Nudge, Dont Shove: A Case for Reflexive WASH Behavioural Change, Part II Behavioural hange is a ru ial site for

WASH interventions, and in Part I Ive argued that !ra titioners should fo us u!on reflexive "ehavioural influen es instead of reflective ones# While existing WASH "ehavioural hange strategies are "ased u!on !u"li health $odels that target reflective "ehaviour, Ive suggested that %e turn to%ards "ehavioural e ono$i s for reflexive "ehavioural insight# &hat said, not all "ehavioural e ono$i s studies are stri tl' a"out reflexive "ehaviour# &he field itself is sha!ed in refutation of rational hoi e theor', and onsists of diverse studies unified "' their interest in deviations fro$ traditional e ono$i s# Behavioural e ono$i s annot "e dire tl' $a!!ed onto WASH "ehavioural hange, and %hat I see( to do here is to elu idate !aths for a tion resear h rather than !res ri"e %a's of a!!l'ing "ehavioural e ono$i s to WASH# &he funda$ental tenet of "ehavioural e ono$i s is that ontext $atters# WASH interventions $ust therefore develo! fro$ the site)s!e ifi findings of a tion resear h, and es he% a o!')and)!aste a!!roa h to "ehavioural e ono$i s studies# &he *!rin i!les+ of "ehavioural e ono$i s are less universal rules than !arti ular (inds of ontextual infor$ation that %e should !a' attention to %hen designing "ehavioural hange interventions# It is te$!ting to extra!olate lo ali,ed findings into universal !rin i!les, and even though so$e "ehavioural e ono$i s studies have su essfull' re!li ated their findings in various settings, I strongl' ontend that WASH !ro-e ts need to invest the ti$e and $one' into develo!ing "ehavioural influen es s!e ifi to site onditions# &he onse.uen es of short uts are too ostl' for those %ho$ WASH serves for us to not ta(e extre$e are in rafting interventions# /urther$ore, reflexive "ehavioural influen es need to "e lo ated %ithin a !arti i!ator' !lanning !ro ess %here target audien es an hoose %hat (inds of "ehaviours the' %ant to ado!t# 0iven the !o%er of su" ons ious "ehavioural influen es, it is ethi all' i$!erative for target audien es to ons iousl' de ide %hat nudges the' desire# &his is %here extant "ehavioural hange a!!roa hes "ased on !u"li health edu ation are hel!ful in offering !eo!le (no%ledge a"out the re!er ussions of WASH 1or la ( thereof2, so that audien es an $a(e infor$ed de isions# Behavioural e ono$i s is also i$!ortant here in ensuring that de ision)$a(ing "iases are neutrali,ed so that audien es are not !redis!osed to%ards ertain hoi es that the' %ould not other%ise !refer# &hat, ho%ever, %ill entail a %hole other arti le on de ision)$a(ing, so I %ill leave it at that and $ove on to the (inds of ontextual ues that a tion resear hers should do u$ent and test %hen an audien e has identified WASH "ehaviours the' %ant to ta(e u!# WASH "ehaviours are ingrained through i$!li it or !ro edural learning, su h as lassi al onditioning or !ri$ing, %here a !erson is !redis!osed to%ards ertain "ehaviours through strategi ex!osure to an earlier sti$ulus# /or exa$!le, in an oft ited so ial !s' holog' ex!eri$ent, ertain !arti i!ants %ere ex!osed to %ords asso iated %ith a stereot'!e of the elderl' and then sho%n to %al( $ore slo%l' do%n the hall in o$!arison to other !arti i!ants %ho %ere !ri$ed %ith non)age)s!e ifi %ords 1Bargh, Chen, Burro%s 34452# 6f ourse, there are $an' varia"les that have to "e ontrolled and $an' li$itations to ex!eri$ental results 17a href8*htt!:99 hroni le# o$9"logs9!er olator9daniel)(ahne$an) sees)train)%re ()loo$ing)for)so ial)!s' holog'9:3::;+< see the re ent s holarl' s uffle a"out the validit' of !ri$ing ex!eri$ents 79a<2, "ut the gist is that ex!osure to !arti ular i$ages and %ords a tivate asso iations that $anifest in our su"se.uent "ehaviours# Behaviours an "e en ouraged or dis ouraged if !ro-e t !lanners see( out an audien es alread' learned "ehaviours and transfer the$ to a WASH ontext through !lanned ex!osure to sti$uli# A tion resear h needs to !a' attention to lo al stereot'!es, asso iation lusters, and alread' onditioned rea tions, no $atter ho% see$ingl' unrelated the' $a' "e to WASH# =e$ories and e$otions triggered !revious to an en ounter %ith soa! or a toilet an !redis!ose their u!ta(e# De!lo'ing i$ages, sounds, or s$ells that an audien e alread' asso iates %ith a ertain (ind of "ehaviour, or having an audien e !erfor$ a gesture that is laden %ith e$otions and $e$ories an suggest "ehavioural rea tions that %e an leverage# In another !ri$ing ex!eri$ent, No"el laureate Daniel >ahne$an instru ted ertain !arti i!ants to hold a !en il in their $outh so that their fa ial $us les %ere un ons iousl' for ed into ex!ressions of ha!!iness 1a s$ile2 or dis$a' 1a fro%n2, and found that their e$otional rea tions to res!e tive hu$orous or u!setting i$ages %ere $ore elevated o$!ared to other !arti i!ants 1>ahne$an ?@332# An ons ious a ts and gestures indu e e$otions in us that transfer to our su"se.uent ex!erien es# Affe t studies

s holar Sara Ah$ed des ri"es e$otions as *sti ('+: the' $aintain onne tions "et%een ideas, values and o"-e ts, orienting us to%ards ertain "ehavioural tra-e tories over others 1Ah$ed ?@3@2# WASH hard%are and "ehaviour introdu tions need to ensure that an audien e is e$otionall' "iased to%ards WASH so that the' an ta(e advantage of %hat >ahne$an alls the *halo effe t+ ) our desire for e$otional oheren e that results in us li(ing or disli(ing ever'thing a"out so$ething on e %eve -u$!ed to the on lusion that its *good+ or *"ad+ 1?@332# 6ur first i$!ressions of ne% things o$e to do$inate ho% %e rea t to the$, overshado%ing our su"se.uent ex!erien es even if these ounter our initial -udg$ent# A tion resear h an hel! to identif' %hat !ri$es %ill resonate $ost %ith a target audien e, and there"' in rease the li(elihood of the$ su" ons iousl' !referring WASH interventions# Bven though the audien e $a' have ons iousl' stated that the' desire a WASH intervention, su" ons ious -udg$ent is (e' to influen ing reflexive rea tions to sanitation and h'giene !ra ti es# Not onl' does the audien e need to "e e$otionall' !ri$ed !rior to the introdu tion of a WASH intervention, the e$otional ar of an' WASH session and ho% it dra%s to a lose need to also "e arefull' designed# >ahne$an distinguishes "et%een our *ex!erien ing self+ and our *re$e$"ering self+, %ith the latter steering our future rea tions "ased u!on our sele ted $e$or' of a !ast ex!erien e# In an ex!eri$ent %here !arti i!ants had their hand !ainfull' su"$erged in old %ater %ith so$e $o$ents of relief at different !oints of the trial, >ahne$an found that $e$ories of an ex!erien e are *strongl' influen ed "' the !ea( and the end+ 1?@332# &o reate a !ositive $e$or' of WASH that %ill dis!ose audien es to%ards engaging %ith WASH in the future, !ra titioners should ai$ to !rogra$ sessions %ith a !ositive e$otional !ea( and ending, regardless of %hether or not the !ositive e$otions are rationall' onne ted to WASH# &he $ost diffi ult !art of WASH "ehavioural hange is dail' $aintenan e# Ne% WASH !ra ti es need to "e !er eived as the nor$ in order to "e !ra ti ed as the nor$: re!resentation of %hat the status .uo onsists of strongl' influen es %hat a tuall' "e o$es the status .uo# As Ri hard &haler and Cass Sunstein suggest in Nudge 1?@@;2, *CiDf hoi e ar hite ts %ant to shift "ehavior and to do so %ith a nudge, the' $ight si$!l' infor$ !eo!le a"out %hat other !eo!le are doing+# Rather than using Behaviour Change Co$$uni ation to ela"orate u!on the "enefits of WASH, $essages should see( to o$$uni ate ho% $ost of the target audien e alread' !ra ti es WASH "ehaviours# Note that it is !er e!tion of !eer !ressure that is at %or( here, not a tual enfor e$ent through !eer !oli ing# We are leveraging existing desires for so ial onfor$it' 1*so ial ontagion+ in nudge)s!ea(2, and the existing "elief that other !eo!le are !a'ing lose attention to %hat %e are doing 1the *s!otlight effe t+2 to esta"lish ne% default "ehaviours# We are also leveraging re!resentation in a situation %here !eo!le are not ertain as to %hat the status .uo is# Nudges are $ost effe tive in situations %here !eo!le are un ertain as to %hat to do or "elieve# &hose %ho have staun h ounter)"eliefs %ill not "e as sus e!ti"le to nudging, %hi h is %h' it is i$!ortant to ensure that the audien e ons iousl' desires to ado!t ne% "ehaviours in the first !la e# When ne% WASH "ehaviours are !er eived as the nor$, alternative "ehaviours o$e less to $ind %hen en ountering a sanitation or h'giene situation, there"' narro%ing the $argin for alternative !ra ti es# Sa$uelson and Ee (hauser argue that *CiDn da')to)da' de ision $a(ingFa de ision $a(er $a' not even re ogni,e the !otential for a hoi e+ so that *the status .uo is then even $ore li(el' to !revail+ 134;;2# While ne% WASH "ehaviours %ill not "e o$e the status .uo overnight, %e an leverage infor$ation distri"ution to a elerate hanges in !er e!tion# Behaviour Change Co$$uni ation an "e a !o%erful deter$inant of infor$ation availa"ilit'# Readil' availa"le infor$ation a"out a !arti ular "ehaviour reates a !er e!tion that the "ehaviour is o$$on# &vers(' and >ahne$an all this the *availa"ilit' heuristi + 134GH2# &he easier it is for us to retrieve an exa$!le of so$ething in our $e$or', the $ore %e are !rone to "elieve that it ha!!ens a lot# Retrieva"ilit' is affe ted not onl' "' re!eated ex!osure to a !arti ular !ie e of infor$ation, "ut also the vividness or !ersonal i$!a t of the infor$ation# We an re all a "urning house %eve seen in !erson "etter than a re!ort a"out a "urning house %e heard on the radio, and %ill therefore "e $ore li(el' to "elieve that our o%n house is at ris( of fire if %e have seen a "urning house in !erson# Behaviour Change Co$$uni ation an ta(e advantage of the availa"ilit' heuristi "' develo!ing ontent and $odes of deliver' that s!ea( to the audien e !ersonall'# Infor$ation a"out !rior or alternative "ehaviours should "e su!!ressed, even %hen su h "ehaviours are !ortra'ed negativel'# Anli(e !u"li health $odels and "ehavioural hange theories that offer a general a tion !lan

%hi h an "e ada!ted for s!e ifi ases, individual nudges have to "e develo!ed for ea h s enario, and %hat %or(s in one ontext %ill not ne essaril' %or( for another# While "ehavioural e ono$ists have the luxur' of s!ending ti$e and resour es devising and evaluating ontrolled trials, WASH "ehaviouralists %ill have to li$it their design !ro ess and %or( %ith s$all sa$!le si,es in an un ontrolled test environ$ent that %ill li(el' generate a lot of data onta$ination# &he hallenge for WASH "ehavioural hange is to sta' ontext sensitive and to develo! riteria for ade.uate testing %ithout sa rifi ing validit'#

Wor(s Cited: Ah$ed, Sara# *Ha!!' 6"-e ts+ in The Affect Theory Reader# Bd# =elissa 0regg and 0regor' I# Seig%orth# Durha$: Du(e Aniversit' Press, ?@3@# Bargh, Iohn, =ar( Chen and Jara Burro%s# *Auto$ati it' of So ial Behavior: Dire t Bffe ts of &rait Constru t and Stereot'!e A tivation on A tion#+ Journal of Personality and Social Psychology G3#? 134452: ?:@)?HH# >ahne$an, Daniel# Thinking, Fast and Slow# Canada: Dou"leda', ?@33# Sa$uelson, Willia$ and Ri hard Ee (hauser# *Status Kuo Bias in De ision =a(ing#+ Journal of Risk and Uncertainty 3 134;;2: G)L4# &haler, Ri hard H# and Cass R# Sunstein# Nudge !"#roving $ecisions a%out &ealth, 'ealth, and &a##iness# Ne% Haven: Male Aniversit' Press, ?@@;# &vers(', A$os and Daniel >ahne$an# *Iudg$ent under An ertaint': Heuristi s and Biases#+ Science 3;L#H3LG 134GH2: 33?H)33:3#