Engaging stakeholders in the development of a Theory of Change to support a systematic review aimed at WASH (Water, Sanitation, Hygiëne) policy makers.
POGONATUM : morphology, anatomy, reproduction etc.
Engaging stakeholders in ToC development
1. Engaging stakeholders
in the development of a Theory of Change
to support a systematic review aimed at WASH
(Water, Sanitation, Hygiene) policy makers
Hans Van Remoortel, Emmy De Buck, Axel Vande Veegaete, Philippe
Vandekerckhove, Taryn Young
2. I have no actual or potential conflict
of interest in relation to this
presentation.
Project is funded by
3. Name Affiliation Role, area of expertise
Karin Hannes Faculty of Social Sciences,
Catholic University of Leuven,
Belgium
Expert qualitative research
Hans-Joachim
Mosler
EAWAG, Environmental Social
Sciences, Switzerland
WASH behaviour change expert
Colex Chapendeka Red Cross Malawi MSc in WatSan, WatSan expert
and PHAST trainer
Alfonso Alvestegui UNICEF Mozambique Water and Environmental
Sanitation Specialist, Small
Towns WASH Programme
Manager
Brian Kae Enriquez Red Cross Philippines Expert WASH software
approaches, IFRC Asia Pacific
Zone
Harun Jojo British Red Cross WatSan expert, Public health
engineer
Chaitali
Chattopadhyay
WSSCC Funding agency
4. Theory of change?
✚An ongoing process of reflection
to explore change and how it
happens – and what that means
in a particular context, sector,
and/or group of people
• Contains hypothesized causal links
• Short versus intermediate versus longer-
term outcomes
• Possible effect of positive/negative
mediators or moderators
5. Intermediate outcomes
Longer-term
outcomes
EDUCATION
Intention to
practice
handwashing
and
sanitation
interventions
(readiness,
willingness)
Use: uptake,
adherence,
and longer-
term use
of/to
handwashing
and
sanitation
activities
(latrine use,
faeces
disposal,…)
Habit to
practice
handwashing
and
sanitation
interventions
(routinized
behaviour)
Knowledge
concerning
sanitation
and
handwashing
program
Skills
concerning
sanitation
and
handwashing
program
Attitude
concerning
sanitation and
handwashing
program
Norms
concerning
sanitation
and
handwashing
program
Self-
regulation
concerning
sanitation
and
handwashing
program
BEHAVIOUR
CHANGE:
Short-term outcomes
Psychosocial
theories
Community-
based
participatory
approaches
Marketing
approaches
Incentives
Advocacy
Target population
Process
evaluation
factors:
-recruitment
-attrition
-reach
-dose
-fidelity
-adaptation
-engagement
-satisfaction
-acceptability
(Elements of)
promotional
approach
Outputs
Potential
Influencing factors
Program environment factors:
-training/qualifications of
implementers
-leadership of implementing
organization
-(adapted) training materials
-partnership, coordination between
providers of same intervention or
other health interventions
-funding
-contextual factors implementers (e.g.
gender)
-intent of program to change a
specific outcome
Recipient-related factors:
-awareness of personal risk
-self-efficacy
-awareness about costs and benefits
-public commitment
-others showing behaviour
-planning skills
Recipients socio-cultural context: dignity/respect, culture, religion, ethnicity, law/regulation, socioeconomic status/authority/role model, minorities, social capital, information environment, division of labour
Recipients physical context: place of residence (rural vs urban), low vs middle income countries, natural and built environment ((quality/maintenance of) infrastructure, geophysical), safety, remote areas, available space
Recipients personal context: demographic variables (age, gender, race, cast, language, education, occupation), physical health, mental health
Other promotional
elements such as
the use of pride and
disgust, behaviour
change
techniques,…
Morbidity,Mortality
6. Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
BEHAVIOUR
CHANGE:
Short-term outcomes
Psychosocial
theories
Community-
based
participatory
approaches
Marketing
approaches
Incentives
Advocacy
Target population
Process
evaluation
factors:
-recruitment
-attrition
-reach
-dose
-fidelity
-adaptation
-engagement
-satisfaction
-acceptability
(Elements of)
promotional
approach
Outputs
Potential
Influencing factors
Program environment factors:
-training/qualifications of
implementers
-leadership of implementing
organization
-(adapted) training materials
-partnership, coordination between
providers of same intervention or
other health interventions
-funding
-contextual factors implementers (e.g.
gender)
-intent of program to change a
specific outcome
Recipient-related factors:
-awareness of personal risk
-self-efficacy
-awareness about costs and benefits
-public commitment
-others showing behaviour
-planning skills
Recipients socio-cultural context: dignity/respect, culture, religion, ethnicity, law/regulation, socioeconomic status/authority/role model, minorities, social capital, information environment, division of labour
Recipients physical context: place of residence (rural vs urban), low vs middle income countries, natural and built environment ((quality/maintenance of) infrastructure, geophysical), safety, remote areas, available space
Recipients personal context: demographic variables (age, gender, race, cast, language, education, occupation), physical health, mental health
Other promotional
elements such as
the use of pride and
disgust, behaviour
change
techniques,…
Morbidity,Mortality
8. Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
BEHAVIOUR
CHANGE:
Short-term outcomes
Psychosocial
theories
Community-
based
participatory
approaches
Marketing
approaches
Incentives
Advocacy
Target population
Process
evaluation
factors:
-recruitment
-attrition
-reach
-dose
-fidelity
-adaptation
-engagement
-satisfaction
-acceptability
(Elements of)
promotional
approach
Outputs
Potential
Influencing factors
Program
environment factors:
-training/qualifications of
implementers
-leadership of implementing
organization
-(adapted) training materials
-partnership, coordination between
providers of same intervention or
other health interventions
-funding
-contextual factors implementers (e.g.
gender)
-intent of program to change a
specific outcome
Recipient-related
factors:
-awareness of personal risk
-self-efficacy
-awareness about costs and benefits
-public commitment
-others showing behaviour
-planning skills
Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients
:personal context (e.g. demographic variables (gender))
Other promotional
elements such as
the use of pride and
disgust, behaviour
change
techniques,…
Morbidity,Mortality
Layer 2: Short-term,
intermediate and longer-
term outcomes
1. creating an
additional
outcome layer
with short-term
outcomes,
2. Better defining
the intermediate
outcome “use”
3. clear distinction
between
program
outputs and
outcomes
9. Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
BEHAVIOUR
CHANGE:
Short-term outcomes
Psychosocial
theories
Community-
based
participatory
approaches
Marketing
approaches
Incentives
Advocacy
Target population
Process
evaluation
factors:
-recruitment
-attrition
-reach
-dose
-fidelity
-adaptation
-engagement
-satisfaction
-acceptability
(Elements of)
promotional
approach
Outputs
Potential
Influencing factors
Program
environment factors:
-training/qualifications of
implementers
-leadership of implementing
organization
-(adapted) training materials
-partnership, coordination between
providers of same intervention or
other health interventions
-funding
-contextual factors implementers (e.g.
gender)
-intent of program to change a
specific outcome
Recipient-related
factors:
-awareness of personal risk
-self-efficacy
-awareness about costs and benefits
-public commitment
-others showing behaviour
-planning skills
Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients
:personal context (e.g. demographic variables (gender))
Other promotional
elements such as
the use of pride and
disgust, behaviour
change
techniques,…
Morbidity,Mortality
Layer 2: Short-term, intermediate
and longer-term outcomes
1. creating an additional
outcome layer with
short-term outcomes,
2. Better defining the
intermediate outcome
“use”
3. clear distinction between
program outputs and
outcomes
10. Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
BEHAVIOUR
CHANGE:
Short-term outcomes
Psychosocial
theories
Community-
based
participatory
approaches
Marketing
approaches
Incentives
Advocacy
Target population
Process
evaluation
factors:
-recruitment
-attrition
-reach
-dose
-fidelity
-adaptation
-engagement
-satisfaction
-acceptability
(Elements of)
promotional
approach
Outputs
Potential
Influencing factors
Program
environment factors:
-training/qualifications of
implementers
-leadership of implementing
organization
-(adapted) training materials
-partnership, coordination between
providers of same intervention or
other health interventions
-funding
-contextual factors implementers (e.g.
gender)
-intent of program to change a
specific outcome
Recipient-related
factors:
-awareness of personal risk
-self-efficacy
-awareness about costs and benefits
-public commitment
-others showing behaviour
-planning skills
Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients
:personal context (e.g. demographic variables (gender))
Other promotional
elements such as
the use of pride and
disgust, behaviour
change
techniques,…
Morbidity,Mortality
Layer 2: Short-term,
intermediate and longer-
term outcomes
1. creating an
additional
outcome layer
with short-term
outcomes,
2. Better defining
the intermediate
outcome “use”
3. clear
distinction
between
program
outputs and
outcomes
11. Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE:
UPTAKE VS
ADHERENCE
VS
LONGER-
TERM USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
BEHAVIOUR
CHANGE:
Short-term outcomes
Psychosocial
theories
Community-
based
participatory
approaches
Marketing
approaches
Incentives
Advocacy
Target population
Process
evaluation
factors:
-recruitment
-attrition
-reach
-dose
-fidelity
-adaptation
-engagement
-satisfaction
-acceptability
(Elements of)
promotional
approach
Outputs
Potential
Influencing factors
Program
environment factors:
-training/qualifications of
implementers
-leadership of implementing
organization
-(adapted) training materials
-partnership, coordination between
providers of same intervention or
other health interventions
-funding
-contextual factors implementers (e.g.
gender)
-intent of program to change a
specific outcome
Recipient-related
factors:
-awareness of personal risk
-self-efficacy
-awareness about costs and benefits
-public commitment
-others showing behaviour
-planning skills
Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients
:personal context (e.g. demographic variables (gender))
Other promotional
elements such as
the use of pride and
disgust, behaviour
change
techniques,…
Morbidity,Mortality
Layer 3: Factors influencing the implementation
1. completed and clarified a list of
contextual factors
2. added a layer of “recipient-related
factors”
3. added a layer of “program environment
factors”
12. Intermediate outcomes
Longer-term
outcomes
EDUCATION
INTENTION
USE
HABIT
KNOWLEDGE
SKILLS
ATTITUDE
NORMS
SELF-
REGULATION
BEHAVIOUR
CHANGE:
Short-term outcomes
Psychosocial
theories
Community-
based
participatory
approaches
Marketing
approaches
Incentives
Advocacy
Target population
Process
evaluation
factors:
-recruitment
-attrition
-reach
-dose
-fidelity
-adaptation
-engagement
-satisfaction
-acceptability
(Elements of)
promotional
approach
Outputs
Potential
Influencing factors
Program
environment factors:
-training/qualifications of
implementers
-leadership of implementing
organization
-(adapted) training materials
-partnership, coordination between
providers of same intervention or
other health interventions
-funding
-contextual factors implementers (e.g.
gender)
-intent of program to change a
specific outcome
Recipient-related
factors:
-awareness of personal risk
-self-efficacy
-awareness about costs and benefits
-public commitment
-others showing behaviour
-planning skills
Recipients socio-cultural context (e.g. SES), Recipients physical context (e.g.: place of residence (rural vs urban),) and Recipients
:personal context (e.g. demographic variables (gender))
Other promotional
elements such as
the use of pride and
disgust, behaviour
change
techniques,…
Morbidity,Mortality
13. Conclusions and next steps
✚ Discussion with the different stakeholders resulted in
a ToC that is more relevant to our target groups
✚ Stakeholder involvement in the ToC development
created a sense of ownership and stakeholder buy-in
✚ ToC will be used as a central thread during the
development of a systematic review (SR) + will be
further refined with findings from the SR
✚ Theory-based approach will help policy makers to
understand the important role of implementation,
and the processes determining behaviour change in
handwashing and sanitation
14. More information?
✚ Protocol of our mixed-methods SR:
registered in Campbell Library (http://bit.ly/2eNfVCn)
✚ Webpages at Belgian Red Cross website
(http://bit.ly/2emJk50)
✚ cebap@redcross.be
✚ http://bit.ly/2epYjbp
✚ @CEBaP_evidence
17. ToC is based on…
1. WASH behavioural models
• RANAS model as a basis: intermediate outcomes,
contextual factors
• IBM-WASH model: some additional contextual factors
2. PROGRESS framework: additional items for the
contextual factors
3. Checklist for implementation & SURE framework:
selection of factors playing a role in implementation
4. Phase 1 of the project: overview of existing
systematic reviews
5. Stakeholder consultation (face-to-face meeting Cape
Town)
