1. Socio-psychological determinants for safe drinking water consumption behaviors: a multi-country review
Prof. Dr. phil. et dipl. zool. Hans-Joachim Mosler
MSc. Jonathan Lilje
Environmental and Health Psychology
Environmental Social Sciences
Eawag: Swiss Federal Institute of Aquatic Science and Technology

2. How can we understand behavior?
Promotion of Behavior
Person
Behavior

3.  Need to know these behavioral factors
How can we understand behavior?
Promotion of Water Disinfection
Person
Factor A
Factor C
Factor B
Factor D
Behavioral Factors
Drinking disinfected water
 Need to know these behavioral factors

4. Promotion of Water Disinfection Drinking disinfected water
Psychology is the Science of Behavior
 For knowing the relevant behavioral factors we should use Health Psychology
Only studies which used behavioral psychological theory
Person
Factor A
Factor C
Factor B
Factor D
Behavioral
Factors
Drinking disinfected water

5. The objectives of this review are
to show whether by using psycho-social determinants safe water consumption practices can be explained sufficiently well
to identify determinants which are with great probability useful to be targeted in all environmental and socio-cultural contexts
to recognize determinants which might be specific for different populations
to detect determinants which probably are specific for different safe water practices

6. We identified a total of 15 studies using health psychology in a quantitative way for explaining safe water consumption behavior
Theories encountered:
Health Belief Model (HBM) (Rosenstock 1974)
Protection Motivation Theory (PMT) (Floyd, Prentice-Dunn & Rogers 2000)
Theory of Planned Behavior (TPB) (Fishbein & Ajzen 2010)
Health Action Process Approach (HAPA) (Schwarzer 2008)
RANAS Model (Risk, Attitudes, Norms, Abilities, Self-Regulation) (Mosler, 2012)
Types of safe water consumption behaviors
9 studies household water treatment: 5 solar water disinfection, 2 boiling, 1 household level filter usage, and 1 chlorination.
5 studies on switching to safe sources
1 study looked at domestic well testing to monitor water quality
1 study on cleaning behavior of water storage containers
10 Countries:
Benin, Burundi, Chad, Ethiopia (2), Kenya, Zimbabwe
Bangladesh (3),
Bolivia (3), Nicaragua, USA

7. Template: The RANAS-Model: Risk, Attitudes, Norms, Ability and Self-regulation
HBM
TPB
PMT
HAPA
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), .

8. Authors
Country
Safe water option/ Target behavior
Vulnerability
Severity
Health Knowledge
Costs & benefits
Feelings
Others’ Behavior
Others’ Approval
Personal Importance
How-to-do Knowledge
Confidence in Performance
Confidence in Continuation
Confidence in Recovering
Action Planning/ Action Control
Barrier Planning
Remembering
Commitment R2
POU household water treatment
Altherr et al.27
Nicaragua
SODIS intention and usage
n.a. o +
log .863
Graf et al.29
Kenya
SODIS usage
log .245
Kraemer et al.34
Zimbabwe
log .700
Tamas et al.39
Bolivia
SODIS water consumption
.807
Heri & Mosler30
.690
consumption of boiled water
.522
Sonego & Mosler37
Burundi
boiling water for consumption
Huber et al.39
Ethiopia
consumption of fluoride free water from household filter
log .679
Lilje et al.35
Chad
chlorination of domestic drinking water
log .365
switching to safe source
Huber & Mosler31
consumption of fluoride free water from community filter
.568
Inauen et al.32
Bangladesh
use of arsenic-safe drinking water options
.688
Mosler et al.10
consumption of arsenic free deep tubewell water
.590
Inauen et al.33
use of arsenic free shallow tubewell
log .894
hygienic handling of water
Stocker & Mosler36
Benin
cleaning of water storage container
.625
water testing
Flanagan et al.28
USA
domestic well water testing for arsenic
.415

9. Can psycho-social determinants explain safe water consumption practices?
Authors
Country
Safe water option/ Target behavior
Vulnerability
Severity
Health Knowledge
Costs & benefits
Feelings
Others’ Behavior
Others’ Approval
Personal Importance
How-to-do Knowledge
Confidence in Performance
Confidence in Continuation
Confidence in Recovering
Action Planning/ Action Control
Barrier Planning
Remembering
Commitment R2
POU household water treatment
Altherr et al.27
Nicaragua
SODIS intention and usage
n.a. o +
log .863
Graf et al.29
Kenya
SODIS usage
log .245
Kraemer et al.34
Zimbabwe
log .700
Tamas et al.39
Bolivia
SODIS water consumption
.807
Heri & Mosler30
.690
consumption of boiled water
.522
Sonego & Mosler37
Burundi
boiling water for consumption
Huber et al.39
Ethiopia
consumption of fluoride free water from household filter
log .679
Lilje et al.35
Chad
chlorination of domestic drinking water
log .365
switching to safe source
Huber & Mosler31
consumption of fluoride free water from community filter
.568
Inauen et al.32
Bangladesh
use of arsenic-safe drinking water options
.688
Mosler et al.10
consumption of arsenic free deep tubewell water
.590
Inauen et al.33
use of arsenic free shallow tubewell
log .894
hygienic handling of water
Stocker & Mosler36
Benin
cleaning of water storage container
.625
water testing
Flanagan et al.28
USA
domestic well water testing for arsenic
.415
High quality of prediction of different safe water consumption behaviors: average R2 value of .637

10. Determinants which are with great probability useful to be targeted in all contexts
Authors
Country
Safe water option/ Target behavior
Vulnerability
Severity
Health Knowledge
Costs & benefits
Feelings
Others’ Behavior
Others’ Approval
Personal Importance
How-to-do Knowledge
Confidence in Performance
Confidence in Continuation
Confidence in Recovering
Action Planning/ Action Control
Barrier Planning
Remembering
Commitment R2
POU household water treatment
Altherr et al.27
Nicaragua
SODIS intention and usage
n.a. o +
log .863
Graf et al.29
Kenya
SODIS usage
log .245
Kraemer et al.34
Zimbabwe
log .700
Tamas et al.39
Bolivia
SODIS water consumption
.807
Heri & Mosler30
.690
consumption of boiled water
.522
Sonego & Mosler37
Burundi
boiling water for consumption
Huber et al.39
Ethiopia
consumption of fluoride free water from household filter
log .679
Lilje et al.35
Chad
chlorination of domestic drinking water
log .365
switching to safe source
Huber & Mosler31
consumption of fluoride free water from community filter
.568
Inauen et al.32
Bangladesh
use of arsenic-safe drinking water options
.688
Mosler et al.10
consumption of arsenic free deep tubewell water
.590
Inauen et al.33
use of arsenic free shallow tubewell
log .894
hygienic handling of water
Stocker & Mosler36
Benin
cleaning of water storage container
.625
water testing
Flanagan et al.28
USA
domestic well water testing for arsenic
.415

11. N of studies w/w-o effect
Determinants which may or may not be targeted in all environmental and socio-cultural contexts
% Studies
N of studies w/w-o effect
Behavioral factor determining the difference between doers/non-doers
86%
12/14
Perceived others behavior
80%
12/15
Beliefs about costs and benefits
71%
10/14
Feelings about the behavior
54%
7/13
Confidence in performance
50%
3/6
How-to-do knowledge
38%
5/13
Perceived others’ (dis)approval
33%
2/6
Personal importance
27%
3/11
Health knowledge
25%
3/12
Perceived vulnerability
20%
2/10
Perceived severity

12.  Behavioral factors are always specific for populations and countries
Determinants which are with great probability specific for different populations
Differences can be observed between countries and project settings even within one country
E.g. SODIS usage was determined by a different combination of factors for each of the six different studies
Different combinations of factors explain boiling behaviors in both Burundi and Bolivia.
Switching to safe water sources was also explained by varying psychological factors between - Ethiopia and Bangladesh - even within Bangladesh
 Behavioral factors are always specific for populations and countries

13. Determinants which are specific for different safe water practices
Do we find common patterns or systematic differences in the factors identified as relevant for specific target behaviors?
No systematic differences in relevant factors from the different types of HWTS options (SODIS vs. boiling vs. filtration vs. chlorination).
 No systematic differences between relevant factors for HWTS options compared to switching to safer sources or well testing.

14. Implications for Practice
Using psycho-social factors nearly all practices over all studied countries can be explained very well (mean explained variance 64%).
Perceived others’ behavior, costs and benefits as well as feelings (e.g. taste) about safe water consumption should nearly always be taken into account in behavior change campaigns.
Confidence in performance (self-efficacy), how-to-do knowledge, perceived others’ approval varied more strongly for different target behaviors but also between specific settings and populations and are thus to be evaluated from case to case.
The individual’s health risk perceptions played a role in only very few cases.
Between countries and between different types of safe water behaviors no systematic differences can be observed.
 These findings highlight the usefulness of a systematic approach using psycho-social behavioral determinants in order to design effective behavior change strategies.

15. For more information about Systematic Behavior Change: Side event “Systematic behavior change using the RANAS Approach: an introduction and experiences of implementing organizations” Convened by Eawag and HELVETAS Thursday morning 8:30 – 10:00 Windflower