Safe
Water System Manual
10.0
Prepare to implement the behavior change strategy
Tasks:
Use
information from formative research (see 7.1) to develop
plans and materials to carry out the behavior change strategy. Effective messages,
materials and other behavior change interventions will increase demand, purchase,
and use of appropriate water storage vessels and disinfectant. Developing effective
materials requires pretesting them with the target audience to find out whether
they create the desired effect and revising them accordingly.
Developing
an effective behavior change strategy and its components, such as brand name,
logo, messages, materials, etc., requires special skills. It is recommended that
the project works with specialists to undertake this development. Individuals
who have the skills and experience to contribute in this area may be found in
HIV/AIDS health education within the MOH, in private firms or advertising companies
within the country that have produced effective marketing campaigns, or in NGOs
with substantial behavior change activities. In Kenya, for example, CARE
hired a marketer who had worked in the private sector. He appreciated the opportunity
to apply his skills to a socially useful product.
10.1
Develop brand name and logo
Development
of the brand name and logo to position the Safe Water System positively for the
target population is a very important step. Having a brand name and logo can be
very beneficial because it gives people an easy way to identify the products.
The best brand names are simple, catchy, and evoke healthy images in the minds
of the target population. When the brand name and logo are completed, they should
be incorporated in the various promotional and educational materials.
10.2
Develop key messages
Use
appropriate language, terms and local dialect to ensure that messages are relevant
to the audience and can be understood by them. If a new term is needed, it may
be necessary to introduce the new term and teach what it means in educational
messages. Prepare educational and promotional messages in pictures and words.
The pictures should be understandable without the words, so that illiterate people
in the target population can also understand the message.
Formative
research provides information on:
•
local language and terms _ to decide on wording of messages
•
current knowledge about diarrhea
•
positive perceptions about water disinfection and storage
•
negative perceptions and barriers to address in messages
The
project must decide which positive perceptions to reinforce and which benefits
to emphasize in promotion, according to local circumstances. Some messages may
need to address negative perceptions (e.g., about chlorine) or barriers to use
of the Safe Water System. Negative messages or warnings tend not to work as well
as positive messages. Messages must give information the audience wants and needs
but does not know. Promotion can be effective by associating use of the Safe Water
System with a status and lifestyle that people aspire to have.
Develop
messages that fulfill specific educational and promotional objectives and that
are:
•
easy to understand _ simple, using appropriate language and local terms
• easy to remember _ simple, conveying only 1 or 2 ideas
•
positive — conveying positive benefits of products in a way that encourages
use
•
specific and action-oriented, not general
•
accurate, feasible and relevant
•
sensitive to existing cultural beliefs
•
attractive and interesting
•
conveyed in pictures that can be understood without words (particularly important
for messages about how to use products)
The
actual messages will depend on findings of the formative research and the behavior
change objectives. The box below lists some common messages.
Figure
14: Key Messages or Topics for Education and Promotion
Diarrhea
How water
is contaminated •
Animal and human feces on the open ground get washed into water sources (surface
water, shallow wells)by rain •
Sewage is dumped in surface water sources •
Crossed connections are accidentally made between sewer and water lines
• Cracks or holes
in water pipes allow surface contami-nants (animal and human feces) to get into
water lines (particularly when there are power outages which shut off pumps and
create negative pressure which sucks surface contaminants into the water lines)
•
People with fecally-contaminated hands touch water stored in wide-mouthed containers
such as buckets How
drinking contaminated water causes diarrhea •
Microbes that cause diarrhea are present in feces. These are ingested when a person
drinks contaminated water. •
Microbes are too small to see. Clear water can be very contaminated.
The
problem of diarrheal disease in our community •
Use local data that is meaningful, for example, the number of episodes of diarrhea
in children under age 5 per month in the community, the percentage of children
who die of diarrheal diseases annually Young
children are at particular risk of diarrhea, which can be very severe in infants
and toddlers.
You can prevent diarrhea by using the Safe Water System.
Protect
your family from diarrhea by using the Safe Water System. Acquiring
vessels and disinfectant
Where to go to get disinfectant and a vessel
Get a safe water storage vessel
What disinfectant is; it is safe
Buy
disinfectant and always use it
Prices of the vessel and disinfectant
How
long disinfectant lasts in the bottle; when to discard
How to obtain more
disinfectant Treating
water
How the intervention works
Disinfectant kills microbes in
water within 30 minutes
Storage container keeps new microbes out of water
Cloth filter removes dirt from water so disinfectant is more effective
Allowing
water to settle and separating the clear water makes disinfectant stronger.
The
correct amount of disinfectant to use in recommended containers.
How to measure
and add the correct amount of disinfectant to water
Wait 30 minutes to allow
the disinfectant to work and then drink
Always treat water before drinking
it, or using it to wash or prepare food Storing
water
Use the vessel correctly to store water and protect it from
contamination
Do not put your hands or let anyone else put their hands or
utensils into water
Clean the vessel at least once a week Uses
of treated water
Drinking
Washing hands
Washing produce
Cleaning
cooking and eating utensils Storage
of disinfectant bottle
Out of reach of children
Indoors, in a
dark cool place Benefits
of water treatment and safe storage
Your family, particularly children,
will stay healthier and will have less diarrhea if you use disinfectant and a
safe water storage vessel.
Shows that you are a better mom
Shows that
you are a smart mom
Shows that you are a trend setter |
10.3
Make detailed plans for implementing the methods for behavior change
Describe the methods
selected for behavior change and make detailed plans for each. Plans should include
channels and the numbers and types of staff needed to implement the methods. Plan
where, when, how often staff will implement the methods, and produce a list or
schedule.
For
example:
•
In both the Central and Northern districts, project will conduct informational
meeting for teachers and distribute materials to them by (date). Teachers will
do educational activities in the schools at least once weekly.
•
Project will distribute promotion and education materials to outlets by (date)
in the Central district and (date) in the Northern district. Shopkeepers will
do education and promotion on an ongoing basis.
•
In the Central district only, house-to-house visitors will be selected, trained
in motivational interviewing (specify date, location and trainer), and will make
house-to-house visits in their assigned areas according to a schedule developed
at their training (to visit each house twice monthly).
•
In both districts, posters will be hung in market places and in government offices
by (date).
•
In the Northern district, a local drama group will be contacted and their help
enlisted by (date); local drama group will perform once weekly at market days
plus at community mobilization meetings in the towns of Adaba and Cristo on (dates).
•
Project will distribute educational and promotional materials to 8 health centers
in the Central district by (date) and 4 health centers in the Norther district
by (date).
•
The project will conduct 4 training sessions for health center staff in the Central
district and 2 sessions in the Northern district (specify schedule). Health center
staff will teach mothers about the Safe Water System at well-baby clinics each
week. Health center staff will teach mothers of children who come with diarrhea
about the Safe Water System.
10.4
Plan training of staff to implement behavior change methods
Key steps in organizing
training in any project are:
•
Decide who needs training
•
Develop a training curriculum and materials, if not already available
•
Identify suitable trainers
•
Develop a plan to implement training, and consider whether this training can be
integrated into other training activities
List
the types of staff that will be involved in the project and list the tasks that
they should perform. Assess their need for training. Everyone will need to be
informed of the tasks that they are expected to do. Some will need further training
to provide new skills. Staff will require training for their role in distribution
of products as well as their tasks related to behavior change methods. Training
may include oral instruction, written instruction, review of reference materials,
discussions, demonstrations, practice exercises, and practice on the job.
For
effective interpersonal communications, the project must train staff about the
Safe Water System and its use, and how to use printed materials. Effectiveness
of communications can be greatly increased if staff are trained how to communicate
effectively and ensure that messages are understood. For example, a group of community
volunteers received training in a behavior change technique known as motivational
interviewing (see Annex F for a description of the training).
Prior to training, 1% of the target population used disinfectant in their water
compared to 2% of a neighboring community. Three months after the community volunteers
received training, 78% of the target population had detectable chlorine residuals
in their stored water, compared to 4% in the neighboring community.(Quick,
unpublished data)
10.5
Develop communication materials and training materials
Develop
text, artwork and layout for the materials needed. This may include point-of-purchase
signs, stickers and cards to identify outlets and sales persons; brochures with
instructions on product use and benefits; posters to promote the products and
benefits.
Develop
video. Video development includes writing a script, filming, editing a film, and
adding narration and graphics.
Develop
specifications for and list messages that may be included in wall paintings or
murals. Then commission community artists to do the paintings.
Write
newspaper stories or advertisements.
Design
small group activities such as presentations and demonstrations for community
meetings, club meetings, etc. This includes writing scripts and instructions,
and designing visual aids.
Produce
radio spots, including writing scripts, taping a speaker, adding music, and editing.
Figure
15: Characteristics of good educational and promotional materials
A
good logo •
Simple, not cluttered •
Explicit and not abstract, the audience should understand it immediately •
Related to the key benefits of the Safe Water System, a symbol of the idea •
Positive, uplifting, conveys the idea of results •
Easily reproducible •
Works in different sizes and settings •
Dramatizes the overall tone of the behavior change strategy | A
useful flyer, visual aid or brochure •
Carries the information most likely to be forgotten •
Uses visuals to tell the story, not just words •
Shows people performing key behaviors •
Uses images attractive to the audience •
Concise •
Maintains same tone as overall behavior change strategy •
Organized so that it favors a logical action sequence
• Designed for
easy use as a visual aid •
Matches graphic and language skills of specific audience |
An
effective public poster •
Dramatizes a single idea •
Attracts attention from at least ten meters away •
Uses visuals to carry the message •
Memorable •
Models the behavior whenever possible •
Shows how the product benefits people •
Consistent with tone of overall change strategy | An
effective radio spot •
Presents one idea •
Begins with an attention getter •
Is direct and explicit •
Repeats the key idea at least two or three times •
Asks listeners to take action •
Makes the audience feel part of the situation •
Maintains the same tone as the overall change strategy |
Training
materials may be needed in addition to the educational and promotional materials
for the community described above. Training materials should prepare staff to
do their specific tasks in the Safe Water System project. For example, shopkeepers
may need:
•
a description of how they should promote the Safe Water System to customers, including
main points to describe
•
frequently asked questions and how to answer them
•
instructions for keeping records of sales
•
instructions for reordering stock of disinfectant and/or vessels.
Training materials
may also describe how shopkeepers should display posters and other point-of-purchase
materials and suggest how to use the pamphlet when talking with customers.
Training materials
are most effective when they are simple and focus just on behaviors that the person
is supposed to do.
Some
participants in the project will not need written training materials but will
be trained by another person. In this case, prepare a trainer's outline of points
to address and exercises to do with the group, to show them how and have them
practice carrying out their tasks correctly. See Annex I for an example of a plan
for a training session.
10.6
List the activities related to behavior change and desired outputs (quantities)
List
the activities and outputs (quantities) that the project plans to achieve. These
should be main activities and level of effort required to achieve the objectives
specified in step 2.0. See an example in Figure 16.
Figure
16: Sales and Behavior Change Activities to Lead to Achievement of the Objectives
(This
example is for illustration only. Actual implementation plans will be much more
detailed.) To
achieve the following project objectives: 1.1
- Sell 20,000 bottles of disinfectant in first 3 months 1.2
- Sell 1,000 water storage vessels in first 3 months 2.1
- 70% of target population will recognize the brand name of the Safe Water
System products (vessel and disinfectant) after 6 months 2.2
- 30% of households will report use of approved water storage vessel and disinfectant
after 6 months 2.3
- 25% of households will have knowledge of correct dose of disinfectant after
6 months 2.4
- 25% of households will have observed safe water storage practices after
6 months 2.5
- 10% of households will have measurable residual free chlorine levels >0.2
mg/liter after 6 months. 2.6
- 10% of households will have no detectable E. coli colonies in stored
water
The
project will implement the following activities: Production
and Sales 1.
Produce 1500 liters of solution per month
2. Produce 100% of batches of solution with hypochlorite concentration >0.5%
3. Train
30 community-based distributors (such as community volunteers)
4. Place disinfectant and vessels in 60 retail shops and demonstrate consistent
supply
5. Place disinfectant or vessels in 10 health facilities
Education and
promotion 6.
Design and produce 20,000 information brochures
7. Hold informational meeting in 10 communities per month
8. Train 10 community health workers to deliver education methods per day
9. Design and broadcast one advertisement on the radio 3 times per day 10.
Conduct educational event in 4 schools per month 11.
Produce video and show it to 3 communities per week 12.
Observe health facility staff providing education to mothers once per week
Community
mobilization 13.
Establish neighborhood committees in 3 communities in first 3 months 14.
Have 3 committees work through participatory process in 3 months 15.
Have 3 communities organize themselves for the project in first 3 months
Motivational
interviewing 16.
Train 10 trainers in first 3 months 17.
Each trainer trains 5 additional trainers in 3 months 18.
Each of 50 trainers trains 10 volunteers in 3 months 19.
Each volunteer conducts motivational interviewing intervention in 10 community
households in 3 month period
|
10.7
Arrange use of channels selected
Arrange
use of channels as planned in step 7.5.
Seek radio time
that may be donated by government stations or purchased time from commercial stations.
Arrange for air time on stations that the target audience listens to and schedule
broadcasts at times the target audience listens.
Arrange
for use of a video projection truck. Schedule where and when the truck will visit
different communities, markets, businesses, etc.
Arrange
with the local newspaper to print advertisements or notices on certain dates.
Arrange
for interpersonal communications through health staff, shop keepers, sales persons.
This includes distributing materials to them and training them how to communicate
the messages (see 10.10 below).
10.8
Pretest messages and materials
It
is essential to pretest messages and materials with members of the community to
be sure they convey the message clearly and have the positive effect intended.
Pretest pictures as well as words to be used in promotional messages. Pretesting
can avoid expensive and time-consuming mistakes.
Pretesting
can be done through in-depth interviews or focus group discussions with a sample
of the target audience. It is important that the interviewers listen carefully
to the participants' impressions of the materials and NOT tell them what the messages
are. If the participants do not understand something, the interviewer should record
that and not explain until the interview or focus group is over. This method enables
an unbiased assessment of how well the materials convey the intended message.
Pretesting should check the following:
•
Presentation: Do people like the words and pictures?
•
Attention: Does the message hold the audience's attention?
•
Comprehension: Does the audience understand the intended messages and products?
• Personal
relevance: Does the audience perceive the messages to be made for them or
made for other people?
•
Believability: Does the audience perceive the message and its source to
be credible?
•
Acceptability: Is anything (words, pictures, implications) offensive or
culturally inappropriate?
Frequently
the same material is presented in two or more formats, so that people can choose
the one they prefer. Arrange to actually observe people using the materials or
products. For example, if a brochure teaches how to add the disinfectant to water,
it is best to ask women to actually perform these tasks, using instructions in
the brochure. In this way one can observe whether women can actually follow the
instructions.
Based
on feedback from pretesting, revise the messages and materials. Revision may involve
changing text or illustrations, eliminating a particular element such as distracting
sound effects in a radio spot, combining parts of two different materials, or
actually beginning from scratch with a new idea made evident by the tests. Pretest
again with a sample of the target audience to see that the modifications have
improved the materials in terms of the audience's comprehension and other criteria
listed above. If new materials are developed, they should be pretested before
being produced in final form.
In
Madagascar, for example, the original draft of an instructional brochure showed
a close up of a hand holding a cap of disinfectant and pouring it into a bucket.
Mothers were confused by the brochure and could not understand the picture. When
this picture was replaced by a drawing of a woman holding and pouring the capful
of solution, understanding improved. Also, in this draft brochure, the different
steps of treatment were numbered. Step 3 showed the woman pouring a half capful,
the recommended dosage, into her container. Several people, when referring to
the brochure, poured 3 half capfuls into their containers, mistakenly
interpreting
the number 3 as the number of capfuls to use. This problem was corrected by using
arrows to point from one step to the next, rather than numbers.
10.9
Produce and distribute materials
Estimate
the number of copies of different materials needed for distribution to the target
population (e.g., brochures, point-of-
purchase
displays, posters, videos). Print the needed quantities and distribute them to
health facilities and other outlets, health staff, marketing staff, organizations
such as neighborhood health committees, and warehouses that will resupply outlets.
Also provide sufficient quantities for training sessions.
10.10
Train persons who will implement the behavior change methods
To
prepare for implementation of the educational and promotional activities:
• Train health
staff to use educational materials to teach the target population about products
and behaviors.
•
Train pharmacists, shopkeepers, volunteers and other persons who will sell products
about the messages to tell customers, use of sales brochures and other point-of-purchase
materials, procedures for managing money from sales, and procedures for restocking
supplies.
•
Hire and train promotional workers (e.g., communicators, video projection truck
drivers) how to communicate messages, and how to answer likely questions from
families.
•
If plans include use of motivational interviewing, train the selected staff in
those skills (see Annex F).
Training
should include information, examples and practice. The trainer should:
• describe
the task and give necessary information about it such as tools and supplies needed,
when to perform it, and main steps.
•
demonstrate himself or show the learners an example of someone doing the task
correctly.
•
ask the learners to practice the task (or part of the task) so that they gain
experience.
•
watch carefully and give additional help as needed until every learner can perform
the task. People learn better and remember longer how to do a task that they actually
perform, as opposed to only hearing about it or seeing someone else perform it.
10.11
Plan additional behavior change interventions, if possible
Consider planning
additional methods to increase demand for products and behavior change, if possible.
Below are some methods used in Safe Water System projects so far:
•
use of volunteers for door-to-door sales (Zambia)
•
payment of commissions/incentives for sales (Zambia)
•
home visits by health workers to reinforce messages (Pakistan, Madagascar, Kenya,
Zambia)
•
use of Safe Water System in schools to teach school children (Equador, Bolivia)
• branded
items such as drinking glasses, cups, t-shirts, stickers and pens to promote awareness
of water system project-approved vessels and disinfectant solution.
