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In a time when COVID-19 infection rate is on the rise in Bangladesh, what approaches could work to enable people to adopt safe hygiene practices? Here’s what we’ve learnt.
Bangladesh experienced a sharp surge in infection rates a year after the pandemic’s advent, when we were hoping to bid COVID-19 adieu. Although safe hygiene practices continue to be promoted by various organisations via different channels, compliance has been observed to gradually reduce over the duration of the pandemic. But not all is bleak! There are approaches that can work to enable people to adopt and sustain safer hygiene behaviours.
As part of the FCDO-Unilever led Hygiene and Behaviour Change Coalition (HBCC), BRAC has been implementing various interventions in Bangladesh to generate evidence on what works best in this context. Here are some approaches we have learnt that can lead to impact:
Make messaging fact-based and contextualised
Since the COVID-19 crisis started, people have been inundated with innumerable messages on what constitutes safe behaviour. But only circulation of messages does not guarantee retention, especially when there is a clutter of information. Then, how do we get people to adopt recommended behaviours?
First, only circulate information vetted by global and local experts, and disseminate via trusted agents. Fact-based messaging gains the trust of viewers, while simultaneously dispelling rumour-mongering. BRAC activated Daktar Apa and engaged local pharmacists across Bangladesh – as these are figures people trust regarding healthcare, it is likely people would adhere to their recommendations.
Secondly, messaging should be simplified, easy to understand, and easy to recall. Under the coalition, we designed posters to be placed on handwashing stations, and we pre-tested variants online with varying complexities for handwashing guidelines, to generate evidence on how much information users can absorb and recall. This resulted in our posters having simple visual cues denoting just five handwashing steps, and being placed in line of sight of the station users. The resulting poster also yielded 90% recall of messaging from users we later surveyed.
Read more: COVID-19 prevention: Too much information?
Messaging that may be appropriate for one part of the world may fail to elicit reaction in another. It is important to understand the context of the place and the demographics of the target users, before even designing. When the COVID-19 vaccine programme started to roll out in Bangladesh, we conducted a nationwide survey that revealed that while the masses knew of the vaccine being available, very few were aware of who should actually get the vaccine, or what its benefits were. We then released a video using Daktar Apa to debunk myths regarding the vaccine, which received much traction on social media.
Takeaway: Understand end-users, and disseminate fact-based information that has been contextualised.
Take a holistic, long-term approach to behaviour change
While regular hand washing was promoted from the get-go as a means of fighting against COVID-19, many people lacked access to appropriate facilities. Only motivating people to wash hands, when more than a billion people around the world lack access to soap and water, would not result in behaviour change. BRAC decided to tackle this by improving access to handwashing facilities and soap.
Foot-pedal operated hand washing stations were built in public hotspots to ensure contactless use. Households received hand washing devices in a bid to improve hand hygiene. In-person meetings were held in communities which demonstrated the proper way to wash hands, to increase awareness.
Read more: Stepping up hand hygiene: How to make hand hygiene more accessible and inclusive
Evidence we have generated suggests that presence of a proximate hand washing device increases frequency of handwashing, and pairing this access with motivating people to wash hands leads to more thorough hand washing.
Takeaway: Identify if the barriers are a factor of motivation, capability or opportunity, and design interventions to enable behaviour change.
Target social behaviours
The COVID-19 crisis meant that behaviours like wearing masks and frequent hand washing, which were unfamiliar in different contexts, suddenly became norms. However, norms only manifest when enough people comply. To motivate people to uptake recommended preventive behaviours, it is important to create an enabling environment.
It may be easier said than done, especially during a time when compliance is at an all-time low in communities due to compliance fatigue and diminishing levels of fear regarding infection. Also, because people inherently have an immediacy bias – whereby they are more likely to focus on the pain points of the present (eg social and monetary cost of compliance) rather than on the long-term health benefits of compliance – it becomes doubly crucial to motivate people to sustain.
We therefore took an active community engagement approach, using various channels – including in-person demonstration sessions, messaging across media channels – to keep reminding people of the benefits of continued compliance.
We are seeing the effects – one of our community meeting attendees opined, “A BDT 10 (USD 0.12) mask that prevents me from contracting the disease is less expensive than the treatment I would need if I get COVID-19, so why shouldn’t I just wear masks?”
Takeaway: Use manifold channels to create an enabling environment and make the benefits of compliance more visible.
Design, evaluate and then scale
Crisis situations such as this pandemic are dynamic in nature, and require responses that are timely and appropriate. To ensure that interventions are impactful, evaluate interventions and generate evidence on what works. We combined observational and survey data with information from in-person interactions to understand which of our approaches work best.
Behaviour change would not happen overnight, and would need time to manifest at scale. We have seen it happen when latrine usage went from being non-existent rurally to becoming practically a necessity for household sanitation.
Read more: From health to wealth: Sanitation standards shifting in rural Bangladesh
Takeaway: Generate contextual evidence both pre- and par- launch, and devise strategies to implement interventions at scale.
The interventions we have implemented have measurably increased people’s knowledge base on safe behaviours, improved access to hand hygiene facilities, and even influenced motivation to comply. Evidence-driven approaches such as ours can be undertaken to overcome the pandemic safely, and until everyone is safe from the risks of COVID-19 transmission, we will operate with the mindset that nobody is truly safe.
Arshae Ahmed is a Project Coordinator for BRAC-HBCC with the BRAC Social Innovation Lab. Shafqat Aurin is an Interaction Designer with the BRAC Social Innovation Lab.
A/N: The evidence we have gathered would not have been possible without the support from our partners and collaborators: The Behavioural Insights Team, BRAC Institute of Governance and Development (BIGD), Jeeon and HappyTap; who are all aligned with our overarching goal of reducing transmission of COVID-19 across Bangladesh.
Social Innovation Lab (SIL) is a knowledge and experimentation hub at BRAC, the world’s largest NGO. We test, prototype and support scaling new ideas to solve the most complex social problems, to support BRAC by capitalising on emerging opportunities and catalysing innovation throughout the organisation. To find out more about SIL, visit: https://innovation.brac.net/
In context of the ongoing COVID-19 pandemic, SIL has been leading initiatives and supporting multiple BRAC programmes in Bangladesh to adopt innovative, human-centred approaches on the ground. To read more about BRAC’s overall response to COVID-19, visit: http://www.brac.net/covid19/