Enhancing handwashing frequency and technique of primary caregivers in Harare, Zimbabwe: a cluster-randomized controlled trial using behavioral and microbial outcomes

Rationale: Consistent hand hygiene prevents diarrheal and respiratory diseases, but it is often not practiced. The disease burden is highest in low-income settings, which need effective interventions to promote domestic handwashing. To date, most handwashing campaigns have focused on promoting frequent handwashing at key times, whereas specifically promoting handwashing techniques proven to be effective in removing microbes has been confined to healthcare settings.
Methods: We used a cluster-randomized, factorial, controlled trial to test the effects of two handwashing interventions on the behavior of primary caregivers in Harare, Zimbabwe. One intervention targeted caregivers directly, and the other targeted them through their children. Outcome measures were surveyed at baseline and six weeks’ follow-up and included observed handwashing frequency and technique and fecal hand contamination before and after handwashing.
Results: Combining the direct and indirect interventions resulted in observed handwashing with soap at 28% of critical handwashing times, while the corresponding figure for the non-intervention control was 5%. Observed handwashing technique, measured as the number of correctly performed handwashing steps, increased to an average of 4.2, while the control averaged 3.4 steps. Demonstrated handwashing technique increased to a mean of 6.8 steps; the control averaged 5.2 steps. No statistically significant group differences in fecal hand contamination before or after handwashing were detected.
Conclusions: The results provide strong evidence that the campaign successfully improved handwashing frequency and technique. It shows that the population-tailored design, based on social-cognitive theory, provides effective means for developing powerful interventions for handwashing behavior change. We did not find evidence that children acted as strong agents of handwashing behavior change. The fact that the microbial effectiveness of handwashing did not improve despite strong improvements in handwashing technique calls for critical evaluation of existing handwashing recommendations. The aim of future handwashing campaigns should be to promote both frequent and effective handwashing.
Friedrich, M. N. D.; Kappler, A.; Mosler, H.-J. (2018) Enhancing handwashing frequency and technique of primary caregivers in Harare, Zimbabwe: a cluster-randomized controlled trial using behavioral and microbial outcomes, Social Science and Medicine, 196, 66-76, doi:10.1016/j.socscimed.2017.10.025, Institutional Repository

Characterizing the last latrine nonowners in rural Malawi

Open defecation is a public health problem worldwide. NGOs in developing countries use various approaches to increase latrine coverage, but for little-understood reasons, some of the population does not adopt latrine construction. The objective of our research was to uncover which of the factors predicting latrine construction are relevant to the last nonowners of latrines, termed laggards in the diffusion of innovations theory. In a cross-sectional study, quantitative face-to-face interviews were conducted in households in rural Malawi (N = 824) to assess the behavioral determinants of latrine construction, mental health, and leadership. Around 14% of the households interviewed did not own a latrine. Study results suggest that nonowners have limited economic resources and perceive that latrine construction is expensive, that it is difficult to find money for latrine construction, and that it needs a lot of time and effort. The last nonowners of latrines live in smaller groups than latrine owners, communicate less with others about latrine construction, and are less influenced by the opinion of their leaders. They consist, in particular, of socially vulnerable households, are younger, are less educated, often have more impaired mental health, feel more vulnerable to contracting diseases, are less aware of the latrine construction of others in the village, feel less personally obliged to construct their own latrines, and are less confident in their ability to rebuild latrines damaged by flooding. The study confirmed that the assumptions of the diffusion of innovation theory are useful in combination with the risks, attitudes, norms, abilities, and self-regulation behavior change approach for developing evidence-based behavior change strategies in developing countries.
Slekiene, J.; Mosler, H.-J. (2018) Characterizing the last latrine nonowners in rural Malawi, American Journal of Tropical Medicine and Hygiene, 98(1), 295-299, doi:10.4269/ajtmh.17-0578, Institutional Repository

Escherichia coli contamination across multiple environmental compartments (soil, hands, drinking water, and handwashing water) in urban Harare: correlations and risk factors

Escherichia coli pathotypes (i.e., enteropathogenic and enterotoxigenic) have been identified among the pathogens most responsible for moderate-to-severe diarrhea in low- and middle-income countries (LMICs). Pathogenic E. coli are transmitted from infected human or animal feces to new susceptible hosts via environmental reservoirs such as hands, water, and soil. Commensal E. coli, which includes nonpathogenic E. coli strains, are widely used as fecal bacteria indicator, with their presence associated with increased likelihood of enteric pathogens and/or diarrheal disease. In this study, we investigated E. coli contamination in environmental reservoirs within households (N = 142) in high-population density communities of Harare, Zimbabwe. We further assessed the interconnectedness of the environmental compartments by investigating associations between, and household-level risk factors for, E. coli contamination. From the data we collected, the source and risk factors for E. coli contamination are not readily apparent. One notable exception is the presence of running tap water on the household plot, which is associated with significantly less E. coli contamination of drinking water, handwashing water, and hands after handwashing. In addition, E. coli levels on hands after washing are significantly associated with handwashing water contamination, hand contamination before washing, and diarrhea incidence. Finally, we observed that animal ownership increases E. coli contamination in soil, and E. coli in soil are correlated with contamination on hands before washing. This study highlights the complexity of E. coli contamination in household environment within LMICs. More, larger, studies are needed to better identify sources and exposure pathways of E. coli—and enteric pathogens generally—to identify effective interventions.
Navab-Daneshmand, T.; Friedrich, M. N. D.; Gächter, M.; Montealegre, M. C.; Mlambo, L. S.; Nhiwatiwa, T.; Mosler, H.-J.; Julian, T. R. (2018) Escherichia coli contamination across multiple environmental compartments (soil, hands, drinking water, and handwashing water) in urban Harare: correlations and risk factors, American Journal of Tropical Medicine and Hygiene, 98(3), 803-813, doi:10.4269/ajtmh.17-0521, Institutional Repository

How does community-led total sanitation (CLTS) affect latrine ownership? A quantitative case study from Mozambique

Background: Community-led total sanitation (CLTS) is a widely used, community-based approach to tackle open defecation and its health-related problems. Although CLTS has been shown to be successful in previous studies, little is known about how CLTS works. We used a cross-sectional case study to identify personal, physical, and social context factors and psychosocial determinants from the Risks, Attitudes, Norms, Abilities, and Self-Regulation (RANAS) model of behavior change, which are crucial for latrine ownership and analyze how participation in CLTS is associated with those determinants.

Methods: Structured interviews were conducted with 640 households in 26 communities, where CLTS had been completed before and compared to 6 control communities, all located in northern Mozambique in 2015. To identify crucial factors for latrine ownership, logistic regression analysis were conducted and mediation analysis were used to analyse the relationship between CLTS participation and latrine ownership mediated by factors identified by the logistic regression analyses.

Results: Mediation analysis reveal that the relationship of CLTS participation with probability of owning a latrine is mediated by social context factors and psychosocial determinants. Data analysis reveal that the probability of building a latrine depends on existing social context factors within the village, the behavior of others in the community, the (dis)approval of others of latrine ownership, personal self-confidence in latrine building, and a precise communication of the benefits of latrine ownership during a CLTS triggering event.

Conclusions: By including activities to focus on the mentioned factors, CLTS could be improved. Exemplary adaptations are discussed.
Harter, M.; Mosch, S.; Mosler, H.-J. (2018) How does community-led total sanitation (CLTS) affect latrine ownership? A quantitative case study from Mozambique, BMC Public Health, 18, 387 (10 pp.), doi:10.1186/s12889-018-5287-y, Institutional Repository

Effects of a behavior change campaign on household drinking water disinfection in the Lake Chad basin using the RANAS approach

Worldwide, an estimated 700 million people rely on unimproved drinking water sources; even more consume water that is not safe to drink. Inadequate drinking water quality constitutes a major risk factor for cholera and other diarrheal diseases around the globe, especially for young children in developing countries. Household water treatment and safe storage systems represent an intermediate solution for settings that lack infrastructure supplying safe drinking water. However, the correct and consistent usage of such treatment technologies rely almost exclusively on the consumer's behavior.
This study targeted at evaluating effects of a behavior change campaign promoting the uptake of household drinking water chlorination in communities along the Chari and Logone rivers in Chad. The campaign was based on formative research using health psychological theory and targeted several behavioral factors identified as relevant. A total of 220 primary caregivers were interviewed concerning their household water treatment practices and mindset related to water treatment six months after the campaign. The Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model was used to structure the interviews as the RANAS approach had been used for designing the campaign.
Results show significantly higher self-reported drinking water chlorination among participants of the intervention. Significant differences from a control group were identified regarding several behavioral factors. Mediation analysis revealed that the intervention positively affected participants' individual risk estimation for diarrheal disease, health knowledge, perceived efforts and benefits of water treatment, social support strategies, knowledge of how to perform chlorination, and perceived ability to do so. The campaign's effect on water treatment was mainly mediated through differences in health knowledge, changes in norms, and self-efficacy convictions. The findings imply that water treatment behavior can be successfully promoted using health psychological theory. However, they also indicate opportunities for improvement in the campaign design and implementation.
Lilje, J.; Mosler, H.-J. (2018) Effects of a behavior change campaign on household drinking water disinfection in the Lake Chad basin using the RANAS approach, Science of the Total Environment, 619, 1599-1607, doi:10.1016/j.scitotenv.2017.10.142, Institutional Repository

Engagement of stakeholders in the development of a Theory of Change for handwashing and sanitation behaviour change

A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice.
De Buck, E.; Hannes, K.; Cargo, M.; Van Remoortel, H.; Vande veegaete, A.; Mosler, H.-J.; Govender, T.; Vandekerckhove, P.; Young, T. (2018) Engagement of stakeholders in the development of a Theory of Change for handwashing and sanitation behaviour change, International Journal of Environmental Health Research, 28(1), 8-22, doi:10.1080/09603123.2017.1415306, Institutional Repository

Is community-led total sanitation connected to the rebuilding of latrines? Quantitative evidence from Mozambique

To reduce open defecation, many implementers use the intervention strategies of Community-Led Total Sanitation (CLTS). But CLTS focuses on latrine construction and does not include latrine maintenance and repair damage or collapse. Some households rebuild their latrine while others return to open defecation. The reasons why are unknown. Using data from a cross-sectional survey, this article shows how physical, personal, and social context factors and psychosocial factors from the RANAS model are associated with CLTS participation, and how these factors connect to latrine rebuilding. In 2015, heavy rains hit the north of Mozambique and many latrines collapsed. Subsequently, 640 household interviews were conducted in the affected region. Logistic regression and mediation analyses reveal that latrine rebuilding depends on education, soil conditions, social cohesion, and a feeling of being safe from diarrhea, the perception that many other community members own a latrine, and high confidence in personal ability to repair or rebuild a broken latrine. The effect of CLTS is mediated through social and psychosocial factors. CLTS already targets most of the relevant factors, but can still be improved by including activities that would focus on other factors not yet sufficiently addressed.
Mosler, H.-J.; Mosch, S.; Harter, M. (2018) Is community-led total sanitation connected to the rebuilding of latrines? Quantitative evidence from Mozambique, PLoS One, 13(5), e0197483 (16 pp.), doi:10.1371/journal.pone.0197483, Institutional Repository

2017

Contextual and psychosocial determinants of effective handwashing technique: recommendations for interventions from a case study in Harare, Zimbabwe

Handwashing has been shown to considerably reduce diarrhea morbidity and mortality. To decontaminate hands effectively, the use of running water, soap, and various scrubbing steps are recommended. This study aims to identify the behavioral determinants of effective handwashing. Everyday handwashing technique of 434 primary caregivers in high-density suburbs of Harare, Zimbabwe, was observed and measured as an 8-point sum score of effective handwashing technique. Multiple linear and logistic regression analyses were performed to predict observed handwashing technique from potential contextual and psychosocial determinants. Knowledge of how to wash hands effectively, availability of a handwashing station with functioning water tap, self-reported frequency of handwashing, perceived vulnerability, and action planning were the main determinants of effective handwashing technique. The models were able to explain 39% and 36% of the variance in overall handwashing technique and thoroughness of handscrubbing. Memory aids and guided practice are proposed to consolidate action knowledge, and personalized risk messages should increase the perceived vulnerability of contracting diarrhea. Planning where, when, and how to maintain a designated place for handwashing with sufficient soap and water is proposed to increase action planning. Since frequent self-reported handwashing was associated with performing more effective handwashing technique, behavior change interventions should target both handwashing frequency and technique concurrently.
Friedrich, M. N. D.; Binkert, M. E.; Mosler, H.-J. (2017) Contextual and psychosocial determinants of effective handwashing technique: recommendations for interventions from a case study in Harare, Zimbabwe, American Journal of Tropical Medicine and Hygiene, 96(2), 430-436, doi:10.4269/ajtmh.16-0553, Institutional Repository

Socio-psychological determinants for safe drinking water consumption behaviors: a multi-country review

The effectiveness of household water treatment practices relies heavily on consumers' compliance. However, what is driving these behaviors from a health psychological perspective is not well understood. A review of studies on safe water collection, treatment, handling and storage practices was conducted to identify important socio-psychological determinants. The objectives are to show which determinants commonly explain safe water consumption practices and how well they do so, and to identify behavior- and population-specific determinants to be targeted in different contexts. The results of the review reveal that all the practices studied can be explained well, with a mean of 62% explained variance between performers and non-performers. Social norms, action knowledge, and perceived self-efficacy were shown to be the most common influential factors for safe water practices. Instrumental beliefs around costs and benefits as well as affective beliefs such as taste are important in a majority of cases but varied more strongly, both for different target behaviors and between specific settings and populations, and are thus to be evaluated from case to case. The review gives clear recommendations on which behavioral factors to address with priority and corresponding behavior change techniques to be made use of in contexts where formative research is not possible.
Lilje, J.; Mosler, H.-J. (2017) Socio-psychological determinants for safe drinking water consumption behaviors: a multi-country review, Journal of Water Sanitation and Hygiene for Development, 7(1), 13-24, doi:10.2166/washdev.2017.080, Institutional Repository

Contextual and psychosocial factors predicting Ebola prevention behaviours using the RANAS approach to behaviour change in Guinea-Bissau

Background: The outbreak of the Ebola virus disease (EVD) in West Africa in December 2013 was the largest Ebola outbreak in history. This study aimed to measure the underlying contextual and psychosocial factors of intentions to perform Ebola prevention behaviours (not touching people who might be suffering from Ebola, reporting suspected cases to the National Ebola Hotline, NEH) in Guinea-Bissau. Geographical location, cross-border market activities, poor water, sanitation and hygiene (WASH) conditions, and burial practices in some communities pose a serious risk in terms of potential EVD outbreak and seriously hamper its prevention in Guinea-Bissau.
Methods: In July and August 2015, quantitative data from 1369 respondents were gathered by structured faceto- face interviews. The questionnaire was based on the psychosocial factors of the RANAS (risks, attitudes, norms, abilities, and self-regulation) model. Data were analyzed by multiple linear regression analyses.
Results: The most important predictors for the intention to call the NEH were believing that calling the Hotline would help the infected person, perceiving that important members from the household approve of calling the Hotline, thinking that calling the Hotline is something they should do, and believing that it is important to call the Hotline to report a suspected case. For the intention not to touch someone who might be suffering from Ebola, the most important predictors were health knowledge, the perception of risk with regard to touching a person who might be suffering from Ebola, and the belief that they were able not to touch a possibly infected person. Age in years was the only significant contextual predictor for one of the two behavioural intentions, the intention to call the Hotline. It seems that younger people are more likely to use a service like the NEH than older people.
Conclusions: Strengths and gaps were identified in the study population in relation to the intention to perform prevention behaviours. These call for innovative ways of aligning existing hygiene programs with relevant psychosocial factors. This research is relevant to further outbreaks of contagious diseases as it sheds light on important aspects of the impact of public health interventions during emergencies and epidemics.
Gamma, A. E.; Slekiene, J.; von Medeazza, G.; Asplund, F.; Cardoso, P.; Mosler, H.-J. (2017) Contextual and psychosocial factors predicting Ebola prevention behaviours using the RANAS approach to behaviour change in Guinea-Bissau, BMC Public Health, 17, 446 (12 pp.), doi:10.1186/s12889-017-4360-2, Institutional Repository

Identifying behavioural determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe

Background
This article presents the development of a school handwashing programme in two different sub-Saharan countries that applies the RANAS (risk, attitudes, norms, ability, and self-regulation) systematic approach to behaviour change.
Methods
Interviews were conducted with 669 children enrolled in 20 primary schools in Burundi and 524 children in 20 primary schools in Zimbabwe. Regression analyses were used to assess the influence of the RANAS behavioural determinants on reported handwashing frequencies.
Results
The results revealed that, in both countries, a programme targeting social norms and self-efficacy would be most effective. In Burundi, raising the children’s perceived severity of the consequences of contracting diarrhoea, and in Zimbabwe, increasing the children’s health knowledge should be part of the programme.
Conclusions
The school handwashing programme should create awareness of the benefits of handwashing through educational activities, raise the children’s ability and confidence in washing hands at school through infrastructural improvements, and highlight the normality of washing hands at school through events and poster creation.
Seimetz, E.; Slekiene, J.; Friedrich, M. N. D.; Mosler, H.-J. (2017) Identifying behavioural determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe, BMC Research Notes, 10, 280 (9 pp.), doi:10.1186/s13104-017-2599-4, Institutional Repository

Improved latrine cleanliness through behaviour change and changes in quality of latrine construction: a longitudinal intervention study in rural Burundi

Latrine cleanliness increased in the intervention group compared to the control group (increase from 21 to 31 % of latrines classified as clean in intervention [N = 198] and decrease from 37 to 27 % in control [N = 91]). Improved habitual latrine cleaning lead to latrines being 3.5 times more likely to improve in observed latrine cleanliness (χ2 = 16.36, p < .001) and so did improvements in quality of latrine construction, eg households that had installed a lid were 7.39 times more likely to have a cleaner latrine (χ2 = 4.46, p < .05). Changes in psychosocial factors, namely forgetting, personal norm, satisfaction with cleanliness, explained much of the change in habitual latrine cleaning (adj. r2 = .46). Behaviour change interventions targeting psychosocial factors and quality of latrine construction seem promising to ensure clean and hygienic latrines.
Mosler, H.-J.; Sonego, I. L. (2017) Improved latrine cleanliness through behaviour change and changes in quality of latrine construction: a longitudinal intervention study in rural Burundi, International Journal of Environmental Health Research, 27(5), 355-367, doi:10.1080/09603123.2017.1373274, Institutional Repository

Handwashing, but how? Microbial effectiveness of existing handwashing practices in high-density suburbs of Harare, Zimbabwe

Background: Consistent domestic hand hygiene can reduce diarrhea-related morbidity and mortality and the spread of other communicable diseases. However, it remains uncertain which technique of handwashing is most effective and practicable during everyday life. The goal of this study is to determine how the handwashing technique, as performed in the daily life by the participants of this case study in Harare, Zimbabwe, influences microbial handwashing effectiveness.
Methods: Handwashing technique of 173 primary caregivers was observed in their homes and hand rinse samples were collected before and after handwashing. Samples were analyzed for Escherichia coli and total coliform concentrations. Generalized linear models were used to predict fecal hand contamination after washing from observed handwashing technique.
Results: Cleaning under fingernails, scrubbing the fingertips, using soap, and drying hands through rubbing on clothes or a clean towel statistically significantly reduced E coli contamination of hands after washing. Tap use, scrubbing fingertips, and rubbing hands on clothes to dry them statistically significantly reduced total coliform contamination.
Conclusions: Recommendations for effective and practicable domestic handwashing in Harare, Zimbabwe, should include performing specific handscrubbing steps (ie, cleaning under the fingernails and rubbing the fingertips), and soap and tap use. This calls for further research to develop behavior change interventions that explicitly promote effective handwashing technique at critical times.
Friedrich, M. N. D.; Julian, T. R.; Kappeler, A.; Nhiwatiwa, T.; Mosler, H.-J. (2017) Handwashing, but how? Microbial effectiveness of existing handwashing practices in high-density suburbs of Harare, Zimbabwe, American Journal of Infection Control, 45(3), 228-233, doi:10.1016/j.ajic.2016.06.035, Institutional Repository
De Buck, E.; Van Remoortel, H.; Hannes, K.; Govender, T.; Naidoo, S.; Avau, B.; Vande Veegaete, A.; Musekiwa, A.; Lutje, V.; Cargo, M.; Mosler, H. J.; Vandekerckhove, P.; Young, T. (2017) Promoting handwashing and sanitation behaviour change in low- and middle-income countries. A mixed-method systematic review, 505 p, Institutional Repository

2016

Effects of an awareness raising campaign on intention and behavioural determinants for handwashing

This article assesses the effectiveness of The Great WASH Yatra handwashing awareness raising campaign in India on changing visitors’ intention to wash hands with soap after using the toilet and the underlying behavioural determinants. Interviews based on the RANAS (Risk, Attitudes, Norms, Abilities, Self-regulation) model of behaviour change were conducted with 687 visitors before and after their visit to the campaign. Data showed that a campaign visit had little effect on the intention to wash hands with soap, even when comparing visitors who had actively participated in handwashing games with those who had not. After a campaign visit, knowledge about the benefits of washing hands had increased by almost half a standard deviation. A multiple linear regression analysis revealed that when considering all behavioural determinants change scores simultaneously, they were able to explain 57% of the variance in the intention change score. These findings suggest that substantively changing behaviour requires more than improving knowledge and emphasizing the importance of washing hands. Identifying the crucial behavioural determinants for handwashing may be an important first step in planning effective large-scale promotion programmes.
Seimetz, E.; Kumar, S.; Mosler, H. J. (2016) Effects of an awareness raising campaign on intention and behavioural determinants for handwashing, Health Education Research, 31(2), 109-120, doi:10.1093/her/cyw002, Institutional Repository

Overland transport of recreational boats as a spreading vector of zebra mussel Dreissena polymorpha

In aquatic ecosystems invasive species are among the most important threats to biodiversity worldwide. Understanding the dispersal mechanisms of aquatic invaders is very important for protection and management of vulnerable water bodies. Here we ask how recreational boats that are transported overland could contribute to the dispersal of invasive zebra mussels among lakes in Switzerland. Using a questionnaire sent to registered boat owners, we surveyed properties of transported boats and collected information on self-reported mussel fouling and transport activities of boat owners. We also sampled boat hulls at launching ramps and harbors for biofouling invertebrates. Boats that were kept seasonally or year-round in water were found to have high vector potential with mussel fouling rates of more than 40 %. However, only about 6 % of boats belonging to these groups were transported overland to other water bodies. Considering that approximately 100,000 recreational boats are registered in Switzerland, we estimated that every year around 1400 boats fouled with mussels are transported overland. Such boats pose a high risk of distributing zebra mussels between water bodies. Our results suggest that there is a considerable risk that recreational boats may spread new fouling species to all navigable water bodies within the study area. We speculate that one such species could be the quagga mussel, which has not yet invaded lakes in Switzerland. On a more positive note, our study has identified the group of high-risk boats so that possible control measures would only affect a relatively small number of boat owners.
de Ventura, L.; Weissert, N.; Tobias, R.; Kopp, K.; Jokela, J. (2016) Overland transport of recreational boats as a spreading vector of zebra mussel Dreissena polymorpha, Biological Invasions, 18(5), 1451-1466, doi:10.1007/s10530-016-1094-5, Institutional Repository

Erfolgskontrolle einer Bachrevitalisierung im urbanen Raum – das Beispiel Chriesbach

Im urbanen Gebiet zwischen den Zürcher Gemeinden Dübendorf und Wallisellen wurde der in den 70er-Jahren kanalisierte Chriesbach in exemplarischer Form revitalisiert. Ziel war es, nicht nur für die Natur, sondern auch für die Menschen einen Mehrwert zu schaffen. Das Erreichen dieser Ziele wurde wissenschaftlich evaluiert, wobei in diesem Artikel der Fokus auf der Wirkung der Revitalisierung auf die Anwohnenden liegt. Eine repräsentative Stichprobe von Anwohnenden wurde sowohl vor als auch nach den Baumassnahmen befragt. Neben direkten Fragen z.B. nach der Zufriedenheit wurden auch aus umweltpsychologischen Theorien abgeleitete Grössen erhoben, um Auswirkungen für die Anwohnenden einzuschätzen. Die Resultate zeigen, dass die Anwohnenden nach der Revitalisierung mit verschiedenen Aspekten des Bachs zufriedener sind und sich stärker positiv mit dem Bach verbunden fühlen. Sie nehmen ihn als Ort wahr, der die Erholung fördert, und sie fühlen sich nach einem Aufenthalt am Bach auch erholter. Aus genaueren Analysen geht aber auch hervor, dass Veränderungen an sich negative Wirkungen haben können, auch wenn es sich um Veränderungen zum Guten handelt. Diese Studie zeigt exemplarisch das Potenzial und die Notwendigkeit, Gewässerrevitalisierungen auch sozialwissenschaftlich zu begleiten.
von Lindern, E.; Schirmer, M.; Lichtensteiger, T.; Bryner, A.; Tobias, R. (2016) Erfolgskontrolle einer Bachrevitalisierung im urbanen Raum – das Beispiel Chriesbach, Wasser, Energie, Luft, 108(1), 63-69, Institutional Repository

The influence of contextual and psychosocial factors on handwashing

Even though washing hands with soap is among the most effective measures to reduce the risk of infection, handwashing rates in infrastructure-restricted settings remain seriously low. Little is known about how context alone and in interaction with psychosocial factors influence hand hygiene behavior. The aim of this article was to explore how both contextual and psychosocial factors affect handwashing practices. A cross-sectional survey was conducted with 660 caregivers of primary school children in rural Burundi. Hierarchical regression analyses revealed that household wealth, the amount of water per person, and having a designated place for washing hands were contextual factors significantly predicting handwashing frequency, whereas the contextual factors, time spent collecting water and amount of money spent on soap, were not significant predictors. The contextual factors explained about 13% of the variance of reported handwashing frequency. The addition of the psychosocial factors to the regression model resulted in a significant 41% increase of explained variation in handwashing frequency. In this final model, the amount of water was the only contextual factor that remained a significant predictor. The most important predictors were a belief of self-efficacy, planning how, when, and where to wash hands, and always remembering to do so. The findings suggest that contextual constraints might be perceived rather than actual barriers and highlight the role of psychosocial factors in understanding hygiene behaviors.
Seimetz, E.; Boyayo, A.-M.; Mosler, H.-J. (2016) The influence of contextual and psychosocial factors on handwashing, American Journal of Tropical Medicine and Hygiene, 94(6), 1407-1417, doi:10.4269/ajtmh.15-0657, Institutional Repository

Continuation of health behaviors: psychosocial factors sustaining drinking water chlorination in a longitudinal study from Chad

Behavior that has changed following promotion campaigns is usually not maintained at its initial level. Psychosocial factors for initiating behavior are often not the same as for the continuation of health behaviors such as water treatment and are much less understood. Better knowledge of factors for behavioral continuation would help to improve programs, both in the design of strategies for sustainable behavior change and by defining stronger criteria for the evaluation of sustainability. This study compared the mindsets of caregivers who continuously performed household drinking water treatment over time with individuals that stopped doing so in a population sample from Chad. Several factors from health psychology based on the Risks, Attitudes, Norms, Abilities, and Self-Regulation (RANAS) model were used to compare the two groups and examine their differing development. Normative factors such as others’ behavior, personal obligation, social support and discourse, perceived self-efficacy convictions, action control, and intention best discriminated between the two groups and developed significantly more positively over time for continuers of water treatment. These factors should be considered when designing future interventions intended to lead to sustainable behavior change.
Lilje, J.; Mosler, H.-J. (2016) Continuation of health behaviors: psychosocial factors sustaining drinking water chlorination in a longitudinal study from Chad, Sustainability, 8(11), 1149 (20 pp.), doi:10.3390/su8111149, Institutional Repository

Spot-checks to measure general hygiene practice

A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers’ cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.
Sonego, I. L.; Mosler, H.-J. (2016) Spot-checks to measure general hygiene practice, International Journal of Environmental Health Research, 26(5-6), 554-571, doi:10.1080/09603123.2016.1217314, Institutional Repository

Behavioral determinants of switching to arsenic-safe water wells: an analysis of a randomized controlled trial of health education interventions coupled with water arsenic testing

More than 100 million people globally are estimated to be exposed to arsenic in drinking water that exceeds the World Health Organization guideline of 10 μg/L. In an effort to develop and test a low-cost sustainable approach for water arsenic testing in Bangladesh, we conducted a randomized controlled trial which found arsenic educational interventions when combined with fee-based water arsenic testing programs led to nearly all households buying an arsenic test for their drinking water sources (93%) compared with only 53% when fee-based arsenic testing alone was offered. The aim of the present study was to build on the findings of this trial by investigating prospectively the psychological factors that were most strongly associated with switching to arsenic-safe wells in response to these interventions. Our theoretical framework was the RANAS (risk, attitude, norm, ability, and self-regulation) model of behavior change. In the multivariate logistic regression model of 285 baseline unsafe well users, switching to an arsenic-safe water source was significantly associated with increased instrumental attitude (odds ratio [OR] = 9.12; 95% confidence interval [CI] = [1.85, 45.00]), descriptive norm (OR = 34.02; 95% CI = [6.11, 189.45]), coping planning (OR = 11.59; 95% CI = [3.82, 35.19]), and commitment (OR = 10.78; 95% CI = [2.33, 49.99]). In addition, each additional minute from the nearest arsenic-safe drinking water source reduced the odds of switching to an arsenic-safe well by more than 10% (OR = 0.89; 95% CI = [0.87, 0.92]). Future arsenic mitigation programs should target these behavioral determinants of switching to arsenic-safe water sources.
George, C. M.; Inauen, J.; Perin, J.; Tighe, J.; Hasan, K.; Zheng, Y. (2016) Behavioral determinants of switching to arsenic-safe water wells: an analysis of a randomized controlled trial of health education interventions coupled with water arsenic testing, Health Education and Behavior, 44(1), 1-11, doi:10.1177/1090198116637604, Institutional Repository

mHealth: past success, future challenges, and the role of the EHPS

Mobile technologies have great potential to extend the reach and effectiveness of health behaviour change interventions, and while a number of important developments have been realised, mHealth research remains in its infancy. As the EHPS is already quite active in mHealth research, it is well-placed to lead from the front on future innovations in the area. At the 2015 EHPS SYNERGY Expert Meeting, our group examined the past, present and future of mHealth. This piece provides an overview of our discussions and offers guidance to EHPS members, including a summary of early successes within mHealth, promising avenues for ongoing research, and research challenges to address that could revolutionize the science and practice of behaviour change.
Knittle, K.; Morrison, L.; Inauen, J.; Warner, L. M.; Kassavou, K.; Naughton, F.; Michie, S. (2016) mHealth: past success, future challenges, and the role of the EHPS, European Health Psychologist, 18(6), 266-272, Institutional Repository

2015

Identifying the psychological determinants of handwashing: results from two cross-sectional questionnaire studies in Haiti and Ethiopia

Background: Diarrheal disease kills around 760,000 infants every year. Many of these deaths could have been prevented by handwashing with soap. However, the whole range of psychological factors encouraging handwashing is not yet identified and handwashing campaigns are often limited to awareness-raising and education. The purpose of this article was to identify the psychological determinants of handwashing in Haiti (study 1) and Ethiopia (study 2).
Methods: Data were collected cross-sectionally by administering face-to-face interviews with the primary caregiver in a participating household (NHaiti = 811; NEthiopia = 463). Hierarchical multiple regression analyses were performed on self-reported handwashing.
Results: In both countries, risk factors—meaning awareness and health knowledge—accounted for only 11%-19% of variance in handwashing and were not consistently associated with handwashing. The inclusion of additional factor-groups, namely attitude, norm, ability, and self-regulation factors, led to significant increases in explained variance (P ≤ .01), accounting for 25%-44% of additionally explained variance. The attitude factor disgust, the norm factor, the ability factors motivational self-efficacy and perceived impediments, and the self-regulation factors coping planning and commitment emerged as especially relevant.
Conclusions: Handwashing campaigns should focus especially on attitudes and norms and not only on risk.
Contzen, N.; Mosler, H.-J. (2015) Identifying the psychological determinants of handwashing: results from two cross-sectional questionnaire studies in Haiti and Ethiopia, American Journal of Infection Control, 43(8), 826-832, doi:10.1016/j.ajic.2015.04.186, Institutional Repository

Factors determining water treatment behavior for the prevention of cholera in Chad

Cholera is a well-known and feared disease in developing countries, and is linked to high rates of morbidity and mortality. Contaminated drinking water and the lack of sufficient treatment are two of the key causes of high transmission rates. This article presents a representative health survey performed in Chad to inform future intervention strategies in the prevention and control of cholera. To identify critical psychological factors for behavior change, structured household interviews were administered to N = 1,017 primary caregivers, assessing their thoughts and attitudes toward household water treatment according to the Risk, Attitude, Norm, Ability, and Self-regulation model. The intervention potential for each factor was estimated by analyzing differences in means between groups of current performers and nonperformers of water treatment. Personal risk evaluation for diarrheal diseases and particularly for cholera was very low among the study population. Likewise, the perception of social norms was found to be rather unfavorable for water treatment behaviors. In addition, self-reported ability estimates (self-efficacy) revealed some potential for intervention. A mass radio campaign is proposed, using information and normative behavior change techniques, in combination with community meetings focused on targeting abilities and personal commitment to water treatment.
Lilje, J.; Kessely, H.; Mosler, H.-J. (2015) Factors determining water treatment behavior for the prevention of cholera in Chad, American Journal of Tropical Medicine and Hygiene, 93(1), 57-65, doi:10.4269/ajtmh.14-0613, Institutional Repository

Contextual and sociopsychological factors in predicting habitual cleaning of water storage containers in rural Benin

Recontamination of drinking water occurring between water collection at the source and the point of consumption is a current problem in developing countries. The household drinking water storage container is one source of contamination and should therefore be cleaned regularly. First, the present study investigated contextual factors that stimulate or inhibit the development of habitual cleaning of drinking water storage containers with soap and water. Second, based on the Risk, Attitudes, Norms, Abilities, and Self-regulation (RANAS) Model of behavior, the study aimed to determine which sociopsychological factors should be influenced by an intervention to promote habitual cleaning. In a cross-sectional study, 905 households in rural Benin were interviewed by structured face-to-face interviews. A forced-entry regression analysis was used to determine potential contextual factors related to habitual cleaning. Subsequently, a hierarchical regression was conducted with the only relevant contextual factor entered in the first step (R2 = 6.7%) and the sociopsychological factors added in the second step (R2 = 62.5%). Results showed that households using a clay container for drinking water storage had a significantly weaker habit of cleaning their water storage containers with soap and water than did households using other types of containers (β = −0.10). The most important sociopsychological predictors of habitual cleaning were commitment (β = 0.35), forgetting (β = −0.22), and self-efficacy (β = 0.14). The combined investigation of contextual and sociopsychological factors proved beneficial in terms of developing intervention strategies. Possible interventions based on these findings are recommended.
Stocker, A.; Mosler, H.-J. (2015) Contextual and sociopsychological factors in predicting habitual cleaning of water storage containers in rural Benin, Water Resources Research, 51(4), 2000-2008, doi:10.1002/2014WR016005, Institutional Repository

Changing handwashing behaviour in southern Ethiopia: a longitudinal study on infrastructural and commitment interventions

Improved hand hygiene efficiently prevents the major killers of children under the age of five years in Ethiopia and globally, namely diarrhoeal and respiratory diseases. Effective handwashing interventions are thus in great demand. Evidence- and theory-based interventions, especially when matched to the target population's needs, are expected to perform better than common practice. To test this hypothesis, we selected two interventions drawing on a baseline questionnaire-study that applied the RANAS (Risk, Attitudes, Norms, Abilities, Self-regulation) approach and focused on the primary caregivers of households in four rural, water-scarce kebeles (smallest administrative units of Ethiopia) in southern Ethiopia (N=462). The two interventions were tested in combination with a standard education intervention in a quasi-experiment, as follows: kebele 1, education intervention, namely an f-diagram exercise, (n=23); kebele 2, education intervention and public-commitment (n=122); kebele 3, education intervention and tippy-tap-promotion (i.e. handwashing-station-promotion; n=150); kebele 4, education intervention, public-commitment and tippy-tap-promotion (n=113). In kebeles 3 and 4, nearly 100% of the households followed the promotion and invested material and time to construct for themselves a tippy-tap. Three months after intervention termination, the tippy-taps were in use with water and soap being present in up to 83% of the households (kebele 4). Pre-post data analysis on self-reported handwashing revealed that the population-tailored interventions, and especially the tippy-tap-promotion, performed better than the standard education intervention. Tendencies in observed behaviour and a recently developed implicit self-measure pointed to similar results. Changing people's hand hygiene is known to be a challenging task, especially in a water-scarce environment. The present project suggests not only to apply theory and evidence to improve handwashing interventions' effectiveness, but also emphasizes the relevance of tailoring interventions to the target population.
Contzen, N.; Meili, I. H.; Mosler, H.-J. (2015) Changing handwashing behaviour in southern Ethiopia: a longitudinal study on infrastructural and commitment interventions, Social Science and Medicine, 124, 103-114, doi:10.1016/j.socscimed.2014.11.006, Institutional Repository

Over-reporting in handwashing self-reports: potential explanatory factors and alternative measurements

Handwashing interventions are a priority in development and emergency aid programs. Evaluation of these interventions is essential to assess the effectiveness of programs; however, measuring handwashing is quite difficult. Although observations are considered valid, they are time-consuming and cost-ineffective; self-reports are highly efficient but considered invalid because desirable behaviour tends to be over-reported. Socially desirable responding has been claimed to be the main cause of inflated self-reports, but its underlying factors and mechanisms are understudied. The present study investigated socially desirable responding and additional potential explanatory factors for over-reported handwashing to identify indications for measures which mitigate over-reporting. Additionally, a script-based covert recall, an alternative interview question intended to mitigate recall errors and socially desirable responding, was developed and tested. Cross-sectional data collection was conducted in the Borena Zone, Ethiopia, through 2.5-hour observations and 1-hour interviews with the primary caregivers in households. A total sample of N = 554 was surveyed. Data were analysed with correlation and multiple regression analyses and dependent t-tests. Over-reporting of handwashing was associated with factors assumed to be involved in (1) socially desirable responding, (2) encoding and recall of information, and (3) dissonance processes. The latter two factor groups explained over-reported handwashing beyond socially desirable responding. The alternative interview question—script-based covert recall—reduced over-reporting compared to conventional self-reports. Although the difficulties involved in measuring handwashing by self-reports and observations are widely known, the present study is the first to investigate the factors which explain over-reporting of handwashing. This research contributes to the limited evidence base on a highly important subject: how to evaluate handwashing interventions efficiently and accurately.
Contzen, N.; De Pasquale, S.; Mosler, H.-J. (2015) Over-reporting in handwashing self-reports: potential explanatory factors and alternative measurements, PLoS One, 10(8), e0136445 (22 pp.), doi:10.1371/journal.pone.0136445, Institutional Repository

Social-cognitive factors mediating intervention effects on handwashing: a longitudinal study

Handwashing with soap effectively prevents diarrhoea, a leading cause of death in infants. Theory-based interventions are expected to promote handwashing more successfully than standard approaches. The present article investigates the underlying change processes of theory-based handwashing interventions. A nonrandomised field study compared a standard approach to two theory-based interventions that were tailored to the target population, the inhabitants of four villages in southern Ethiopia (N = 408). Data were collected before and after interventions by structured interviews and analysed by mediation analysis. In comparison to the standard approach (i.e., education only), education with public commitment and reminder was slightly more effective in changing social-cognitive factors and handwashing. Education with an infrastructure promotion and reminder was most effective in promoting handwashing through enhancing social-cognitive factors. The results confirm the relevance of testing interventions' underlying change processes.
Contzen, N.; Inauen, J. (2015) Social-cognitive factors mediating intervention effects on handwashing: a longitudinal study, Journal of Behavioral Medicine, 38(6), 956-969, doi:10.1007/s10865-015-9661-2, Institutional Repository

Opportunities and limits to market-driven sanitation services: evidence from urban informal settlements in East Africa

The improvement of sanitation conditions in slums(1) is difficult in part because of economic and institutional environments that often prevent private or public investment in infrastructure. This analysis of sanitation conditions in informal settlements in Nairobi and Kampala compares user practices. It also identifies the main actors involved in the provision of overlapping sanitation systems, involving a multitude of small-scale providers, along with the challenges these present. The paper goes on to describe a new market-based approach in Nairobi, developed by a social enterprise, Sanergy, which is responsible for the construction of facilities and the collection and treatment of wastes. The system improves user satisfaction, community wellbeing and environmental quality, pointing to a clear opportunity for such market-based interventions where a customer base already pays for sub-standard services. There remain challenges, however, around the ability to scale up and finance these providers, especially in complex operating environments that increase transactional costs for companies.
O’Keefe, M.; Lüthi, C.; Tumwebaze, I. K.; Tobias, R. (2015) Opportunities and limits to market-driven sanitation services: evidence from urban informal settlements in East Africa, Environment and Urbanization, 27(2), 421-440, doi:10.1177/0956247815581758, Institutional Repository

Slum inhabitants’ perceptions and decision-making processes related to an innovative sanitation service: evaluating the Blue Diversion Toilet in Kampala (Uganda)

The inadequate provision of sanitation in informal urban settlements, also known as slums, continues to be an important issue. New technologies and services are being designed to solve this problem. However, the history of failed sanitation programmes and projects highlights a lack of understanding of how slum inhabitants decide on investing in such products and services. In this paper, we gather perspectives from potential clients and investigate how slum inhabitants (1) perceive the current situation and whether they desire improvements of sanitation, (2) how they evaluate a new toilet that is still in development, and how (3) social processes and (4) constraints affect decisions. Data were collected through interviewing 1538 people within a general household survey. People using shared and public latrines desire an improvement of their sanitation facilities. The lack of water for washing is perceived by residents as a the biggest problem when accessing current latrines. The new toilet was mostly evaluated positively: people like it, expect large health benefits from it and it complies with cultural norms. However, people also expect some problems with the functioning of the toilet and expect opposition to pay for the service, due to the high costs and a lack of space to set up new toilets.
O’Keefe, M.; Messmer, U.; Lüthi, C.; Tobias, R. (2015) Slum inhabitants’ perceptions and decision-making processes related to an innovative sanitation service: evaluating the Blue Diversion Toilet in Kampala (Uganda), International Journal of Environmental Health Research, 25(6), 670-684, doi:10.1080/09603123.2015.1007842, Institutional Repository

Communication about micropollutants in drinking water: effects of the presentation and psychological processes

This study investigates how people change their risk perception, trust, and behavior as a consequence of being informed about the occurrence of micropollutants in drinking water. Micropollutants are substances present in extremely low concentrations that might be dangerous in higher concentrations. Data were gathered in the city of Zurich, Switzerland in 2013 using a questionnaire in which the information on micropollutants was presented differently to 12 experimental groups. Data of the key constructs were gathered before and after this information, so that causal effects could be quantified by regression analyses. Affective reactions to the information turned out to be the critical mediator of changes in risk perception (operationalized as the perceived change of quality due to pollution), which is an important determinant of changes in behavior and trust. Also, direct effects of affective reactions on behavior and trust were observed. Trust before appraising risks reduces negative affective reactions; however, it also reduces perceived quality (i.e., increases risk perception) and trust after risks are appraised. The different forms of information mainly influenced the participants’ affective reactions, but they also influenced perceived quality. The presentation with the least negative effects was a comparison of the intake of the substance by water with intake by food. The experimental design with repeated measurement that considers trust as a determinant and consequence of risk perception uncovered positive and negative effects of trust before appraising risks on changes of risk perception and trust due to appraising risks.
Tobias, R. (2016) Communication about micropollutants in drinking water: effects of the presentation and psychological processes, Risk Analysis, 36(10), 2011-2026, doi:10.1111/risa.12485, Institutional Repository

Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums

Rationale and objective: Access to and use of hygienic shared sanitation facilities is fundamental in reducing the high risk of diseases such as diarrhoea and respiratory infections. We evaluated the effectiveness of group discussions and commitment in improving the cleaning behaviour of shared sanitation users in three urban slums in Kampala, Uganda. The study follows the risk, attitudes, norms, abilities and self-regulation (RANAS) model of behaviour change and some factors of the social dilemma theory.
Methods: A pre-versus post-intervention survey was conducted in three slums of Kampala, Uganda, between December 2012 and September 2013. From the pre-intervention findings, users of dirty sanitation facilities were randomly assigned to discussions, discussions + commitment and control interventions. The interventions were implemented for 3 months with the aim of improving cleaning behaviour. This paper provides an analysis of 119 respondents who belonged to the intervention discussion-only (n = 38), discussions + commitment (n = 41) and the control (no intervention, n = 40) groups.
Results: Compared to the control, discussions and discussions + commitment significantly improved shared toilet users' cleaning behaviour. The rate of improvement was observed through behavioural determinants such as cleaning obligation, cleaning ease, cleaning approval and affective beliefs.
Conclusion: Our study findings show that group discussions and commitment interventions derived from RANAS model of behaviour change are effective in improving the shared sanitation users' cleaning behaviour.
Tumwebaze, I. K.; Mosler, H.-J. (2015) Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums, Social Science and Medicine, 147, 72-79, doi:10.1016/j.socscimed.2015.10.059, Institutional Repository

Mechanisms of behavioural maintenance: longterm effects of theory-based interventions to promote safe water consumption

Theory-based interventions can enhance people’s safe water consumption, but the sustainability of these interventions and the mechanisms of maintenance remain unclear. We investigated these questions based on an extended theory of planned behaviour. Seven hundred and ten (445 analysed) randomly selected households participated in two cluster-randomised controlled trials in Bangladesh. Study 1 promoted switching to neighbours’ arsenic-safe wells, and Study 2 promoted switching to arsenic-safe deep wells. Both studies included two intervention phases. Structured interviews were conducted at baseline (T1), and at 1-month (T2), 2-month (T3) and 9-month (T4) follow-ups. In intervention phase 1 (between T1 and T2), commitment-based behaviour change techniques – reminders, implementation intentions and public commitment – were combined with information and compared to an information-only control group. In phase 2 (between T2 and T3), half of each phase 1 intervention group was randomly assigned to receive either commitment-based techniques once more or coping planning with reminders and information. Initial well-switching rates of up to 60% significantly declined by T4: 38.3% of T2 safe water users stopped consuming arsenic-safe water. The decline depended on the intervention. Perceived behavioural control, intentions, commitment strength and coping planning were associated with maintenance. In line with previous studies, the results indicate that commitment and reminders engender long-term behavioural change.
Inauen, J.; Mosler, H.-J. (2016) Mechanisms of behavioural maintenance: longterm effects of theory-based interventions to promote safe water consumption, Psychology & Health, 31(2), 166-183, doi:10.1080/08870446.2015.1085985, Institutional Repository

Optimizing campaigns for changing routine behaviors by using an empirically calibrated microsimulation model

We used the model of prospective memory and habit development to derive recommendations for designing behavior-change campaigns that used prompts or household visits as reminders. We followed an exemplary procedure comprising the calibration of the model, based on 48 time series gathered during a campaign promoting recycling habits and a systematic exploration of the solution space. For the parameter estimation, an algorithm was developed that worked at two levels. A higher level algorithm optimized parameters that were set to equal values for all agents, whereas a lower level algorithm estimated the values of agent-specific parameters for each agent separately, using the parameter values of the higher level algorithm for the other parameters. This procedure resulted in an excellent fit of the model to the data (R2 = 75%) For the systematic exploration, an indicator expressing campaign effects in one value was defined and the following findings could be derived. Activities should focus on the first week of a campaign. Follow-up visits or refreshing of prompts should be done within 4 days after the initial visit. Later activities, such as additional visits or refreshing of prompts, bring little further effects. Investing heavily in the design of the prompts for improving their salience is only worthwhile in populations with a low commitment to perform the behavior. Furthermore, covering more than 10% of the places where the target behavior should be performed with prompts mostly does not lead to additional effects to make it worthwhile.
Tobias, R.; Mosler, H.-J. (2017) Optimizing campaigns for changing routine behaviors by using an empirically calibrated microsimulation model, Social Science Computer Review, 35(2), 184-202, doi:10.1177/0894439315620866, Institutional Repository

2014

Insights into fisheries management practices: using the theory of planned behavior to explain fish stocking among a sample of Swiss anglers

Using inadequate management tools often threatens the natural environment. This study focuses on the example of Swiss recreational fishermen (hereafter called "anglers") as recreational fisheries management stakeholders. In recreational fisheries, fish stocking conducted by anglers has been identified as one important factor associated with declining fish catches. We therefore aimed to a) gain insights into why anglers want to maintain fish stocking and b) identify entry points for interventions to promote more pro-ecological management practices. Results (N = 349) showed that the majority of anglers think very uncritically about stocking and that they frequently engage in it. We conclude that outcome expectancies and beliefs about risks, in combination with a lack of stocking success controls are the main reasons that anglers retain stocking measures. We suggest that providing anglers with direct experience and feedback about stocking success is suitable to change their intentions regarding stocking and their actual stocking behavior, and thus, to promote more pro-ecological management methods. From a more general perspective, the results of this study are likely to help improve pro-ecological ecosystem management in other domains where problems similar to those in recreational fisheries management might exist.
von Lindern, E.; Mosler, H. J. (2014) Insights into fisheries management practices: using the theory of planned behavior to explain fish stocking among a sample of Swiss anglers, PLoS One, 9(12), e115360 (20 pp.), doi:10.1371/journal.pone.0115360, Institutional Repository

Shared toilet users' collective cleaning and determinant factors in Kampala slums, Uganda

Background: Dirty shared toilets are a health risk to users in urban slum settlements. For health and non-health benefits among users of shared toilets to be guaranteed, their cleanliness is important. The objective of this study was to investigate the cleanliness situation of shared toilets in Kampala's slums and the psychological and social dilemma factors influencing users' cleaning behaviour and commitment by using the risks, attitudes, norms, ability and self-regulation (RANAS) model and factors derived from the social dilemma theory.
Methods: We conducted a cross-sectional study in three slums of Kampala between December 2012 and January 2013. Data were collected from 424 household respondents that were primarily using shared toilets. Semi-structured questionnaires administered through face-to-face interviews were used in data collection. Linear regression was done for the multivariate analysis to test for the association between respondent cleaning behaviour and a combination of RANAS and social dilemma predictors.
Results. Out of 424 respondents interviewed, 44.3% reported cleaning the shared toilet daily, 34.4% cleaned once or several times a week, 1.4% cleaned every second week, 5.4% cleaned once or several times a month and 14.4% did not participate in cleaning. The main RANAS factors significantly associated with respondents' cleaning behaviour were: attitudinal affective belief associated with cleaning a shared toilet (β = -0.13, P = 0.00) and self-regulating factors, such as coping planning (β = 0.42, P = 0.00), commitment (β = 0.24, P = 0.00), and remembering (β = 0.10, P = 0.01). For social dilemma factors, only the social motive factor was statistically significant (β = 0.15, P = 0.00). The R square for the linear model on factors influencing cleaning behaviour was 0.77 and R square for factors influencing cleaning commitment was 0.70.
Conclusion: The RANAS factors provide a more robust understanding of shared toilet users' cleaning behaviour than social dilemma factors. Self-regulating factors and changing the negative affective cleaning feelings are shown to be very important for interventions to increase shared toilet users' collective participation in their cleaning. In addition to RANAS, social dilemma factors have an important influence on slum residents' commitment to clean their shared toilets.
Tumwebaze, I. K.; Mosler, H.-J. (2014) Shared toilet users' collective cleaning and determinant factors in Kampala slums, Uganda, BMC Public Health, 14, 1260 (19 pp.), doi:10.1186/1471-2458-14-1260, Institutional Repository
Tilley, E.; Strande, L.; Lüthi, C.; Mosler, H.-J.; Udert, K. M.; Gebauer, H.; Hering, J. G. (2014) Looking beyond technology: an integrated approach to water, sanitation and hygiene in low income countries, Environmental Science and Technology, 48(17), 9965-9970, doi:10.1021/es501645d, Institutional Repository

Enhancing arsenic mitigation in Bangladesh: findings from institutional, psychological, and technical investigations

As part of a trans-disciplinary research project, a series of surveys and interventions were conducted in different arsenic-affected regions of rural Bangladesh. Surveys of institutional stakeholders identified deep tubewells and piped water systems as the most preferred options, and the same preferences were found in household surveys of populations at risk. Psychological surveys revealed that these two technologies were well-supported by potential users, with self-efficacy and social norms being the principal factors driving behavior change. The principal drawbacks of deep tubewells are that installation costs are too high for most families to own private wells, and that for various socio-cultural-religious reasons, people are not willing to walk long distances to access communal tubewells. In addition, water sector planners have reservations about greater exploitation of the deep aquifer, out of concern for current or future geogenic contamination. Groundwater models and field studies have shown that in the great majority of the affected areas, the risk of arsenic contamination of deep groundwater is small; salinity, iron, and manganese are more likely to pose problems. These constituents can in some cases be avoided by exploiting an intermediate depth aquifer of good chemical quality, which is hydraulically and geochemically separate from the arsenic-contaminated shallow aquifer. Deep tubewells represent a technically sound option throughout much of the arsenic-affected regions, and future mitigation programs should build on and accelerate construction of deep tubewells. Utilization of deep tubewells, however, could be improved by increasing the tubewell density (which requires stronger financial support) to reduce travel times, by considering water quality in a holistic way, and by accompanying tubewell installation with motivational interventions based on psychological factors. By combining findings from technical and social sciences, the efficiency and success of arsenic mitigation in general – and installation of deep tubewells in particular – can be significantly enhanced.
Johnston, R.; Hug, S. J.; Inauen, J.; Khan, N. I.; Mosler, H.-J.; Yang, H. (2014) Enhancing arsenic mitigation in Bangladesh: findings from institutional, psychological, and technical investigations, Science of the Total Environment, 488(1), 477-483, doi:10.1016/j.scitotenv.2013.11.143, Institutional Repository

Why are some latrines cleaner than others? Determining the factors of habitual cleaning behaviour and latrine cleanliness in rural Burundi

Access to improved sanitation is fundamental for the prevention of diarrhoea and other diseases. However, for a sanitation facility to be safe, its cleanliness must be assured. The aim of the present study was, first, to assess how cleaning behaviour, household characteristics and infrastructural factors influenced latrine cleanliness and, second, to assess which psychological factors influenced cleaning behaviour. In a study in rural Burundi, 762 standardised household interviews with the primary household caregiver were carried out to assess habitual cleaning behaviour and psychological factors according to behaviour change models. In addition, the characteristics and cleanliness of the latrine were observed, and two multiple linear regressions were performed to analyse predictors of latrine cleanliness and of cleaning behaviour. Latrine cleanliness was determined by cleaning behaviour, the possibility of locking the door, the height of the superstructure, the material of the superstructure and the availability of an even slab. The number of households or people sharing the latrine was not influential. Commitment to cleaning, satisfaction with the cleanliness of the latrine and self-efficacy determined habitual cleaning behaviour. Interventions focussing on commitment, self-efficacy and satisfaction with a clean latrine like public commitment or guided practice interventions are recommended to promote cleaning behaviour.
Sonego, I. L.; Mosler, H.-J. (2014) Why are some latrines cleaner than others? Determining the factors of habitual cleaning behaviour and latrine cleanliness in rural Burundi, Journal of Water Sanitation and Hygiene for Development, 4(2), 257-267, doi:10.2166/washdev.2014.147, Institutional Repository

Determinants of households' cleaning intention for shared toilets: case of 50 slums in Kampala, Uganda

Cleaning shared toilets is important if users are to receive the significant health, social and economic benefits associated with having access to these facilities. However, achieving and maintaining hygienic toilets shared by several user households in urban slums is usually a challenge. This study assesses determinants of households' cleaning intention for shared toilets in Kampala, Uganda. Using a structured questionnaire for the household interviews and an observation checklist, data from 1019 users of shared toilets was collected in 50 randomly selected urban slums. Data analysis showed that most of the shared toilets are unhygienic. Less than a quarter of the shared toilets, for instance, were hygienically clean to users' satisfaction. The main cleaning intention determinants (p-value <.05) included: importance of using a clean toilet, the effort involved in cleaning the toilet, the disgust felt from using a dirty toilet, and cleaning habits. Although it is important to have access to sanitation facilities, emphasis should be placed on how to engage users to ensure that the facilities used are appropriately cleaned and maintained.
Tumwebaze, I. K.; Niwagaba, C. B.; Günther, I.; Mosler, H.-J. (2014) Determinants of households' cleaning intention for shared toilets: case of 50 slums in Kampala, Uganda, Habitat International, 41, 108-113, doi:10.1016/j.habitatint.2013.07.008, Institutional Repository

Evidence-based tailoring of behavior-change campaigns: increasing fluoride-free water consumption in rural Ethiopia with persuasion

Two hundred million people worldwide are at risk of developing dental and skeletal fluorosis due to excessive fluoride uptake from their water. Since medical treatment of the disease is difficult and mostly ineffective, preventing fluoride uptake is crucial. In the Ethiopian Rift Valley, a fluoride-removal community filter was installed. Despite having access to a fluoride filter, the community used the filter sparingly. During a baseline assessment, 173 face-to-face interviews were conducted to identify psychological factors that influence fluoride-free water consumption. Based on the results, two behavior-change campaigns were implemented: a traditional information intervention targeting perceived vulnerability, and an evidence-based persuasion intervention regarding perceived costs. The interventions were tailored to household characteristics. The campaigns were evaluated with a survey and analyzed in terms of their effectiveness in changing behavior and targeted psychological factors. While the intervention targeting perceived vulnerability showed no desirable effects, cost persuasion decreased the perceived costs and increased the consumption of fluoride-free water. This showed that altering subjective perceptions can change behavior even without changing objective circumstances. Moreover, interventions are more effective if they are based on evidence and tailored to specific households.
Huber, A. C.; Tobias, R.; Mosler, H.-J. (2014) Evidence-based tailoring of behavior-change campaigns: increasing fluoride-free water consumption in rural Ethiopia with persuasion, Applied Psychology: Health and Well-Being, 6(1), 96-118, doi:10.1111/aphw.12018, Institutional Repository

Why clean the toilet if others don’t? Using a social dilemma approach to understand users of shared toilets’ collective cleaning behaviour in urban slums: a review

Shared toilets are a common good in urban slums, but need to be maintained and cleaned for users to positively benefit from having access to them. Collective participation of the shared toilet users is required to keep them clean and ensure adequate hygiene. However, users' decisions on whether to participate or not in the cleaning of the shared toilets are a social dilemma. If each of the shared toilets' users decided not to participate in their cleaning, the facilities could end up in a deteriorated unhygienic state and become a health risk to them and to the community at large. In this paper, we provide an overview of the social dilemma approach and highlight how the factors important in the management of social dilemmas can be relevant to understanding the cleaning behaviour of shared toilet users in urban slums.
Tumwebaze, I. K.; Mosler, H.-J. (2014) Why clean the toilet if others don’t? Using a social dilemma approach to understand users of shared toilets’ collective cleaning behaviour in urban slums: a review, Journal of Water Sanitation and Hygiene for Development, 4(3), 359-370, doi:10.2166/washdev.2014.152, Institutional Repository

2013

Developing and testing theory-based and evidence-based interventions to promote switching to arsenic-safe wells in Bangladesh

Millions of people in Bangladesh drink arsenic-contaminated water despite increased awareness of consequences to health. Theory-based and evidence-based interventions are likely to have greater impact on people switching to existing arsenic-safe wells than providing information alone. To test this assumption, we first developed interventions based on an empirical test of the Risk, Attitudes, Norms, Abilities and Self-regulation (RANAS) model of behaviour change. In the second part of this study, a cluster-randomised controlled trial revealed that in accordance with our hypotheses, information alone showed smaller increases in switching to arsenic-safe wells than information with reminders or information with reminders and implementation intentions.
Inauen, J.; Mosler, H.-J. (2014) Developing and testing theory-based and evidence-based interventions to promote switching to arsenic-safe wells in Bangladesh, Journal of Health Psychology, 19(12), 1483-1498, doi:10.1177/1359105313493811, Institutional Repository

A methodology for quantifying effects and psychological functioning of behavior-change techniques

We present a methodology to quantify the effects of behavior change techniques (BCTs) that allows forecasting campaign effects on behavior and psychological constructs. The approach involves the gathering of longitudinal data during actual campaigns in which different combinations and sequences of BCTs are applied to different groups. Approximate metric data are gathered by asking for simple and specific evaluations. The data are analyzed using regression models that consider the value range of the dependent variable as bounded (bounded linear regression). Based on these models, forecasts of the intervention effects are calculated, considering the uncertainty of the parameter estimates. The methodology is applied to investigate the effects of prompts (external memory aids), public self-commitments, and implementation intentions on affective and instrumental attitudes, injunctive and descriptive norms, forgetting, perceived behavior control, and behavior in a health-promotion campaign in Bolivia. Prompts and public self-commitments reached more than half of the target population but only showed relevant effects when combined or repeated. The effects of both BCTs on behavior were mainly mediated by forgetting. Implementation intentions were not well received by the promoters and the population. From the few cases that implemented this BCT, no clear psychological effects could be derived.
Tobias, R.; Huber, A. C.; Tamas, A. (2013) A methodology for quantifying effects and psychological functioning of behavior-change techniques, SAGE Open, 1-16, doi:10.1177/2158244013517245, Institutional Repository

Impact of different promotional channels on handwashing behaviour in an emergency context: Haiti post-earthquake public health promotions and cholera response

Aim. In a disaster context, where risk for diarrhoeal disease is elevated, personal hygiene, i.e. handwashing with soap, is especially relevant. However, to date, the promotion of hygiene in an emergency context has not been adequately addressed in the literature. The aim of the present study is to evaluate the effectiveness of hygiene promotions in post-earthquake Haiti.
Subject and Methods. Cross-sectional data was collected by means of structured interviews in camps and neighbourhoods in which three affiliates of a well-known relief organisation had conducted hygiene promotions. Primary caregivers were targeted. A total sample of 811 was obtained. Data was analysed using multiple linear regression and mediation analysis. Results. Analysis revealed six promotional channels with positive associations with handwashing behaviour: hygiene radio spots, radio programs with experts answering listener's questions, material distributions with instructions for use, information from friends or neighbours, hygiene theatres, and community clubs. However, five of the promotional channels were negatively related with handwashing. Respondents who experienced a focus group, stickers, posters and paintings, hygiene songs, special hygiene days and home visits tended to wash their hands less often.
Conclusions. By revealing positive but also negative associations between hygiene promotions and handwashing behaviour, the study underlines the need to apply theory-driven emergency hygiene promotions which are subjected to in-depth evaluation. Only through doing this, is it ensured that effective hygiene promotions are implemented for the most vulnerable people — those affected by a humanitarian disaster.
Contzen, N.; Mosler, H.-J. (2013) Impact of different promotional channels on handwashing behaviour in an emergency context: Haiti post-earthquake public health promotions and cholera response, Journal of Public Health (Berlin, Heidelberg), 21(6), 559-573, doi:10.1007/s10389-013-0577-4, Institutional Repository

The role of commitment strength in enhancing safe water consumption: mediation analysis of a cluster-randomized trial

Objectives. The objectives of this study were to investigate the importance of commitment strength in the theory of planned behaviour (TPB) and to test whether behaviour change techniques (BCTs) aimed at increasing commitment strength indeed promote switching to arsenic-safe wells by changing commitment strength.
Design. A cluster-randomized controlled trial with four arms was conducted to compare an information-only intervention to information plus one, two, or three commitment-enhancing BCTs.
Methods. Randomly selected households (N = 340) of Monoharganj, Bangladesh, in seven geographically separate areas, whose members were drinking arsenic-contaminated water at baseline and had access to arsenic-safe wells, participated in this trial. The areas were randomly allocated to the four intervention arms. Water consumption behaviour, variables of the TPB, commitment strength, and socio-demographic characteristics were assessed at baseline and at 3-month follow-up by structured face-to-face interviews. Mediation analysis was used to investigate the mechanisms of behaviour change.
Results. Changes in commitment strength significantly increased the explanatory power of the TPB to predict well-switching. Commitment-enhancing BCTs - public self-commitment, implementation intentions, and reminders - increased the behaviour change effects of information by up to 50%. Mediation analyses confirmed that the BCTs indeed increased well-switching by increasing commitment strength. Unexpectedly, however, mediation via changes in behavioural intentions was the strongest mechanism of the intervention effects.
Conclusions. Commitment is an important construct to consider in water- and health-related behaviour change and may be for other health behaviours as well. BCTs that alter behavioural intentions and commitment strength proved highly effective at enhancing the behaviour change effects of information alone.
Inauen, J.; Tobias, R.; Mosler, H.-J. (2014) The role of commitment strength in enhancing safe water consumption: mediation analysis of a cluster-randomized trial, British Journal of Health Psychology, 19(4), 701-719, doi:10.1111/bjhp.12068, Institutional Repository

Does the implementation of hardware need software? A longitudinal study on fluoride-removal filter use in Ethiopia

Evidence suggests that the effectiveness of technology designed to provide safe and healthy water is dependent on the degree of its use. In addition to providing safe water "hardware" (i.e., new infrastructure or equipment) to populations at risk, it might be necessary to also provide suitable "software" programs (behavior change strategies) to support use. A longitudinal survey was conducted in rural Ethiopia following the distribution of fluoride-removal household filters. Three intervention groups were evaluated. Group 1 only received the hardware, i.e., the fluoride-removal filter. Groups 2 and 3 also received software in the form of two evidence-based psychological interventions: a planning and social prompts intervention and an educational workshop with pledging. Group 2 received both software interventions, and Group 3 only received the educational workshop. The effects of the hardware and software on behavior and thus filter use were analyzed along with specific psychological factors. The results showed that the provision of the hardware alone (the fluoride-removal filter) was not enough to ensure sufficient use of the equipment. The addition of a software component in the form of psychological interventions increased filter use up to 80%. An increase in filter use was measured following each intervention resulting in the health-risk being minimized. We conclude that it is necessary that the implementation of hardware of this nature is accompanied by evidence-based intervention software.
Sonego, I. L.; Huber, A. C.; Mosler, H.-J. (2013) Does the implementation of hardware need software? A longitudinal study on fluoride-removal filter use in Ethiopia, Environmental Science and Technology, 47(22), 12661-12668, doi:10.1021/es402787s, Institutional Repository

Predicting water consumption habits for seven arsenic-safe water options in Bangladesh

Background: In Bangladesh, 20 million people are at the risk of developing arsenicosis because of excessive arsenic intake. Despite increased awareness, many of the implemented arsenic-safe water options are not being sufficiently used by the population. This study investigated the role of social-cognitive factors in explaining the habitual use of arsenic-safe water options.
Methods: Eight hundred seventy-two randomly selected households in six arsenic-affected districts of rural Bangladesh, which had access to an arsenic-safe water option, were interviewed using structured face-to-face interviews in November 2009. Habitual use of arsenic-safe water options, severity, vulnerability, affective and instrumental attitudes, injunctive and descriptive norms, self-efficacy, and coping planning were measured. The data were analyzed using multiple linear regressions.
Results. Linear regression revealed that self-efficacy (B = 0.42, SE = .03, p < .001), the instrumental attitude towards the safe water option (B = 0.24, SE = .04, p < .001), the affective attitude towards contaminated tube wells (B = −0.04, SE = .02, p = .024), vulnerability (B = −0.20, SE = .02, p < .001), as well as injunctive (B = 0.08, SE = 0.04, p = .049) and descriptive norms (B = 0.34, SE = .03, p < .001) primarily explained the habitual use of arsenic-safe water options (R2 = 0.688). This model proved highly generalizable to all seven arsenic-safe water options investigated, even though habitual use of single options were predicted on the basis of parameters estimated without these options.
Conclusions. This general model for the habitual use of arsenic-safe water options may prove useful to predict other water consumption habits. Behavior-change interventions are derived from the model to promote the habitual use of arsenic-safe water options.
Inauen, J.; Tobias, R.; Molser, H.-J. (2013) Predicting water consumption habits for seven arsenic-safe water options in Bangladesh, BMC Public Health, 13, 417 (10 pp.), doi:10.1186/1471-2458-13-417, Institutional Repository

Determining the differential preferences of users of two fluoride-free water options in rural Ethiopia

Aim. In the Ethiopian Rift Valley, 8.5 million people depend on water sources with excessive fluoride. In one rural village, a fluoride-removal community filter was implemented; a personalized reminder was distributed to change people's behavior and increase the usage of the in-village community filter. During this promotion phase, an alternative fluoride-removal option was installed in a neighboring village.
This study examines psychological factors that explain the differences in preference between the two options and their influence on the usage of the different sources. In addition, the effectiveness of the applied behavior change technique, a personalized reminder, on the use of the in-village community filter was analyzed.
Subject and methods. In a complete longitudinal survey, 180 households, with access to both mitigation options, were interviewed through structured, face-to-face interviews. Logistic regressions were carried out to reveal factors predicting the usage of the two mitigation options and the effect of the implemented behavior change intervention.
Results. The results showed that the better the taste, the lower the effort and the lower the costs for using the in-village community filter are perceived; in addition, the lower the perceived vulnerability to contract disease, the more the in-village community filter is used. Moreover, it was found that the personalized reminder also had a positive effect on the usage of the in-village mitigation option.
Conclusion. Based on the results, possible recommendations for practitioners and researchers are made to help plan and implement mitigation options.
Huber, A. C.; Mosler, H.-J. (2013) Determining the differential preferences of users of two fluoride-free water options in rural Ethiopia, Journal of Public Health (Berlin, Heidelberg), 21, 183-192, doi:10.1007/s10389-012-0537-4, Institutional Repository

Acceptance and use of eight arsenic-safe drinking water options in Bangladesh

Arsenic contamination of drinking water is a serious public health threat. In Bangladesh, eight major safe water options provide an alternative to contaminated shallow tubewells: piped water supply, deep tubewells, pond sand filters, community arsenic-removal, household arsenic removal, dug wells, well-sharing, and rainwater harvesting. However, it is uncertain how well these options are accepted and used by the at-risk population. Based on the RANAS model (risk, attitudes, norms, ability, and self-regulation) this study aimed to identify the acceptance and use of available safe water options. Cross-sectional face-to-face interviews were used to survey 1,268 households in Bangladesh in November 2009 (n = 872), and December 2010 (n = 396). The questionnaire assessed water consumption, acceptance factors from the RANAS model, and socioeconomic factors. Although all respondents had access to at least one arsenic-safe drinking water option, only 62.1% of participants were currently using these alternatives. The most regularly used options were household arsenic removal filters (92.9%) and piped water supply (85.6%). However, the former result may be positively biased due to high refusal rates of household filter owners. The least used option was household rainwater harvesting (36.6%). Those who reported not using an arsenic-safe source differed in terms of numerous acceptance factors from those who reported using arsenic-safe sources: non-users were characterized by greater vulnerability; showed less preference for the taste and temperature of alternative sources; found collecting safe water quite time-consuming; had lower levels of social norms, self-efficacy, and coping planning; and demonstrated lower levels of commitment to collecting safe water. Acceptance was particularly high for piped water supplies and deep tubewells, whereas dug wells and well-sharing were the least accepted sources. Intervention strategies were derived from the results in order to increase the acceptance and use of each arsenic-safe water option.
Inauen, J.; Hossain, M. M.; Johnston, R. B.; Mosler, H.-J. (2013) Acceptance and use of eight arsenic-safe drinking water options in Bangladesh, PLoS One, 8(1), e53640 (10 pp.), doi:10.1371/journal.pone.0053640, Institutional Repository

Achieving long-term use of solar water disinfection in Zimbabwe

Objectives: To use a psychological theory of behavioural change to measure and interpret the effectiveness of different promotional strategies for achieving long-term usage of a household water treatment and safe storage (HWTS) system in peri-urban Zimbabwe.
Study design: Solar disinfection (SODIS) was introduced into five peri-urban communities near Harare, Zimbabwe. Six different interventions were developed and were applied in four communities in different combinations, with the fifth remaining as a control area where no interventions were implemented.
Methods: Throughout the 26 months of the study nine longitudinal panel surveys were conducted in which SODIS usage was estimated using three separate metrics: reported, calculated, and observed. A total of 1551 people were interviewed.
Results: The three indicators of SODIS usage broadly agreed with one another. By any measure, the most effective intervention was household visits by trained promoters in combination with persuasion. Households which received household visits maintained SODIS usage rates of 65% or more, even six months after the cessation of all promotional activities. Households receiving other interventions were significantly less effective. Interventions like prompts or public commitment after the application of household visits were effective at maintaining good practices once these were established.
Conclusions: Household promotion in combination with persuasion appears more effective than other approaches, especially when followed with interventions targeting the maintenance of the new behaviour. With this intervention it is possible that around 65% of the households continue to use solar water disinfection (SODIS) more than two years after the initial promotion, and six months after the end of all interventions
Mosler, H. J.; Kraemer, S. M.; Johnston, R. B. (2013) Achieving long-term use of solar water disinfection in Zimbabwe, Public Health, 127(1), 92-98, doi:10.1016/j.puhe.2012.09.001, Institutional Repository

2012

Solar water disinfection (SODIS): a review from bench-top to roof-top

Solar water disinfection (SODIS) has been known for more than 30 years. The technique consists of placing water into transparent plastic or glass containers (normally 2 L PET beverage bottles) which are then exposed to the sun. Exposure times vary from 6 to 48 h depending on the intensity of sunlight and sensitivity of the pathogens. Its germicidal effect is based on the combined effect of thermal heating of solar light and UV radiation. It has been repeatedly shown to be effective for eliminating microbial pathogens and reduce diarrhoeal morbidity including cholera. Since 1980 much research has been carried out to investigate the mechanisms of solar radiation induced cell death in water and possible enhancement technologies to make it faster and safer. Since SODIS is simple to use and inexpensive, the method has spread throughout the developing world and is in daily use in more than 50 countries in Asia, Latin America, and Africa. More than 5 million people disinfect their drinking water with the solar disinfection (SODIS) technique. This review attempts to revise all relevant knowledge about solar disinfection from microbiological issues, laboratory research, solar testing, up to and including real application studies, limitations, factors influencing adoption of the technique and health impact.
McGuigan, K. G.; Conroy, R. M.; Mosler, H.-J.; du Preez, M.; Ubomba-Jaswa, E.; Fernandez-Ibañez, P. (2012) Solar water disinfection (SODIS): a review from bench-top to roof-top, Journal of Hazardous Materials, 235, 29-46, doi:10.1016/j.jhazmat.2012.07.053, Institutional Repository

Sanitation facilities in Kampala slums, Uganda: users' satisfaction and determinant factors

Access to improved sanitation is a key preventive measure against sanitary-related gastro-enteric diseases such as diarrhoea. We assessed the access to sanitation facilities and users' satisfaction in 50 randomly selected slums of Kampala through a cross-sectional survey conducted in 2010. A total of 1500 household respondents were interviewed. Sixty-eight per cent of the respondents used shared toilets, 20% private, 11% public toilets and less than 1% reported using flying toilets or practising open defecation. More than half of the respondents (51.7%) were not satisfied with their sanitation facilities. Determinants for satisfaction with the facilities used included the nature and type of toilet facilities used, their cleanliness, and the number of families sharing them. The study findings showed that slum dwellers had high access to sanitation facilities. However, most of them were shared and majority of the respondents were not satisfied with their facilities, primarily due to cleanliness and over demand.
Tumwebaze, I. K.; Garimoi Orach, C.; Niwagaba, C.; Lüthi, C.; Mosler, H.-J. (2013) Sanitation facilities in Kampala slums, Uganda: users' satisfaction and determinant factors, International Journal of Environmental Health Research, 23(3), 191-204, doi:10.1080/09603123.2012.713095, Institutional Repository

When is shared sanitation improved sanitation? The correlation between number of users and toilet hygiene

The international debate on the question of whether shared and/or public sanitation facilities should be considered improved is still open. The concern is that a shared sanitation facility cannot be maintained in hygienic conditions when used by too many people. The analysis of 1 '500 randomly selected toilets in the urban slums of Kampala showed that only 22 percent of households have access to private sanitation facilities; the remaining 78 percent share their toilet with an average of 6 households. There is a clear and strong correlation between number of users and the condition and cleanliness of a toilet stance. Less than 20 percent of private toilets are dirty, whereas 60 percent of sanitation facilities are dirty if they are shared by more than 1O households. This policy brief asserts that toilet facilities shared by not more than four households can be considered "acceptable" or improved, with "only" about 25 percent classified as dirty by an objective evaluation.
Günther, I.; Niwagaba, B. C.; Lüthi, C.; Horst, A.; Mosler, H.-J.; Tumwebaze, K. I. (2012) When is shared sanitation improved sanitation? The correlation between number of users and toilet hygiene, 4 p, Institutional Repository

Predictors of treated and untreated water consumption in rural Bolivia

Household water treatment (HWT) has the potential to reduce waterborne diseases in developing countries. In this article, factors from social–psychological theories are analyzed in order to design effective interventions that promote HWT. Two treatment behaviors—solar disinfection (SODIS) and boiling—are compared with untreated-water consumption using data from a SODIS campaign in Bolivia. The main drivers of intention are affective beliefs, health beliefs related to untreated water, and descriptive norms. Behavior is primarily influenced by the habit related to each water type. Strong interrelations between beliefs and the habit related to one water type and the intention or consumption related to the others exist. Future campaigns should not only promote the target health behavior, but also investigate predictors of the health-risk behavior in order to prevent it.
Tamas, A.; Meyer, J.; Mosler, H.-J. (2013) Predictors of treated and untreated water consumption in rural Bolivia, Journal of Applied Social Psychology, 43(7), 1394-1407, doi:10.1111/jasp.12096, Institutional Repository

Determining behavioral factors for interventions to increase safe water consumption: a cross-sectional field study in rural Ethiopia

In developing countries, the lack of safe water options leads to many health risks. In the Ethiopian Rift Valley, most water sources are contaminated with an excess of fluoride. The consumption of fluoride-contaminated water leads to dental and skeletal fluorosis. The article presents an approach to designing community interventions based on evidence from quantitative data. After installing a community filter, a baseline study was conducted in 211 households to survey the acceptance and usage of the filter. To identify important psychological factors that lead to health behavior change, the Risk, Attitude, Norm, Ability, Self-regulation (RANAS) model was taken into account. Descriptive statistics were calculated for behavioral determinants, and their influence on consumption was analyzed with a linear regression. For every behavioral factor, an intervention potential (IP) was calculated. It was found that perceived distance, factual knowledge, commitment, and taste strongly influenced participants' consumption behavior and therefore should be tackled for interventions.
Huber, A. C.; Mosler, H.-J. (2013) Determining behavioral factors for interventions to increase safe water consumption: a cross-sectional field study in rural Ethiopia, International Journal of Environmental Health Research, 23(2), 96-107, doi:10.1080/09603123.2012.699032, Institutional Repository

Determinants of exclusive consumption of fluoride-free water: a cross-sectional household study in rural Ethiopia

Aim. The occurrence of high fluoride concentrations in the ground- and surface water all over the world leads to the risk of developing dental and skeletal fluorosis. In Ethiopia, 8 million people depend on water sources with excessive fluoride. In four project areas in the Ethiopian Rift Valley, fluoride removal household filters based on bone char media have been implemented. This study examines possible predictors of consuming filtered water derived from various behavior change theories.
Subject and methods. In a complete cross-sectional survey, 160 filter users were interviewed through structured face-to-face interviews. A logistic regression was carried out to reveal factors predicting consumption of filtered water.
Results. The results show that the consumption of fluoride-free water is mainly related to people's pride in offering filtered water to guests (status norm) and the feeling of being able to produce enough water with the filter (perceived behavioral control). Moreover, the study showed that the more filter users like the taste of filtered water and the more expensive they perceive the filter media, the more likely users will exclusively consume filtered water (attitudinal beliefs). Furthermore, perceiving the act of filling as a matter of habit (perceived habit) enhances filtered water consumption.
Conclusion. Based on the results, possible intervention strategies to change the influential psychological factors and, hence, increase the consumption of treated water can be designed.
Huber, A. C.; Bhend, S.; Mosler, H.-J. (2012) Determinants of exclusive consumption of fluoride-free water: a cross-sectional household study in rural Ethiopia, Journal of Public Health (Berlin, Heidelberg), 20(3), 269-278, doi:10.1007/s10389-011-0445-z, Institutional Repository

A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline

Public health practitioners increasingly agree that it is not enough to provide people with water and sanitation hardware. Numerous approaches are used to tackle the “software” which means to ensure behavior change necessary to come along with the sanitation hardware. A review of these approaches reveals several shortcomings, most importantly that they do not provide behavioral change interventions which correspond to psychological factors to be changed. This article presents a sound psychological model, which postulates that for the formation of new habitual behavior, five blocks of factors must be positive with regard to the new behavior: risk factors, attitudinal factors, normative factors, ability factors, and self-regulation factors. Standardized tools for measuring the factors in face-to-face interviews are presented, and behavioral interventions are provided for each factor block. A statistical analysis method is presented, which allows the determination of the improvement potential of each factor.
Mosler, H.-J. (2012) A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline, International Journal of Environmental Health Research, 22(5), 431-449, doi:10.1080/09603123.2011.650156, Institutional Repository

Effectiveness and effects of promotion strategies for behaviour change: solar water disinfection in Zimbabwe

Solar water disinfection (SODIS) is a sustainable method of water treatment. Despite the simplicity and many advantages of SODIS, past behaviour change campaigns have seen limited success. This study aims to compare intervention strategies in their efficiency in changing behaviour and to analyse which behavioural factors are differentially affected. The following factors were analysed in this study: intention, subjective norm, behavioural control, beliefs, habits, frequency of talking, knowledge and tension. The promotion strategies used in this intervention study were promoters, a pass-on task, prompts, public commitment and disseminating knowledge with inducing tension. Inhabitants of high-density areas near Harare, Zimbabwe, were interviewed at different points in time. High SODIS consumption was achieved when the promoter intervention was followed by a memory-aiding technique such as prompts or public commitment. Consequently, this combined-intervention strategy increased all behavioural factors and kept them at a high level. A continued pass-on task alone did not change behaviour and had decreasing effects on several behavioural factors. When the pass-on task was combined with disseminating knowledge with inducing tension, high SODIS water consumption was also reached, but several behavioural factors stayed at a low level. More effective intervention strategies are identified and discussed.
Kraemer, S. M.; Mosler, H.-J. (2012) Effectiveness and effects of promotion strategies for behaviour change: solar water disinfection in Zimbabwe, Applied Psychology, 61(3), 392-414, doi:10.1111/j.1464-0597.2011.00475.x, Institutional Repository

Which psychological factors change when habitual water treatment practices alter?

Aim. Household water treatment systems (HWTS) and safe storage systems are an effective measure to ensure safe water supply. The adoption of HWTS requires long-term changes in behavior. During campaigns for health related behavior change, many people appear to have fixed behavioral patterns that are difficult to change. Since behavior change originates in the altering of inner psychological factors, it is necessary to investigate the transformation of these factors. Five categories of psychological factors are identified as responsible for the formation of habitual behavior: risk beliefs, attitudinal beliefs, normative beliefs, ability beliefs, and maintenance beliefs. This study analyzes which factors change when long-term users of HWTS, non-users, or 'tryers' (using HWTS occasionally), transform their behavior type or remain in their current behavior type.
Subjects and methods. Data were obtained by conducting six panel interviews about the use of solar water disinfection (SODIS) over a period of 14 months, with 694 households, in the slum areas of Harare, Zimbabwe.
Results. The results reveal that progressing to a higher level of user type (one who increases their use of SODIS), or staying at a high level of use (maintaining their level of use) is associated with the user’s ability to avoid being hindered by other habits, to remember the behavior in respective situations, and to notice that other people are also using SODIS.
Conclusion. Suggested strategies which may foster these factors include the control of distracting stimuli, forming implementation intentions, daily routine planning, applying reminders, and using public commitments.
Mosler, H.-J.; Kraemer, S. (2012) Which psychological factors change when habitual water treatment practices alter?, Journal of Public Health (Berlin, Heidelberg), 20(1), 71-79, doi:10.1007/s10389-011-0435-1, Institutional Repository

2011

Sustainable use of arsenic-removing sand filters in Vietnam: psychological and social factors

Elevated arsenic concentrations in drinking water pose a health threat to millions of people. Although point-of-use sand filters provide an effective technical solution for mitigating arsenic exposure, the actual reduction in health risk also depends on psychological factors that influence behaviors related to this device. For example, acquiring a sand filter must be preferred to competing options for investing effort and money and, once installed, the users must regularly maintain the filters. These key behaviors of sustainable use are related to psychological factors, such as problem awareness, benefits and costs, social and affective influences, and the perception of practical difficulties. This study investigated the sustainable use of arsenic-removing sand filters in Vietnam. Based on questionnaire surveys, data were gathered in 319 rural households and analyzed with regression models. Psychological factors explained significant variance in the investigated key behaviors. Significant factors included perceived improvements in water healthiness and taste, monetary costs, social norms, and affective influences. In questions with open answers, interviewees mentioned various practical problems, particularly those related to the inflexibility of the device and the effort of changing the sand. Interestingly, many interviewees operate the sand filters for removing iron from the water but are unaware of problems with arsenic.
Tobias, R.; Berg, M. (2011) Sustainable use of arsenic-removing sand filters in Vietnam: psychological and social factors, Environmental Science and Technology, 45(8), 3260-3267, doi:10.1021/es102076x, Institutional Repository

Why do people stop treating contaminated drinking water with solar water disinfection (SODIS)?

Solar Water Disinfection (SODIS) is a simple method designed to treat microbiologically contaminated drinking water at household level. This article characterizes relapse behavior in comparison with continued SODIS use after a 7-month nonpromotion period. In addition, different subtypes among relapsers and continuers were assumed to diverge mainly in their intention to use SODIS and their degree of cognition intensity. Data were taken from a longitudinal SODIS promotion study. Cluster analyses were applied to find subtypes among 166 relapsers and 123 continuers. Overall relapsers have lower values for all psychological variables compared to overall continuers. A low-value and a high-value relapser subtype as well as a low-value and a high-value continuer subtype were found. Low-value relapsers differ from high-value relapsers in one central belief (taste), in affective connotation, social norms, and dissonance. Interestingly, high-value relapsers have values almost as high as low-value continuers, differing only in their degree of habit. Only high-value continuers seem to be stable and did not show a decrease in critical habit variables over time. The different subtypes are placed along the behavior change process, and possible interventions for each type are highlighted.
Tamas, A.; Mosler, H.-J. (2011) Why do people stop treating contaminated drinking water with solar water disinfection (SODIS)?, Health Education and Behavior, 38(4), 357-366, doi:10.1177/1090198110374702, Institutional Repository

Factors from the transtheoretical model differentiating between solar water disinfection (SODIS) user groups

Solar water disinfection (SODIS) is a sustainable household water treatment technique that could prevent millions of deaths caused by diarrhoea. The behaviour change process necessary to move from drinking raw water to drinking SODIS is analysed with the Transtheoretical Model of Change (TTM). User groups and psychological factors that differentiate between types of users are identified. Results of a 1.5 year longitudinal study in Zimbabwe reveal distinguishing factors between groups, from which it can be deduced that they drive the development of user groups. Implications are drawn for campaigns with the aim of bringing all user types to a regular use.
Kraemer, S. M.; Mosler, H.-J. (2011) Factors from the transtheoretical model differentiating between solar water disinfection (SODIS) user groups, Journal of Health Psychology, 16(1), 126-136, doi:10.1177/1359105310370630, Institutional Repository

Information preferences and corresponding consumption behavior in common pool resource management

For the purpose of managing a common pool resource (CPR), it may be crucial to know what kind of information is important to the actors involved. The present study tests a set of hypotheses from the social ecological relevance (SER) model of decision-making in commons dilemma situations. The results showed that (1) information about the resource increased in importance with decreasing resource availability, (2) this increase was more pronounced in the presence of high ecological uncertainty, and (3) individuals attributing the availability of the resource to the group attached more importance to information on others’ behavior. These findings were reflected by the results on consumption behavior, as (1) the average consumption decreased with decreasing resource availability, (2) it decreased more pronounced in the presence of high ecological uncertainty, and (3) individuals attributing the availability of the resource to the group were more inclined to follow the group’s consumption than individuals attributing to the resource.
Brucks, W. M.; Mosler, H.-J. (2011) Information preferences and corresponding consumption behavior in common pool resource management, Social Psychology, 42(4), 261-270, doi:10.1027/1864-9335/a000057, Institutional Repository

How people perceive and will cope with risks from the diffusion of ubiquitous information and communication technologies

Information and communication technologies (ICTs) are increasingly pervasive and continue to reshape our environment. This trend carries different risks. Therefore, the early sensitization of people to these risks, as well as improving their capacity for protective coping behavior, is essential. Based on the protection motivation theory (PMT), we examined with structural equation modeling the relationships between different components of threat and coping appraisal to explain protective and nonprotective responses. Calculations were performed with data from a representative survey on perception and use of ICT among German residents (N= 5,030). Our findings largely supported the proposed model: an increased perceived threat was positively related to the intentions to react protectively and nonprotectively. Perceived coping efficacy increased the protective and decreased the nonprotective responses. Negative affect enhanced the perceived threat and the nonprotective response, but inhibited protective intentions. The implications of these findings on how to sensitize people to the risks of these new technologies are outlined.
Moser, S.; Bruppacher, S. E.; Mosler, H.-J. (2011) How people perceive and will cope with risks from the diffusion of ubiquitous information and communication technologies, Risk Analysis, 31(5), 832-846, doi:10.1111/j.1539-6924.2010.01544.x, Institutional Repository

2010

Factors affecting farmers’ decisions on fertilizer use: a case study for the Chaobai watershed in Northern China

The Chaobai watershed in northern China is the most important source of drinking water for Beijing. The level of fertilizer use, especially overuse, as well as farming practices in the region have therefore a great impact on the water quality downstream. This study analyses the factors influencing farmers' decision on fertilizer use and the implications for water quality. The analysis is based on a survey of 349 farm households. It takes into consideration both farm and farmer specific characteristics and farmers' subjective evaluation of factors shaping their decisions. Regression models are used to examine the determinants of fertilizer use intensity across farm households and to investigate the factors influencing the overuse of nitrogen. The results suggest the significance of many of these 'subjective' factors, indicating the importance of considering them in the analyses. The results also show that irrigation, gains in crop yield and farming goal of earning are positively correlated to fertilizer use intensity while farm size, manure application, soil fertility and the distance to fertilizer market are negatively correlated. Investigation of the overuse problem shows that higher education level significantly reduces the probability of overfertilization. Based on these findings a few policy relevant implications are discussed.
Zhou, Y.; Yang, H.; Mosler, H.-J.; Abbaspour, K. C. (2010) Factors affecting farmers’ decisions on fertilizer use: a case study for the Chaobai watershed in Northern China, Consilience. Journal of Sustainable Development, 4(1), 80-102, doi:10.7916/D8C24WT5, Institutional Repository

Gathering time-series data for evaluating behavior-change campaigns in developing countries: reactivity of diaries and interviews

Gathering time-series data of behaviors and psychological variables is important to understand, guide, and evaluate behavior-change campaigns and other change processes. However, repeated measurement can affect the phenomena investigated, particularly frequent face-to-face interviews, which are often the only option in developing countries. This article presents three intervention control studies to investigate this issue. Daily diaries in Cuba did not affect behavior or attitudes for persons with intervention but reduced attitudes for persons without intervention. Reactivity of face-to-face interviews in Bolivia was negligible if applied weekly, but strong if applied twice per week. The article concludes with recommendations for gathering time-series data in developing countries.
Tobias, R.; Inauen, J. (2010) Gathering time-series data for evaluating behavior-change campaigns in developing countries: reactivity of diaries and interviews, Evaluation Review, 34(5), 367-390, doi:10.1177/0193841X10383940, Institutional Repository

Persuasion factors influencing the decision to use sustainable household water treatment

Solar water disinfection (SODIS) is a sustainable water treatment method. With the help of the sun and plastic bottles, water is treated and illnesses prevented. This paper aims to identify the factors influencing SODIS uptake, that is, why someone may become a SODIS user. This uptake decision can be influenced by persuasion. From behaviour theory, variables are recognised which have been proven to influence intention and behaviour and simultaneously can be influenced by persuasion. A total of (n = 878) structured interviews were conducted in a field study in Zimbabwe. Linear and binary logistic regressions showed that several of the initially proposed persuasion variables have significant influence. Persuasion factors have a stronger influence on the uptake of SODIS use and on intention to use SODIS in the future than on the amount of SODIS water consumed. Ideas are presented for using the effective variables in future SODIS campaigns and campaigns in other fields.
Kraemer, S. M.; Mosler, H.-J. (2010) Persuasion factors influencing the decision to use sustainable household water treatment, International Journal of Environmental Health Research, 20(1), 61-79, doi:10.1080/09603120903398301, Institutional Repository

Personal, social, and situational factors influencing the consumption of drinking water from arsenic-safe deep tubewells in Bangladesh

Naturally occurring arsenic in groundwater in Bangladesh poses a well-known public health threat. The aim of the present study is to investigate fostering and hindering factors of people's use of deep tubewells that provide arsenic-safe drinking water, derived from the Protection Motivation Theory and the Theory of Planned Behavior. Structured personal interviews were conducted with 222 households in rural Sreenagar, Bangladesh. Multiple linear regressions were carried out to identify the most influential personal, social, and situational behavior determinants. Data revealed that social factors explained greater variance in the consumption of drinking water from deep tubewells than did situational and personal factors. In an overall regression, social factors played the biggest role. In particular, social norms seem to strongly influence deep tubewell use. But also self-efficacy and the perceived taste of shallow tubewell water proved influential. Concurrently considering other important factors, such as the most mentioned response cost (i.e., time needed to collect deep tubewell water), we propose a socially viable procedure for installing deep tubewells for the extended consumption of arsenic-safe drinking water by the Bangladeshi population.
Mosler, H.-J.; Blöchliger, O. R.; Inauen, J. (2010) Personal, social, and situational factors influencing the consumption of drinking water from arsenic-safe deep tubewells in Bangladesh, Journal of Environmental Management, 91(6), 1316-1323, doi:10.1016/j.jenvman.2010.02.012, Institutional Repository

Adoption of agricultural water conservation practices – a question of individual or collective behaviour? The case of the North China Plain

This article compares two approaches to identifying the factors that motivate farmers' application of agricultural water saving measures. On the one hand, it is assumed that farmers respond individually to falls in the groundwater table. Cognitive and socio-demographic parameters are employed to explain the individual conditions under which farmers may change their behaviour in response to groundwater table decline. Farmers' decisions to adopt water saving measures also appear to be triggered by the social environment. The authors tested and compared the assumptions of both approaches using a survey from the Hai River basin on the North China Plain. They found that, although farmers applied water saving measures, this was not as a response to a decline in water resources. The village societal structures appeared to be pivotal in motivating agricultural water saving to the advantage of farmers and the water reserves.
Bluemling, B.; Yang, H.; Mosler, H.-J. (2010) Adoption of agricultural water conservation practices – a question of individual or collective behaviour? The case of the North China Plain, Outlook on Agriculture, 39(1), 7-16, doi:10.5367/000000010791170022, Institutional Repository

Implications of stakeholder constellations for the implementation of irrigation rules at jointly used wells-cases from the North China Plain, China

In view of the declining groundwater table in the North China Plain, this article explores whether, under current farmer groups' irrigation rules and their enforcement, control on irrigation water use can be high. This article first explores whether the sample's rule designs enable potentially excessive irrigation water use to be monitored and sanctioned. It then examines whether this potential to monitor and sanction is exploited under the given stakeholder constellation. The results of the study show that excessive water use and delays in irrigation handover could only be monitored and sanctioned in one case. In many cases, the rule design leads to a low potential to back monitoring with sanctioning, which is why monitoring becomes less effective. Furthermore, in these cases, the stakeholder constellation and group size have a major effect on the effort required to monitor excessive water use.
Bluemling, B.; Pahl-Wostl, C.; Yang, H.; Mosler, H.-J. (2010) Implications of stakeholder constellations for the implementation of irrigation rules at jointly used wells-cases from the North China Plain, China, Society and Natural Resources, 23(6), 557-572, doi:10.1080/08941920903376998, Institutional Repository

Quality of drinking-water at source and point-of-consumption-drinking cup as a high potential recontamination risk: a field study in Bolivia

In-house contamination of drinking-water is a persistent problem in developing countries. This study aimed at identifying critical points of contamination and determining the extent of recontamination after water treatment. In total, 81 households were visited, and 347 water samples from their current sources of water, transport vessels, treated water, and drinking vessels were analyzed. The quality of water was assessed using Escherichia coli as an indicator for faecal contamination. The concentration of E. coli increased significantly from the water source [median=0 colony-forming unit (CFU)/100 mL, interquartile range (IQR: 0-13)] to the drinking cup (median=8 CFU/100 mL; IQR: 0-550; n=81, z=-3.7, p<0.001). About two-thirds (34/52) of drinking vessels were contaminated with E. coli. Although boiling and solar disinfection of water (SODIS) improved the quality of drinking-water (median=0 CFU/100 mL; IQR: 0-0.05), recontamination at the point-of-consumption significantly reduced the quality of water in the cups (median=8, IQR: 0-500; n=45, z=-2.4, p=0.015). Home-based interventions in disinfection of water may not guarantee health benefits without complementary hygiene education due to the risk of posttreatment contamination.
Rufener, S.; Mäusezahl, D.; Mosler, H.-J.; Weingartner, R. (2010) Quality of drinking-water at source and point-of-consumption-drinking cup as a high potential recontamination risk: a field study in Bolivia, Journal of Health Population and Nutrition, 28(1), 34-41, doi:10.3329/jhpn.v28i1.4521, Institutional Repository

2009

Developing strategies for waste reduction by means of tailored interventions in Santiago de Cuba

This article introduces an approach to tailoring behavior-change campaigns to target populations using the example of solid waste reduction in Santiago de Cuba. Tailoring is performed in the following steps: (1) Psychological constructs are selected to detect problems in performing the target behavior, and data are gathered on these constructs. (2) Cluster analyses are performed on these data to identify different psychological types and their distribution in the population. (3) Intervention techniques are assigned according to the spatial and quantitative distribution and the characteristics of these types. Results of the cluster analyses are presented for three different behaviors that can reduce the amount of deposited solid waste (recycling, composting, reuse) on the basis of the four psychological constructs of instrumental and affective attitude, difficulty, and social pressure. The tailoring of interventions could be used to design environmental campaigns more efficiently.
Tobias, R.; Brügger, A.; Mosler, H.-J. (2009) Developing strategies for waste reduction by means of tailored interventions in Santiago de Cuba, Environment and Behavior, 41(6), 836-865, doi:10.1177/0013916509338004, Institutional Repository

Promotion of solar water disinfection: comparing the effectiveness of different strategies in a longitudinal field study in Bolivia

Solar water disinfection (SODIS) is a simple method designed to treat microbiologically contaminated drinking water at the household level. This study focused on the effective promotion of the SODIS method using various strategies. In a longitudinal field study, we compared 2 interpersonal strategies (promoters and opinion leaders) and a centralized strategy (health fair) with a control group. Indicators of effectiveness were SODIS knowledge, SODIS adoption rate, and potential reach. The results suggest that use of promoters is the most successful strategy in terms of reaching people and changing their behavior toward SODIS use. The opinion leaders - although less effective - show some potential to stimulate communication among people about SODIS. Only the health fair did not have a big impact on behavior. Further discussion includes the costs of the various promotional activities, limitations, and recommendations for future projects.
Tamas, A.; Tobias, R.; Mosler, H.-J. (2009) Promotion of solar water disinfection: comparing the effectiveness of different strategies in a longitudinal field study in Bolivia, Health Communication, 24(8), 711-722, doi:10.1080/10410230903264022, Institutional Repository

Economic impacts on farm households due to water reallocation in China's Chaobai watershed

Our study area in the Chaobai watershed, upstream of Miyun Reservoir, has been undergoing agricultural water transfers to downstream municipal uses in Beijing. We examine the impacts of water reallocation on crop production and farmers' income and discuss issues relating to current compensation mechanisms. We use data from a survey of 349 farm households and their farm plots in the upper Chaobai watershed within Hebei province. Water reallocation from upstream to downstream areas has reduced agricultural water supply and the area irrigated. Regression results show that in plots deprived of irrigation, maize yields decrease by 21% and crop revenues decline by 32%. On average, losing irrigation on one hectare of cultivated land reduces net crop income by 2422 yuan. We examine compensation arrangements and social equity for the major policies implemented in the region and we identify gaps between current compensation levels and farmers' income and production losses. The current compensation received by farmers is generally lower than the losses incurred due to reduced irrigation. A more appropriate compensation mechanism is called for in future water transfers.
Zhou, Y.; Zhang, Y.; Abbaspour, K. C.; Mosler, H.-J.; Yang, H. (2009) Economic impacts on farm households due to water reallocation in China's Chaobai watershed, Agricultural Water Management, 96(5), 883-891, doi:10.1016/j.agwat.2008.11.011, Institutional Repository

Changing behavior by memory aids: a social psychological model of prospective memory and habit development tested with dynamic field data

This article presents a social psychological model of prospective memory and habit development. The model is based on relevant research literature, and its dynamics were investigated by computer simulations. Time-series data from a behavior-change campaign in Cuba were used for calibration and validation of the model. The model scored well in several system-analytical tests, including the replication of the data and the forecast of later developments based on earlier data. Additionally, the calibrated parameter values indicate that the accessibilities of intentions decay at the same rate as retrospective memories. However, the accessibilities may stay high due to a reminder, the effectiveness of which depends on a person's commitment to performing the behavior. Furthermore, the effect of the reminder decays over time. This decay is much slower than the development of habits, which, after about a month, were nearly fully developed if the person had executed the behavior sufficiently often. Finally, over time, habits were shown to replace the reminding effect of the external memory aid. This article points to a new understanding of the role of habits in supporting the performance of repeated behaviors through remembering.
Tobias, R. (2009) Changing behavior by memory aids: a social psychological model of prospective memory and habit development tested with dynamic field data, Powder Metallurgy, 116(2), 408-438, doi:10.1037/a0015512, Institutional Repository

2008

Water disinfection and hygiene behaviour in an urban slum in Kenya: impact on childhood diarrhoea and influence of beliefs

In this research project, we studied factors that presumably affect the incidence of diarrhoea among young children in urban slums in developing countries: consumption of safe drinks, hygiene behaviour, cleanliness of household surroundings and the quality of raw water. Beliefs concerning the causes of diarrhoea were also related to health-improving behaviour, namely the application of the water-treatment method SODIS (solar water disinfection) and hygiene behaviour. We conducted a survey in a shanty town in Nairobi, Kenya. Field workers interviewed 500 households. Analysis with regression models revealed that two out of the four postulated factors were significant: children have a lower risk of contracting diarrhoea when they consume high percentages of safe drinks and live in households with good hygiene. As regards beliefs, we found that biomedical knowledge of children's diarrhoea as well as the perceived social norm for treating water was associated with the use of SODIS and good hygiene.
Graf, J.; Meierhofer, R.; Wegelin, M.; Mosler, H.-J. (2008) Water disinfection and hygiene behaviour in an urban slum in Kenya: impact on childhood diarrhoea and influence of beliefs, International Journal of Environmental Health Research, 18(5), 335-355, doi:10.1080/09603120801966050, Institutional Repository

Factors affecting the diffusion of solar water disinfection: a field study in Bolivia

This study examines a broad array of theory-based factors derived from diffusion research that affect the current and intended use of solar water disinfection (SODIS), a simple, low-cost technology for treating drinking water at the household level. The perceived attributes of an innovation, the nature of the social system in which it is diffused, the extent of change agents' promotional efforts in diffusing it, and the nature of the communication channels used were operationalized by 16 variables. The aim of the study is to determine the influence of each factor and its predictive power. Eight areas in Bolivia were visited, and 644 families were interviewed on the basis of a structured questionnaire. Simultaneous multiple regression analysis showed that 9 of the 16 factors derived from diffusion research contributed significantly to predicting the current use of SODIS. The implications of the findings for customizing future SODIS diffusion activities are outlined.
Heri, S.; Mosler, H.-J. (2008) Factors affecting the diffusion of solar water disinfection: a field study in Bolivia, Health Education and Behavior, 35(4), 541-560, doi:10.1177/1090198108321248, Institutional Repository

Attitudinal and relational factors predicting the use of solar water disinfection: a field study in Nicaragua

Solar water disinfection (SODIS) is an uncomplicated and cheap technology providing individuals with safe drinking water by exposing water-filled plastic bottles to sunlight for 6 hours to kill waterborne pathogens. Two communities were visited, and 81 families (40 SODIS users and 41 nonusers) were interviewed. The relationship between several factors and the intention to use SODIS in the future and actual use were tested. The results showed that intention to use and actual use are mainly related to an overall positive attitude, intention to use is related to the use of SODIS by neighbors, and actual use is related to knowledge about SODIS; SODIS users reported a significantly lower incidence in diarrhea than SODIS nonusers. These results suggest that promotion activities should aim at creating a positive attitude, for example, by choosing a promoter that is able to inspire confidence in the new technology.
Altherr, A.-M.; Mosler, H.-J.; Tobias, R.; Butera, F. (2008) Attitudinal and relational factors predicting the use of solar water disinfection: a field study in Nicaragua, Health Education and Behavior, 35(2), 1-14, doi:10.1177/1090198106288251, Institutional Repository

Differences in influence patterns between groups predicting the adoption of a solar disinfection technology for drinking water in Bolivia

The lack of safe drinking water is one of the major problems faced by developing countries. The consequences of contaminated water are diseases such as diarrhea, one of the main causes of infant mortality. Because of its simplicity, solar water-disinfection technology provides a good way of treating water at the household level. Despite its obvious advantages and considerable promotional activities, this innovation has had rather a slow uptake. We conducted a field survey in which 644 households in Bolivia were interviewed in order to gain insights on motivations that resulted in adopting the technology. The aim was to examine possible differences in the predictors for adopting this technology during the diffusion process using the theory of innovation diffusion. Our findings indicate that early adoption was predicted by increased involvement in the topic of drinking water and that adoption in the middle of the diffusion process was predicted by increased involvement by opinion leaders and by recognition of a majority who supported the technology. Finally, late adoption was predicted by recognition that a majority had already adopted. Suggestions for future promotional strategies are outlined.
Moser, S.; Mosler, H.-J. (2008) Differences in influence patterns between groups predicting the adoption of a solar disinfection technology for drinking water in Bolivia, Social Science and Medicine, 67(4), 497-504, doi:10.1016/j.socscimed.2008.04.002, Institutional Repository

Designing environmental campaigns by using agent-based simulations: strategies for changing environmental attitudes

Agent-based computer simulation was used to create artificial communities in which each individual was constructed according to the principles of the elaboration likelihood model of Petty and Cacioppo [1986. The elaboration likelihood model of persuasion. In: Berkowitz, L. (Ed.), Advances in Experimental Social Psychology. Academic Press, New York, NY, pp. 123–205]. Campaigning strategies and community characteristics were varied systematically to understand and test their impact on attitudes towards environmental protection. The results show that strong arguments influence a green (environmentally concerned) population with many contacts most effectively, while peripheral cues have the greatest impact on a non-green population with fewer contacts. Overall, deeper information scrutiny increases the impact of strong arguments but is especially important for convincing green populations. Campaigns involving person-to-person communication are superior to mass-media campaigns because they can be adapted to recipients' characteristics.
Mosler, H.-J.; Martens, T. (2008) Designing environmental campaigns by using agent-based simulations: strategies for changing environmental attitudes, Journal of Environmental Management, 88(4), 805-816, doi:10.1016/j.jenvman.2007.04.013, Institutional Repository

Deriving interventions on the basis of factors influencing behavioral intentions for waste recycling, composting, and reuse in Cuba

In this article the authors study existing waste-disposal intentions and behavior-influencing factors at the household level in Santiago de Cuba. The authors analyze the perceived reputation of the behavior, two different attitude components (sentiment and cost-value ratio), and perceived difficulties. Our focus is to compare three types of waste-disposal behaviors and derive specific interventions. The behaviors most suitable to Cuba are recycling, composting, and reuse. Analysis with structural equation modeling (SEM) reveals relevant differences in factor influence for attitude components and perceived reputation. Recycling and composting are most strongly influenced by affective aspects of attitude, whereas the general attitude toward reuse seems to have a more rational basis. The influence of perceived reputation on recycling is strong, that on composting is moderate, and no influence at all is found for reuse. The authors combine the SEM results with those of the qualitative data analysis of problems and incentives assessed from the participants and suggest behavior-specific interventions.
Mosler, H.-J.; Tamas, A.; Tobias, R.; Caballero Rodríguez, T.; Guzmán Miranda, O. (2008) Deriving interventions on the basis of factors influencing behavioral intentions for waste recycling, composting, and reuse in Cuba, Environment and Behavior, 40(4), 522-544, doi:10.1177/0013916507300114, Institutional Repository

2007

Psychological factors determining individual compliance with rules for common pool resource management: the case of a cuban community sharing a solar energy system

This study focuses on individuals’ subjective reasons for complying with rules for common pool resource management. We examine the topic of individual rule compliance, which the commons literature has addressed only marginally, and outline recent empirical findings. Hypotheses are derived based on rule compliance theory and explored using data gathered in a Cuban community sharing a solar energy system. The statistical analyses reveal that compliance with rules for energy management is influenced by various factors. Depending on the particular rule, factors such as sanctioning, legitimacy, and compatibility, among others, influence the frequency of individual rule compliant behavior to differing extents.
Jenny, A.; Fuentes, F. H.; Mosler, H.-J. (2007) Psychological factors determining individual compliance with rules for common pool resource management: the case of a cuban community sharing a solar energy system, Human Ecology, 35(2), 239-250, doi:10.1007/s10745-006-9053-x, Institutional Repository

Identifying the institutional decision process to introduce decentralized sanitation in the city of Kunming (China)

We conducted a study of the institutional barriers to introducing urine source separation in the urban area of Kunming, China. On the basis of a stakeholder analysis, we constructed stakeholder diagrams showing the relative importance of decision-making power and (positive) interest in the topic. A hypothetical decision-making process for the urban case was derived based on a successful pilot project in a periurban area. All our results were evaluated by the stakeholders. We concluded that although a number of primary stakeholders have a large interest in testing urine source separation also in an urban context, most of the key stakeholders would be reluctant to this idea. However, the success in the periurban area showed that even a single, well-received pilot project can trigger the process of broad dissemination of new technologies. Whereas the institutional setting for such a pilot project is favorable in Kunming, a major challenge will be to adapt the technology to the demands of an urban population. Methodologically, we developed an approach to corroborate a stakeholder analysis with the perception of the stakeholders themselves. This is important not only in order to validate the analysis but also to bridge the theoretical gap between stakeholder analysis and stakeholder involvement. We also show that in disagreement with the assumption of most policy theories, local stakeholders consider informal decision pathways to be of great importance in actual policy-making.
Medilanski, E.; Chuan, L.; Mosler, H.-J.; Schertenleib, R.; Larsen, T. A. (2007) Identifying the institutional decision process to introduce decentralized sanitation in the city of Kunming (China), Environmental Management, 39(5), 648-662, doi:10.1007/s00267-005-0321-0, Institutional Repository

Umweltpsychologische Interventionsformen neu gedacht

In this paper we argue that for environmental psychology it is essential and functional to have a sound classification of behavioral interventions. At first well known classification systems are depicted. Based on a model about the mode of action of the intervention techniques a classification system is developed in which the techniques can be grouped in an environmental psychological meaningful way. Corresponding to the developed classification all behavioral change techniques can be divided into two groups accordingly whether the techniques are changing individual preferences for behavior or whether they activate or encourage behavioral change. In the first group we find the traditional distinction between structural and person focused techniques and in the second group between situational and dissemination focused techniques. Further subdivisions follow aspects of psychological and intervention techniques because each class of techniques is determined due to certain problems to be tackled when realizing a behavioral change campaign. Furthermore the choice of the intervention techniques based on the proposed classification is discussed and the classification itself is reviewed.
Mosler, H.-J.; Tobias, R. (2007) Umweltpsychologische Interventionsformen neu gedacht, Umweltpsychologie, 11(1), 35-54, Institutional Repository

Einsatz der Computersimulation in der Umweltpsychologie

The method of computer-simulation is still a young field, but especially useful for the investigation of complex systems typical for topics of environmental psychology. This paper offers a brief overview of the method, especially its field of application, the procedure of developing simulation models and ideas for using them for solving practical tasks of environmental psychologists. The method is especially useful for handling problems, where the system of interest can not be reduced to a few simple parts with a few simple interactions. Additionally, the method is ideal for investigating and forecasting dynamic developments over time. When using simulation models for planning and guiding campaigns, which aim at influencing social developments, it is crucial not to assign their results directly to reality. Simulation-results must be concretized to plans, which also consider aspects that were not included in the abstract formal model. Further, the simulation models must be adapted continuously to information about the influenced system that becomes available during the realization of the campaign.
Tobias, R.; Mosler, H.-J. (2007) Einsatz der Computersimulation in der Umweltpsychologie, Umweltpsychologie, 11(2), 22-37, Institutional Repository

Outdoor recreation: from analysing motivations to furthering ecologically responsible behaviour

Outdoor-recreation activities can have negative effects on nature. The Swiss authorities and sport associations have, therefore, been trying to encourage people to behave more responsibly towards nature during outdoor recreation. To provide scientific support for this, the study aimed at: 1) clarifying people's motivations for outdoor recreation and in particular how important experiencing nature is for them; 2) analysing the predictors of ecologically responsible recreation behaviour according to Ajzen's theory of planned behaviour, and 3) evaluating concrete intervention measures to further such behaviour. To this end qualitative interviews, a representative survey as well as intervention experiments were conducted in Switzerland. The results of the nationwide survey showed that "experiencing nature" is one of the most important motivational factors, whereas experiencing thrill is not as important as it is often assumed. Regression models revealed the importance of Ajzen's general predictors of ecological behaviour as well as the significance of specific factors such as landscape preferences. Combining prompts and information, and providing suitable infrastructure are recommended to encourage people to be more ecologically responsible in their outdoor recreation.
Zeidenitz, C.; Mosler, H. J.; Hunziker, M. (2007) Outdoor recreation: from analysing motivations to furthering ecologically responsible behaviour, Forest Snow and Landscape Research, 81(1-2), 175-190, Institutional Repository

Waste-resource flows of short-lived goods in households of Santiago de Cuba

In this paper, we apply the method of material flow analysis to analyze the consumption and waste mass flows of short-lived goods and we provide first insights into the waste management behavior of households in Santiago de Cuba. The goods analyzed are glass, aluminum, organic material and PET. The necessary data were gathered in personal interviews with 1171 households using a standardized questionnaire. The questionnaire contained questions about socio-demographic variables, such as age, sex, education, income and occupation. The households were asked how many PET bottles, aluminum and glass containers they consume per month and how they dispose of the different kinds of garbage.
Our investigations show that:

(i) Cuba has a high recycling rate closely comparable to that of Switzerland and Germany, which have the highest recycling rates world-wide. The high recycling rate is achieved through a combination of social organization, control and internalized norms. In contrast to other developing countries, where the informal sector plays an important role in recycling activities, in Santiago de Cuba the contribution of the informal sector is marginal.
(ii) The preferred recycling path, where 50–70% of the waste is disposed of, is Comité de Defensa de la Revolución, Revolution Defense Committee (CDR), a collection entity organized at the neighborhood sector level, which also fulfills social control functions.
(iii) Recyclable goods could also be sold in the "cases to compra", where for 20 empty bottles, a filled one can be obtained. However, this recycling path is only used for 1.5–5% of the waste fraction. This can be explained by the fact that, in addition to the social control provided by CDR, pushing people to bring their recyclable materials to CDR, there is a problem of reputation: people who collect empty bottles are looked down on.
(iv) There are virtually no differences in the disposal and recycling pattern between the rich and the poor quartile of the population.
Binder, C. R.; Mosler, H.-J. (2007) Waste-resource flows of short-lived goods in households of Santiago de Cuba, Resources, Conservation and Recycling, 51(2), 265-283, doi:10.1016/j.resconrec.2006.04.001, Institutional Repository

Simulating human behavior for understanding and managing environmental resource use

Computer simulation allows for the experimental study of dynamic interactions between human behavior and complex environmental systems. Behavioral determinants and processes as identified in social-scientific theory may be formalized in simulated agents to obtain a better understanding of man-environment interactions and of policy measures aimed at managing these interactions. A number of exemplary agent-based simulation studies is discussed to demonstrate how simulations can be used to identify behavioral determinants and processes underlying environmental problems, and to explore the possible effects of policy strategies. Finally, we highlight how agent-based simulation may contribute to our understanding of the dynamics of environmental resources, and how to manage them in a sustainable way.
Jager, W.; Mosler, H. J. (2007) Simulating human behavior for understanding and managing environmental resource use, Journal of Social Issues, 63(1), 97-116, doi:10.1111/j.1540-4560.2007.00498.x, Institutional Repository

2006

Household energy use patterns and social organisation for optimal energy management in a multi-user solar energy system

Multi-user systems (MUS) for electrification of rural villages have specific advantages compared with individual systems (SHS). However, as MUS serve multiple consumers, shared energy use presents a challenging problem to the communities. Despite the increased performance of MUS over SHS, they still produce a limited amount of available energy, and users cannot consume as much electricity as they wish without considering the needs of the other users. This means that energy distribution among village residents has to be organised and energy consumption has to be controlled. There are different ways to achieve energy distribution. One possibility is to leave it to the users themselves to organise rational energy use according to their needs and daily routines. For the development of a self-managed scheme, knowledge is required not only of the users' total energy consumption, but also of their individual energy use patterns. With knowledge of the community's energy consumption habits, rules for adequate energy use can be developed more accurately. The present study describes community energy management in a Cuban village using a central photovoltaic installation. Applying different methods, data were collected in order to identify individual energy use patterns and to investigate how villagers distribute energy and what rules of use are in effect. We wanted to find out whether their energy management leads to well-adapted energy use patterns and reasonable system performance. The results show that the village residents have developed rules and agreements for coordination of their energy use that have led to good adaptation to the dynamics of energy production.
Jenny, A.; Díaz López, J. R.; Mosler, H.-J. (2006) Household energy use patterns and social organisation for optimal energy management in a multi-user solar energy system, Progress in Photovoltaics, 14(4), 353-362, doi:10.1002/pip.672, Institutional Repository

Wastewater management in Kunming, China: a stakeholder perspective on measures at the source

Large sewer systems with central wastewater treatment plants were long considered a successful model that could be exported to practically any city of the world. This centralized, highly water-consuming system has, however, shown its limits in some developing and transition countries, especially in fastgrowing cities with limited water resources. This study from around Lake Dianchi in Yunnan, China, investigated the feasibility of introducing measures at the source for the different urban wastewater contributions in the city of Kunming, and the stakeholder perspectives on this approach. In addition, the stakeholders evaluated the potential of two different sanitation alternatives that allowed the separation and re-use of human excreta as fertilizer. Most of those interviewed approved of measures at the source, especially for industrial wastewater and toilet waste. There was a prevailing optimism with respect to the potential of technical developments and the likelihood of increased environmental awareness within a relatively short time span of 20 years. The findings suggest that China will prove to be one of the most interesting and productive "laboratories" for the development of decentralized wastewater treatment alternatives.
Medilanski, E.; Chuan, L.; Mosler, H.-J.; Schertenleib, R.; Larsen, T. A. (2006) Wastewater management in Kunming, China: a stakeholder perspective on measures at the source, Environment and Urbanization, 18(2), 353-368, doi:10.1177/0956247806069615, Institutional Repository

Better be convincing or better be stylish? A theory based multi-agent simulation to explain minority influence in groups via arguments or via peripheral cues

Very often in the history of mankind, social changes took place because a minority was successful in persuading the dominant majority of a new idea. Social psychology provides empirically well-founded theories of social influence that can explain the power of minorities at individual level. In this contribution, we present an agent-based computer simulation of one such theory, the Elaboration Likelihood Model (ELM). After introducing the theoretical background and our agent model, we present three simulation experiments that confirm past laboratory research but also go beyond its findings by adopting the method of computer simulation. First, we found that even a minority with low argument quality can be successful as long as it has positive peripheral cues. Second, our results suggest that a higher personal relevance of a topic for the majority led it to be more receptive to minority influence only when the minority showed neutral peripheral cues and very good arguments. Third, we found evidence that a neutral or only slightly biased majority is influenced more easily than a strongly biased one. To sum up, we consider these results to illustrate the notion that a well-presented, comprehensible and valid computer simulation provides a useful tool for theory development and application in an exploratory manner as long as it is well founded in terms of the model and theory.
Mosler, H.-J. (2006) Better be convincing or better be stylish? A theory based multi-agent simulation to explain minority influence in groups via arguments or via peripheral cues, Journal of Artificial Societies and Social Simulation, 9(3), (18 pp.), Institutional Repository

Formulating waste management strategies based on waste management practices of households in Santiago de Cuba, Cuba

Rapid urbanisation, population growth and changes in lifestyles in low- and middle-income countries contribute to increasing the per capita domestic waste generation. This trend leads to deplorable environmental and public health conditions, especially in rapidly expanding cities of low- and middle-income countries lacking appropriate waste management systems, Santiago de Cuba is no exception. To improve solid waste management in the city of Santiago de Cuba, the generation of household waste was studied and individual waste treatment approaches were assessed. The principle of a household level analysis was adopted to enable the development of strategies based on the specific conditions of households, their awareness and needs.
In February 2004, a survey covering 1180 households was conducted on issues such as monthly consumed goods, waste generated and its treatment. The waste generated by the households was subsequently assessed by means of a measuring campaign. The measured volume not only comprised the collected waste fraction but also the waste materials treated on-site or recovered and recycled by all the different means available.
The paper contains the results of the composition and distribution of the waste generated by the households as a function of socio-demographic data. Furthermore, the paper describes the various household treatment strategies dependent on specific waste material types. Several types of household waste can be differentiated by statistical cluster analysis. These household types are characterised not only by the amount of waste generated but also by socio-economic status and waste treatment practices. The results obtained are used to develop a range of waste management strategies, each relating to a household type and characterised by its generated amount, waste material type and spatial urban distribution. Since the strategies are adapted to the requirements and needs of the households, they are more readily accepted by the population concerned. Such socially anchored strategies will contribute to improving the waste situation in the city of Santiago de Cuba and allow an optimised allocation of local resources.
Mosler, H. J.; Drescher, S.; Zurbrügg, C.; Caballero Rodríguez, T.; Guzmán Miranda, O. (2006) Formulating waste management strategies based on waste management practices of households in Santiago de Cuba, Cuba, Habitat International, 30(4), 849-862, doi:10.1016/j.habitatint.2005.09.008, Institutional Repository