Development Advisory Team Final Report: Project Ricardo

Catalyzing Behavior Change to Promote Community Health in

Arcabuco, Colombia
Notre Dame Initiative for Global Development: Project Ricardo
Development Advisory Team Final Report

Colleen Ballantyne, Sonia Gonzalez & Sarah Pieslak

IDS 30513 International Development in Practice: What Works in Development?
Fall 2018
Professor Steve Reifenberg
Development Advisory Team Final Report: Project Ricardo
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Table of Contents

Team Biographies 2

I. Context and Inquiry Goals 3

II. Theories of Change 4

a. Heath & Heath’s Switch Theory

b. Theory of Reasoned Action (TRA Case Study)

c. Barrier Analysis

III. Recommendations and Conclusions 11

Bibliography 13

Appendix 15

a. Barrier Analysis Framework Worksheet: Exclusive Breastfeeding in Burundi

b. Starter Barrier Analysis Framework Worksheet: Project Ricardo

c. Case Study 1: Citizenship Culture Building in Bogotá

d. Case Study 2: Spring Cleaning Program

e. Barrier Analysis Sample Survey/Questionnaire

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Development Advisory Team Final Report: Project Ricardo
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I. Context and Inquiry Goals

Many theories regarding behavior change attempt to understand the fundamental causes that drive
human action. These theories seek an understanding and a way to predict the way people will change
established habits and lifestyles to achieve some desired effect or outcome, whether it is negative or
positive. When tasked with understanding the methods and ideas for catalyzing behavior change, we did
not realize how extensive this field of study would be. Behavior change is multifaceted and the reason it
encompasses many components of the human mind can explain why it is a field so widely studied. There
is not a straightforward textbook understanding for it and many theories exist to try to unpack the
fundamental questions of why people behave the way they do and how can that behavior be changed. The
question that directly guided our research was the following: How might we identify and catalyze
behavior change to improve water, sanitation, and hygiene conditions to promote community health in
Arcabuco, Colombia?
The specificity of Project Ricardo in this community within Arcabuco added a distinct dynamic
when directing our research. One of our team members, Colleen Ballantyne, had the opportunity to travel
to Arcabuco in an effort to learn more about water practices and perceptions in the community. She was
able to learn by visiting homes and conducting surveys in 5 of the 9 ​veradas​ in Arcabuco. Revelations
were made surrounding clean water access, knowledge and and perception. She was also able to learn
about people's views of the government and community partners. As important as all of the information
about water practices and water systems is to this project, even more important are the people at the center
of this project. The number one thing that should influence the behaviors being changed and how to best
approach those changes is the people of Arcabuco. In order to work to change a behavior, it is first
important to understand current practices and why practices are what they are, which is why we consider
the insight a privilege.
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II. Theories of Change

In our research, we encountered three main theories that seem best applicable to Project Ricardo’s
goal of transforming water storage practices in Arcabuco, Colombia. In the following sections, we will
explain the basic premise of each behavior change theory and apply specific elements to the water
situation in Arcabuco. The appendix also includes case studies that show these theories in action in the
developing world.

Heath & Heath’s Switch Theory

Switch Theory is featured in Chip Heath and Dan Heath’s book
Switch: How to Change When Change Is Hard​ and focuses on
creating lasting behavior change by targeting the conflict between
the rational mind and the emotional mind. By minimizing or
eliminating the barriers to both the individual’s rational and
emotional side, Switch Theory overcomes this internal conflict to
effect transformative change. Heath and Heath represent this
mental conflict with the analogy of a rider on an elephant. Each
individual has an emotional Elephant side and a rational Rider side
and the path must be cleared for both sides to succeed. The rational
Rider symbolizes the conscious, verbal thinking portion of the brain
that tells us to set our alarm to get up early or to eat a salad, things
that we recognize are logically beneficial in the long-term. The rider focuses on information, patterns and
logic in decision-making. While thoughtful and deliberate, the Rider is
limited in strength and energy; at times, the rational Rider lacks energy to
control the emotional Elephant. The emotional Elephant depicts the
emotional, visceral part of the brain that causes us to hit snooze on our
alarm or reach for french fries instead of a salad. The Elephant. The
emotional Elephant lacks self-awareness or control and acts impulsively for
instant gratification. This portion of the brain is fast, automatic, and very
powerful. While it appears that the Rider is primarily in control of the
Elephant, with sufficient stimulus, the Elephant can easily overtake the
Rider in the decision-making process.
It is often assumed (incorrectly) that the Rider is in control of
decision-making. In the Arcabuco context, the Project Ricardo Baseline Assessment showed that 74% of
households always treat their water before consumption. This indicator demonstrates that the residents of
Arcabuco recognize the ties between unclean water and diarrheal diseases. Some even demonstrated
knowledge of the effects of individual actions on water supplies in downstream villages. The Rider knows
that the problem exists, yet few clean their water storage containers regularly or limit their practices that
pollute downstream water supplies. The fieldwork also uncovered a general lack of urgency within the
community to exercise individual agency around this problem. However, the exact cause(s) of this deficit
is a bit unclear. Perhaps, the Rider is too tired to change, the Elephant finds no value in the change, or
change is perceived as too much work. Fortunately, Switch Theory offers a three-part strategy to
overcome this disconnect: (1) direct the elephant, (2) motivate the Elephant, and (3) shape the path.
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Directing the Rider entails making change simpler to ensure the Rider does not get overly tired
and consequently fail to activate the intended behavior. To achieve this, the Project Ricardo team should
focus on ​following “bright spots.”​ More specifically, the team should investigate residents who are
succeeding in the behavior change in the same context and clone it to a larger scale. In Arcabuco, the
team should find citizens who frequently clean their containers, discern what made them decide to clean
their containers, and recreate the conditions in other households to spread the behavior. Cloning bright
spots may also instill a sense of community-led development and ownership of the behavior change,
which could increase the efficacy of uptake. Additionally, the Project Ricardo team should ensure that
they clearly ​script the critical moves​ required to create the intended behavior. This requires sharing a
behavioral action that is clear, small and specific. For example, if the intended goal was to cut fat out of
an individual’s diet, rather than saying “limit fat in your diet,” the initiative should recommend a clear and
specific direction such as “switch from whole to 2% milk,” an instruction that the target audience can
easily complete to cut a significant source of fat out of their diet. If the intended behavior change in
Arcabuco is to clean water storage containers on the roof, the initiative should instruct residents to “clean
their containers with chlorine every Sunday.” Finally, it is essential for the rational Rider to visualize a
clear end-goal to focus their energy toward so the team must distinctly ​point to the destination.​ As the
Rider thinks more in terms of long-term gratification, a clear “endline” or quantifier of success helps to
make the change seem worthwhile. For example, the community mobilizers associated with Project
Ricardo may set a collective community goal of “completely E. coli-free water.” However, directing the
audience’s Riders alone cannot completely create transformative change.
In addition to directing the Rider, it is essential to also motivate the Elephant to ensure that this
part of the mind does not overtake the logical Rider. One of the best ways to motivate the Elephant is to
find the feeling​ to create a collective sense of urgency, something clearly lacking currently in Arcabuco.
Whether this be shock, fear, excitement, hope, etc., this feeling serves as the backbone of the Elephant’s
desire to actually carry out the intended action. To appeal to residents’ Elephants, the team could publicly
illustrate the amount of bacteria in unclean containers through demonstrations that dye the E. coli in the
water. The behavior change initiative should also ​shrink the change​ into easy, tangible steps to avoid
spooking the Elephant into inaction. In the case of container cleaning, the steps to carry out the behavior
should be broken down into piecemeal tasks (purchasing chlorine, removing the container from roof,
actual cleaning, etc.) The Elephant can also be motivated by ​growing the people​, or cultivating a sense of
identity and instilling a growth mindset among the target audience. The fieldwork in Arcabuco revealed
an existing community closeness among the veredas; the project team should capitalize on the existing
close-knit ties in the community to create an identity that favors individual agency (rather than
government dependency) around water issues. The above strategies remove key barriers for both the
Rider and the Elephant and minimize the conflict between the two.
Beyond reducing the conflict between the Rider and the Elephant, behavior change can be
solidified by shaping the path. Simply making the intended action easier to complete, or ​tweaking the
environment,​ can lead to increased adoption. In Amazon’s one-click ordering, the company changed the
situation (purchase more items) to make the behavior more attainable. This might entail Project Ricardo
distributing some sort of product or toolkit that makes it easier for citizens to access the container from
the roof for cleaning. Habits are generally less taxing on the Rider so setting “action triggers” that ​build
habits​ can also serve as a method to shape the path. Finally, success often snowballs on existing success
and in psychology, behavior is considered to be contagious. So, publishing statistics of decreasing
Development Advisory Team Final Report: Project Ricardo
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diarrheal disease and anecdotes of success can ​rally the herd​ to community-level change. By directing the
Rider, motivating the Elephant, and shaping the path for both, Project Ricardo can promote successful
behavior change within the community that transforms practices to uphold community help.

Theory of Reasoned Action (TRA)

The Theory of Reasoned Action was initially developed by Martin Fishbein and Icek Ajzen in the
late 1960s in an attempt to understand the relationship between attitudes and behaviors within human
action. Both Fishbein and Ajzen would develop a theory that would pinpoint the missing element in the
process of persuasion. The traditional perspective attributed a direct correlation between attitude and
behavior when understanding human action, which Fishbein and Ajzen argue is an incompletely defined
causation. Within Fishbein and Ajzen’s book, “Belief, Attitude, Intention, and Behavior: An Introduction
to Theory and Research,” the focus on behavior shifts from its conventional definition to the determinants
it encompasses. In order to do this, behavior is defined by the following points: action, target, context, and
time. For example, I will go do (action) exercise or physical activity (target) at the gym or out on the trails
(context) two or three times a week (time). TRA predicts that the topic of ​behavioral intention,​ or a
situation or information that limits the influence of an attitude on a behavior for a person or population,​ i​ s
the missing link.
In order to understand how a behavioral intent determines behavior the TRA further explains that
a behavioral intention is influenced by ​pre-existing attitudes​ towards the behavior and ​subjective norms​.
According to TRA, a pre-existing attitude refers to the way a person or population feels towards a
particular behavior. An attitude can also be further influenced by the perceived strength of the ​behavioral
beliefs​ and the ​evaluation of the potential outcomes​. The person or population will consider the
probability of the envisioned outcome and weather the outcome is positive or negative. Both the strength
of the behavior beliefs and evaluation of the outcome determine the desirability of the related outcome,
which in turn influences your attitude towards the particular behavior. Likewise, the subjective norms
regarding a behavioral intent can be further influenced by ​normative beliefs​ and a ​motivation to comply​. A
subjective norm encompasses the perceptions from relevant groups or individuals that will affect the
person’s behavioral intent. Normative beliefs exist based on influence from social pressure coming from
relevant groups (family, friends, colleagues, etc.) that can either approve or disapprove of the action. A
motivation to comply to those pressures is based on the inherent opinions from social circles’ and a
person’s susceptibility of caring and giving in.

TRA Flow Chart

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My understanding of Fishbein and Ajzen’s TRA is that the ability to link the role of attitude and
norms to the influence of a behavioral intent and its components are necessary criteria for identifying the
underlying reasons for a desired behavior change, which ultimately drives the action. I will breakdown the
TRA within the context of exercise. The behavior is exercise which is influenced by my behavioral intent
of starting an exercise program. This intent is influenced by a pre-existing attitude that acknowledges that
exercising would be a good thing for me to do. This attitude is further influenced by the belief that doing
exercise will improve my health and could potentially allow me to lose excess weight. I evaluate the
outcome of the behavior as being positive because I like being health and I enjoy being slim. My
behavioral intent is also influence by a subjective norm that recognizes that exercise is an appropriate
thing to do. A subjective norm is also further influence by normative belief which is that my family and
friends think I should exercise, and I will be motivated to comply because I genuinely want to do what
they want of me.

Barrier Analysis
Barrier analysis is used to identify behavioral determinants, so that more effective behavior
change strategies can be implemented. These behavioral determinants are “barriers” in a specific
community to a specific behavior change. By doing a barrier analysis, a team implementing a behavior
change program can understand what reasons a community may or may not uptake the behavior. While it
might seem that knowing a behavior will have a positive consequence is enough for uptake, there are
actually countless factors that go into a specific target group’s decision of whether to uptake a behavior.
Creating activities that work to decrease barriers to the change can result in a community reaching the
“tipping point”. The tipping point is when the barriers to a behavior change have been reduced enough
that the target community adopts the behavior.

The Decision Balance: Multiple determinants can impact whether a behavior is uptaken. The decision
balance has to be “tipped” to get behavior uptake.
Adapted from: ​Determinants: Factors that Influence Our Decisions and Behaviors.
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To do a barrier analysis, it is necessary to identify important characteristics of the target

community and behavior. The first thing to define is the behavior. The behavior is a a specific action that
the priority group carries out to address a problem they face. The behavior must be very specific,
measurable, and observable. The behavior is often decided upon by the intervening group, however it can
be important in many cases for the priority group to have direct input into what the behavior is. By the
community taking ownership, there could be a reduction in the barriers to behavior uptake. After
determining the behavior you must determine the priority group. This is the group that is being
encouraged to adopt the new behavior. These are also the people that ensure that others, especially minors
and the disabled, take up the behavior when that is necessary. There is often a group or person that can
impact the ability of the priority group to do a behavior. These groups are defined as the influencing
groups. It can often be beneficial to work with the influencing to group. They can either help you better
understand the barriers to behavior change or in some cases help influence the priority to group to take up
the behavior. In some situations the influencing group can be the cause of determinants that prevent
behavior uptake.
Now that you know what behavior you are trying to change and who you are trying to make the
behavior change, it becomes important to identify the determinants. Determinants categories of reasons
why a priority group might not practice a specific behavior. These must be determined in order to use best
practices for uptake. There are a variety of determinants that are defined below. Determinants can be
identified through direct observation and surveying of the priority group and influencing group. You can
also determine the most important determinants in a community by comparing doers and non-doers. A
doer is someone that is already practicing your proposed behavior, while a non-doer is someone in your
priority group who has yet to take up the behavior. By comparing the environments of the doer and
non-doer you are able to gain important insights into why one person does a behavior and why the other
does not.
● Perceived Self-Efficacy/Skills
○ Whether an individual believes they can do a particular behavior in their situation and
with their skill set
● Perceived Social Norms
○ Whether a person believes those important to them will approve of the behavior
● Perceived Positive Consequences
○ Any potential result of the behavior that the person views a positive change
● Perceived Negative Consequences
○ Any potential result of the behavior that the person views as a negative change
● Access
○ The degree of availability of the resources necessary to make the behavior change
○ Includes barriers related to cost, geography, distance, language, culture, and gender
● Cues for action/reminders
○ Whether there are reminders that remind the person to do the behavior
○ Can also include events in the person’s life that could trigger the behavior change
■ I.e. “I got cholera after drinking from the water source so I will not drink from it
again”
● Perceived Susceptibility/Risk
○ How vulnerable a person feels to the problem being addressed by the behavior change
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● Perceived Severity
○ Belief of whether the problem is serious or not serious
○ Is there a sense of urgency?
● Perceived Action Efficacy
○ Belief of whether the action is effective in avoiding the problem
● Perceived Divine WIll
○ Whether a group believes it is God’s will they face the problem, or it will be through God
that they overcome the problem
○ Can also be whether their specific religious group or belief system will approve of the
behavior
● Policy
○ Laws and regulations that could affect behavior and access to the resources necessary for
a behavior
● Culture
○ Anything related to the history, lifestyle, customs, values, and practices of the group

Once barriers have been identified, it is important to determine what determinants need to be
focused on in activities. This could include increasing or decreasing a perception that the community has.
It is important to define exactly what you want to accomplish with your activities. You can do this by
defining bridges to activities. Bridges to activities directly say what you want to change about the
determinants through your activities. From their your activities can be designed with a clear goal for each
activity defined. By desiring a clear outcome from an activity, it is easier to create activities that will be
effective and focused.
Included in the appendix of this report are different barrier analysis worksheet. The first goes
through a case study and works to define all of the different variables mentioned in this section. The case
study is looking at exclusive breastfeeding of infants 0-6 months in Burundi. The next two worksheets are
related to the work being done in Arcabuco.
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III. Recommendations and Conclusions

Blending elements of Switch Theory, Theory of Reasoned Action, and Barrier Analysis will serve
as a robust framework to formulate a program that can have impactful change in the hygiene habits in
Arcabuco. As the residents of Arcabuco recognize that the problem exists, Switch Theory can help
motivate community members to take the additional steps needed for change by appealing to both their
rational and emotional sides. This theory can also be applied to shrink the change to persuade residents to
act. The Theory of Reasoned Action should be utilized to discern any existing focuses on the related
behavioral intention or any pre-established sense of urgency for change. This theory should also be
employed to focus on developing a more immediate, obvious outcome for intervention adoption that
provides short-term gratification in addition to long-term health benefits. Finally, a full-scale Barrier
Analysis should be conducted to determine all the unforeseen obstacles in Arcabuco that prevent a
behavior change regarding water practices. In this work, some barriers will likely emerge as more
significant than others. By tackling these larger barriers, the project team can create a tipping point that
leads to wide scale change. Activity design must also work to change the perceptions that currently
prevent people from taken up an action.

1. Consider the Audience

The final intended behavior action(s) will target a specific audience to carry out the desired change. This
may be groups such as men, women, heads of household, school children, the elderly, etc. The needs of
individuals between groups vary immensely so it is essential to open the path of communication to truly
understand the needs of the intended audience. For example, a behavior should be taught differently to
school children than heads of household. By specifically appealing to the values and desires of the
intended audience demographic, the team will have better leverage to create a sense of urgency around
water hygiene and mobilize residents to take individual action (behavior change) toward the intended
goal.

2. Make Change More Accessible

Individuals are simply more likely to complete an easier task than a difficult task. For example, a busy
parent is more likely to clean their dishes immediately rather than pile them in the sink with a dishwasher
than if they simply have soap and a sponge. Designing a habits framework of related strategies to the final
behavior or offering a product that would make the behavior less taxing on the individual would increase
uptake of Project Ricardo’s intended behavior change.

3. Find Bright Spots

By finding people in the community who already enact the intended behavior change and manifest its
benefits, the Project Ricardo team can determine barriers to change that may not be immediately obvious.
After locating these bright spots, the team should compare their situation to the target group to find the
tipping point for change. This also engages the community within the problem-solving process and
promotes local ownership of the final initiative.

4. Design Activities Based on Barriers

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The barrier analysis stage serves as an essential prerequisite to create a robust program for transformative
change. After these barriers have been determined, the program activities need to work to shift the
“decision balance” to balance out the barriers counteracting the positive attributes of change. In Arcabuco
specifically, it will be helpful to create activities that increase urgency, perhaps by altering perceived
severity or perceived risk.
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References
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Reasoned Action and Planned Behavior as Models of Condom Use: A Meta-Analysis". CHIP
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Ballantyne, Colleen, Sonia Gonzalez, and Sarah Pieslak. (2018, Nov 1). Personal Interview with Terrance
McDonnell.
Ballantyne, Colleen, Sonia Gonzalez, and Sarah Pieslak. (2018, Nov 7). Personal Interview with Paul
Perrin.
Caballero, M. C. (2004, March 11). ​Academic turns city into a social experiment.​ Retrieved from The
Harvard Gazette.
Carrillo, S. (2017, August 10). ​The Rise of Resident Leaders in Mockus' Bogota.​ Retrieved from Living
Cities.
Determinants: Factors that Influence Our Decisions and Behaviors. ​(2004). Feed the Hungry.
http://barrieranalysis.fh.org/what_is/determinants.htm
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Fishbein, M and Ajzen, I. Belief, Attitude, Intention and Behavior: An Introduction to Theory and
Research. Reading, MA: Addison-Wesley, 1975.
Glanz, Karen,, Rimer, Barbara K.,, Viswanath, K. (Kasisomayajula), (Fifth ed.). "Theory of reasoned
action, theory of planned behavior, and the integrated behavioral model". ​Health behavior:
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Heath, Chip and Dan Heath. ​Switch: How to Change Things When Change is Hard.​ New York, NY:
Broadway Books: 2010.
Innovation for Poverty Action (2018, June 4). “Cleaning Natural Spring in Kenya.” IPA, Study Summary.
Innovation for Poverty Action (2018). “Chlorine Dispensers for Safe Water.” IPA, Study Summary
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International.
Kremer, Michael, Jessica Leino, Edward Miguel, and Alix Peterson. 2011. "Spring Cleaning: Rural Water
Impacts, Valuation, and Property Rights Institutions." Quarterly Journal of Economics 126 (1):
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Mockus, A. (2012, Vol 65, No 2). Building "Citizenship Culture" in Bogota. ​Journal of International
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Mockus, A. (2015, July 15). The Art of Changing a City. ​New York Times​.
Nogeria de Oliveira, M. (2009). Ethics and Citizenship Culture in Bogota's Urban Administration.
University of Miami Law School Institutional Repository​.
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Posada, J., Ben-Michael, E., Herman, A., Kahan, E., & Richter, E. (2000). Death and injury from motor
vehicle crashes in Colombia. /​Pan Am J Public Health.​
Rogers Gillmore, Mary; Archibald, Matthew; Morrison, Diane; Wilsdon, Anthony; Wells, Elizabeth;
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Behavior: Applicability of the Theory of Reasoned Action". ​Journal of Marriage and Family​. 64
(Volume 64): 885–897.
Velasco, R. G. (2015, October 1). Big Data are Reducing Homicides in Cities across the Americas.
Retrieved from Scientific American.
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Flagship Report.
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point-of-use.” ​Journal of Tropical Medicine and International Health​ 9: 106-17.
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Appendix 1

Barrier Analysis Framework Worksheet: Case Study of Exclusive Breastfeeding in Burundi

Behavior Priority Group or Determinants Bridges to Activities Activities

Influencing Group

Mothers only give breast Priority Group: Perceived negative Increase the perception Record/write stories
milk to their children Burundian mothers consequences: that a child who is not about mothers with
from birth to 6 months with children 0–6 Mothers don’t know the exclusively breastfed children with good
months of age relationship between can become health/weight who do
of age.
EBF and malnutrition malnourished. EBF and believe in
Live in rural setting EBF. Play the
Perceived divine will: Increase the perception recording/read the
Majority are illiterate Mothers question that religious leaders testimonials on EBF at
whether their religious approve of EBF and meetings in the
Go to church on leaders/ traditions that their religious community/ health
Sunday morning support this behavior tradition is supportive facilities (following
of EBF. postnatal care and
Are busy with daily Perceived social growth monitoring and
household chores norms: Increase the perception promotion sessions).
Mothers believe that that their
Want to be perceived their mothers, mothers-in-law, In household meetings,
as good mothers and mothers-in-law do not mothers approve of use growth charts to
wives approve of EBF EBF. show the difference
between several children
After 3 months, they Perceived action Decrease the growing well who are
think they do not have efficacy: perception that a child exclusively
enough milk to Mothers believe that the will be hungry or breastfeeding and
breastfeed child will be hungry if lacking in nutrition if contrast them to other
not fed other foods at 4 they are exclusively children who are losing
Exclusively breastfeed months of age breastfed. weight who are not
until 4 months, but EBF.
give other foods at that
time Give
pastors/priests/imams
Majority are in partial sermon guides on EBF
action stage and train them in their
use.
Influencing Groups​​:
Mothers-in-law Have Care Group
Volunteers (CGVs)
include mothers-in-law
when teaching mothers
of young children about
EBF.

Explain to mothers (via

CGVs and household
visits) that children cry
for many reasons, and
Development Advisory Team Final Report: Project Ricardo
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crying does not always

mean the child is
hungry. Use growth
charts to show mothers
that many children who
cry a lot (identify cases
ahead of time) are still
growing well and
therefore are not lacking
 Development Advisory Team Final Report: Project Ricardo
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Appendix 2

Starter Barrier Analysis Framework Worksheet: Project Ricardo

Behavior Priority Group or Determinants Bridges to Activities

Influencing Group Activities

Households with large water Priority Group: Perceived Positive Increase the
storage containers will clean Heads of Households Consequences: perception that having
them more often and with better in the 5 target Veradas Safer drinking water unclean containers can
techniques. in Arcabuco Better health lead to water
contamination of
Indicators​​: Children in the Verada treated water.
Schools Perceived Negative
Consequences: Increase the
Influencing Group: More work perception that
More research needs Unsafe if on the roof drinking only clean
to be done to Hard to clean them water is vital to
determine ensuring positive
Perceived health outcomes.
Messengers of Peace Susceptibility:
Could help prevent a Decrease the
Primary School reduce diarrhea in perception that
Teachers their household cleaning water
containers is not worth
Verada Leaders May not view this as a the effort.
huge risk
Perceived Severity

May not see the

problem that this
behavior helps prevent
as serious enough to
put in the extra effort
the behavior requires
Development Advisory Team Final Report: Project Ricardo
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Project Ricardo Water Treatment Barrier Analysis Worksheet

Behavior Priority Group or Determinants Bridges to Activities

Influencing Group Activities

Households will treat Priority Group: Perceived Positive Increase the

water with more Heads of Households Consequences: perception that boiling
efficient and safe in the 5 target Veradas Better quality drinking is not the best method
methods than boiling in Arcabuco water of treating water
water
Children in the Verada Quicker than having Increase the
Schools to boil water everyday perception that wood
Indicators​​: burning stoves indoors
Influencing Group: Decreasing in home can lead to health
More research needs use of wood-burning problems
to be done to stoves
determine Decrease the
Perceived Negative perception that
Messengers of Peace Consequences: chemicals, when used
A new technique may correctly, are harmful
Primary School not be trusted to
Teachers actually get their
water clean
Verada Leaders
If the new technique
involves chemicals
there were some
households that
indicated they did not
trust chemicals in their
water

There may be a cost

associated with the
intervention
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Appendix 3

Case Study 1: Citizenship Culture Building in Bogotá

Switch Theory in Action
“People respond to playfulness and humors; it’s the most powerful tool for change that we have.” -
Antanas Mockus, Mayor of Bogotá

Summary
In 1995, the citizens of Bogotá, Colombia elected Antanas Mockus, former president of the National
University of Colombia, as the mayor to tackle the extreme violence and chaos that dominated the city.
Bogotá was so plagued with rampant violence and mobility issues during this time that the US State
Department advised against civilian travel. Mockus recognized that chaos stemmed for a disregard for
government institutions and lack of individual regulation. To combat urban violence and corruption,
Mockus created a set of behavior-changing initiatives intended to help residents recognize their duties as
citizens and build trust, two prerequisites for safety. Mockus’s rationale focused on generating new social
norms, what he called “citizenship culture,” to ensure compliance with laws. This “citizenship culture”
also prevented a water supply crisis in 1997 when a tunnel that provided Bogotá’s main supply of fresh
water partially collapsed. With the humor, education, clear rules, and a newfound sense of belonging,
Mockus’s “citizenship culture” campaign turned a city that was branded as one of the world’s most
dangerous into a safer, more inclusive, disaster-resilient environment by promoting collective actions for
grassroots-level behavior change.

Goals
1. Promote collective actions for grassroots level behavior change
2. Created shared norms of collectivism to promote law compliance
3. Develop a shared vision for the city that transforms norms of mutual interaction

Methods
Rather than simply educating the public and enforcing harsh sanctions, Mockus strategically designed
creative, humorous methods to disseminate information.
1. Strategic reminders to increase salience for change (Shape the Path)
a. Replaced busy signals on phone with a recording of Shakira saying “Thank you for saving water”
b. Played ads on television featuring the mayor showering with his wife to encourage water
conservation
c. Stickers for every home to place near their main water source to remind to conserve
d. Replacing police officers with mimes to control traffic
2. Educational initiatives to clarify specific actions for change (Direct the Rider)
a. Mockus dressed up as “Super Citizen,” a superhero to teach principles of civic culture
b. Youth volunteers mobilized to households to teach about water conservation
3. Social policing to increase accountability (Shape the Path)
a. Distributed “citizenship cards” (one side with thumbs up, other side with thumbs down) to express
approval/disapproval to others while driving
b. Initiated a voluntary disarmament campaign
c. Held a community workshop to collectively reform police code
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4. Snowballing success stories (Motivate the Elephant)
a. Published violence and water statistics daily
b. Publicized individual anecdotes of success

Why it Worked Connection to Project Ricardo

1 Helped citizens recognize themselves as 1 Citizens may experience a feeling of

agents of change with accountability and powerlessness in tackling wide scale pollution
valuable contributions or water treatment

2 Humorous approach appealed to citizens 2 May also help to overcome existing distrust
around water (particularly in context of local
mayor)

3 Community-building events created feeling of 3 Cross-community building to create

collective responsibility awareness of lower valley communities

4 Peer pressure created accountability & 4 Stigmatizing certain currently accepted

compliance practices
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Appendix 4

Case Study 2: Spring Cleaning Program

Theory of Action

Summary
Within the Innovation for Poverty Action (IPA) realm of work, I came across a case study which
highlighted an initiative attempting to address one of the leading causes of mortality in children under the
age of 5 in rural Kenya, diarrheal diseases. According to the IPA, it is estimated that 20% of the deaths in
children under the age of 5 occur because of diarrhea related illnesses or effects. Based on references by
the IPA, most diarrheal related diseases are transmitted by contaminated water at point of collection,
transportation, and storage. Communities within the context of the issues generally collect drinking water
from nearby springs and transport them in 10-20 L jerry-cans. Partner organizations of IPA launched a
“Spring Cleaning” program, which focused on a point-of-use intervention. Water sources were encased in
concrete to avoid surface rainwater runoff. The infrastructure investment reduced fecal contamination at
the source by a significant amount, but the study also found
that recontamination during transport and storage was also a
leading cause of undrinkable water. The benefits at
collection were not being transferred to improved health
outcomes, which heavily depended on behavioral changes.

The IPA then facilitated a two-phase study that

examined price, persuasion, promotion, and chlorination
products in an attempt to understand the habits, perceptions,
and obstacles affecting health equity among these communities. Many habits believed to be contributing
to contaminated drinking water are minimal hand washing practices and limited demand for disinfection
products. The IPA found that free chlorination dispensed at water sources along with community
promoters proved the most effective strategy to improve water cleanliness in Kenya.
Dispensers for Safe Water was originally launched by Innovations for
Poverty Action following their two phase study. The innovative system
provides dispensers that hold chlorine and are located in the immediate
vicinity of wells and springs. Users can turn the valve to dispense a
correctly measured amount of diluted chlorine to put into their jerry can.
The chlorine disinfects the water and keeps it potable for up to 3 days.
Evidence Action, a leader in managing effective poverty interventions,
adopted the system initiative and scaled the project to a measurable user
base. Evidence Action’s theory of change emphasizes a need for
communities to understand the link between drinkable water and related
illness, which they state has been supported through anecdotes and
experience shared by local representatives.They attribute the successful
sustained user adoption to five areas of importance.
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Why it worked:
● Behavior change:
○ dispensers are accessible, practical, and free to use – the costless attribute to the
dispensers’ use is particularly important, because it is generally accepted that
preventative health care measures are not prioritized if the service, product, or habit is not
free or easy to do
○ project recruits local community members to serve as promoters of the dispensers, a paid
position
○ promoters are responsible for the general upkeep and education concerning the use of the
dispenser

● Sustainable service:
○ circuit riders repair dispensers and deliver chlorine to promoters
○ functional and full dispensers always available

● Cost-Effective:
○ Chlorine disinfection is low cost and proves to be a lower cost per person when compared
to ceramic filters, solar disinfection, and other options

● Health Equity:
○ Once installations of the dispensers occurs (permission from community leaders is
required)
○ Evidence Actions studies the adverse effects on illnesses related to water contamination
within the community
○ Attempting to prove a causal link between chlorine disinfection and the reduction of
diarrhea

● Based on Evidence:
○ randomized controlled trials by Harvard and Berkeley researchers who tested chlorine
dispensers in Kenya against a variety of other water treatment options

Theory of Action:
The applicability of TRA to this case study is founded on the initial priority for this intervention.
The urgency for this service was health. The behavioral intent was defined in terms of adopting the
intervention for that desired health outcome. The attitudes and subjective norms regarding the adoption
revolved around the priority the ministry of health would place on addressing the effect of diarrheal
disease.
The TRA was also relevant within a study released by the University of Connecticut’s Center for
Health, Intervention, and Prevention (CHIP). The paper, located within the references, entitled “Theories
of Reasoned Action and Planned Behavior as Models of Condom use: A Meta-Analysis,” attempts to
quantify the success of TRA as a predictor of condom use across studies.
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Appendix 5
Barrier Analysis Questionnaire Help
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