1. FOAM- From Development to Practice Public Private Partnership Handwashing Initiative

2. 2 Overview of Presentation  The Need for a Model  How FOAM was developed  How FOAM has been used  How PPPHWI fits within WSP

3. 3 A Model for HW BC  Many tools available  All stress audience-centered programming  Lack of holistic model to explain all factors influencing HW  Global Scaling Up HW Project presents an opportunity  Learning objective  Common framework

4. 4 Development of a BCM for HW  Hanoi Vietnam April 24-27, 2007  Participants included HW Coordinators, MoH and Global WSP team  Facilitated by a communication consultant  Key output: a behavior change model for the “Scaling up HW Behavior Change” project

5. 5 What is a behavior change framework? A behavior change framework is a diagram that represents all the various determinants of a behavior that is desirable for a public health outcome to occur:  use of a condom with a commercial sex partner;  sleeping under an insecticide-treated mosquito net to prevent malaria;  hand washing with soap after defecation to prevent diarrheal diseases.

6. 6 What are determinants of behavior? Determinants of behavior are factors that influence whether a person is likely to engage in a certain behavior:  Socio-demographic (such as age, sex and education) or mutable (such as awareness or understanding of a health issue)  Internal (eg. beliefs)  External (eg. social norms)

7. 7 What is a BC Model Diagram that represents the various “determinants” of behavior change  “Determinants” are internal or external factors that influence an individual to perform a behavior

8. 8 Advantages of a BC Model  Provides a common language  Can help identify critical linkages  Informs M&E  Enables comprehensive, evidence- based programming  Can be adapted across populations

9. 9 Example 1: World Bank BC Continuum

10. 10 Example 2: PSI’s PERFORM 4 USERISK-REDUCING BEHAVIOR HEALTH STATUSQUALITY OF LIFE OPPORTUNITYABILITY MOTIVATION POPULATION CHARACTERISTICS SOCIAL MARKETING INTERVENTION PRODUCTPLACEPRICEPROMOTION AT RISK Attitudes Belief Subjective Norm KnowledgeAvailabilityBrand Appeal Quality of Care Threat Outcome Expectation IntentionLocus of Control Willingness to Pay Self Efficacy Social Support Social Norm Brand Attributes

11. 11 F in FOAM  Focus:  desired behavior  target populations

12. 12 O A M  Opportunity: institutional or structural factors that influence an individual’s chance to perform a behavior (external)  Ability: individual’s skills and proficiency to perform a behavior (internal)  Motivation: drives, wishes, urges, or desires that influence an individual to perform a behavior (internal)

13. 13 FOAM

14. 14 From Model to Practice  Enables full marketing mix vision  FOAM can be integrated into existing tools and frameworks (ie Trigger workshops)  FOAM can be applied to:  Analysis of research  Formulation of communication objectives for mass media and IPC  Monitoring & Evaluation  FOAM Operational Matrix (FOM) for program planning

15. 15 FOAM’s can compliment other models Steps of Change See Handout

16. 16 FOAM’s Applications Foam Workshop Used FOAM to analyze main findings from VN HW formative research results Developed three key Communication Objectives for HW program

17. 17 FOAM’s Applications con’t Agency Brief See handout

18. 18 FOAM Tour 2007  Hanoi – Initial FOAM workshop  Dakar – Presentation to global WSP team  Washington DC – input from Tech. working group on BC  Lima – Reanalysis of previous research  Hanoi – National FOAM workshop  Washington DC – Finalize FOAM tools  Dar es Salaam – National FOAM workshop  Senegal – Doer, Nondoer study  Kenya – FOAM workshop

19. 19 WSP’s Other Support Activities Vietnam  Sanitation and Water Partnership for the Mekong Region (SAWAP) is an multi-country technical assistance program in sanitation, hygiene and water supply sectors  Supporting the VN Gov to develop a Unified Sanitation Strategy  Updating the Rural Water Supply & Sanitation Strategy  Study of domestic private sector participation in water supply and sanitation services  Benchmarking study to measure and monitor performance of urban water utility service providers Regionally  EASAN to increase GoV commitment to sanitation in 2008

20. 20 Thank you!