Social marketing of water and sanitation products: A systematic review of peer-reviewed literature

Social marketing

Marketing is about an exchange of value: the product provides value for the customer, in exchange for financial benefit for the marketer. Social marketers promote causes with a social benefit, or behaviors that benefit the audience. They make use of the 4 Ps: place, price, product and promotion. When marketing behavior, price can be seen as time, effort or convenience. Product would be the benefits, social or functional, that the behavior provides. Recently, social marketing has been used to promote healthy drinking water and sanitation, together with preventive treatments for water-related illnesses like diarrhea. The authors of this article set out to study this field by reviewing peer-reviewed literature and identify:

1. The presence or absence of social marketing activities in specific interventions
2. The presence or absence of the 4 Ps in these interventions
3. The outcome of the evaluation in these interventions

Product

Over one third of the studies used the Safe Water System (SWS), which promotes the treatment of water at the point of use (by means of a sodium hypochlorite solution), safe storage and behavior change. Marketing techniques can be recognized in the use of a brand name and logo. However, other interventions used unbranded products, like water vessels or latrines. In some cases, the entire campaign was branded: hygiene behaviors in one study were marketed as a ‘Clean Life Campaign’. All studies also had health gains that resulted from a hygiene-related behavior as a product.

Place

In social marketing, place refers to the distribution channels that are used to make tangible products available to consumers. It may also refer to the location where a customer engages in the desired behavior. Some interventions focused on the exchange of a product, others facilitated availability and easy access by using local resources. Local volunteers were trained to educate households about the benefits of hygienic behaviors. Another way was to use public spaces in the community to promote behavior, such as village loudspeakers or local mosques, or through health education in schools.

Price

Price can refer to providing monetary subsidies (which may not be very effective) or the time and effort expended by individuals to adopt the intervention. In the surveyed interventions, water treatment solutions were sold at low rates made possible by subsidies. Sales occurred both to the customers as well as to local wholesalers and retailers to stimulate sales. When the interventions were investments in sanitation infrastructure, households were often asked to pay for part of the construction, as well as provide labor.

Promotion

Perhaps the most visible aspect of social marketing is promotion. As mentioned before, a common technique in the interventions was to train volunteers to spread knowledge about hygiene. Another strategy was to organize neighborhood meetings to promote awareness. Health education in schools was also a common way to spread knowledge, as well as advertisements on radio and TV and in newspapers and other printed media.

Effectiveness of the Safe Water System and other interventions

Over many different interventions, the SWS led to a significant increase in sales of chlorine bottles, as well as safe storage containers for water. More people were using safe hand washing techniques at the end of the intervention. An effective way to promote behavior changes with the SWS was motivational interviewing. Other interventions that promote correct handwashing techniques and proper stool disposal through media campaigns, house-to-house visits and schools also showed an increase in handwashing with soap. Print media seems to have the best effect, especially when illustrations are used. Oral rehydration therapy is the most cost-effective way to lower childhood mortality due to diarrhea. Social marketing saves lives by promoting the use of oral rehydration packets.

Bullet points

• Social marketers promote causes with a social benefit, or behaviors that benefit the audience. They make use of the 4 Ps: place, price, product and promotion. When marketing behavior, price can be seen as time, effort or convenience. Product would be the benefits, social or functional, that the behavior provides.
• Over many different interventions, the SWS led to a significant increase in sales of chlorine bottles, as well as safe storage containers for water. More people were using safe hand washing techniques at the end of the intervention. Other interventions that promote correct handwashing techniques and proper stool disposal through media campaigns, house-to-house visits and schools also showed an increase in handwashing with soap. Print media seems to have the best effect, especially when illustrations are used.

Tentamentickets

Exam

The exam consists of multiple-choice questions.

Study

Make sure you know what the 4 Ps entail and how they are used in social marketing specifically. Apart from that it is important that you know which forms of social marketing were found to be effective in promoting hygiene behaviors.

Social-cognitive factors mediating intervention effects on handwashing: a longitudinal study

The importance of handwashing

Diarrhea is the main cause of death in children under the age of five worldwide. The most effective preventive measure for diarrhea is handwashing by the primary caregivers, especially after giving food or potential contact with stool. In most developing countries (and even many developed countries) this remains a challenge. Health promoting agencies therefore focus mainly on the development and implementation of handwashing programs. The effectiveness of these programs is increased when they are based on multiple behavioral theories.

RANAS

RANAS is the Risk, Attitudes, Norms, Abilities, Self-Regulation approach, a multi-theoretical framework to design water, sanitation and hygiene (WaSH) interventions in developing countries. The RANAS approach uses quantitative identification of the social-cognitive factors that determine the key behavior in the target population, and selects behavior change techniques (BCTs) expected to target exactly these factors for intervention development. In a study in Ethiopia, the following determinants of handwashing were found:

• The descriptive norm: behaviors typically practiced by and therefore copied from others.
• The injunctive norm: behaviors typically approved or disapproved of by others.
• Impediments: anticipated barriers and distractions to a behavior.
• Forgetting: forgetting to execute a behavior at a specific time or situation.
• Inconvenience of the present handwashing technique.

The BCTs selected to target these factors were public commitment, facilitating resources, and reminders. These proved far more effective than a standard education intervention, showing that using theory-based interventions is indeed preferable.

Mechanisms of change

A public commitment (making a promise to oneself or the public) is linked to an increase in commitment strength and the injunctive norm. In addition, seeing others commit should affect the descriptive norm. Public commitment should also serve as a reminder, to counter forgetting. Impediments can be decreased by providing resources, such as installing a handwashing station and making water and soap more easily accessible. Using the handwashing infrastructure provided should lead to increased motivational and volitional self-efficacy. This is the belief that one is able to initiate and execute the behavior and the belief in one’s capability to maintain the behavior and recover from relapse. Time and energy already invested by the household should serve to create more commitment to using the handwashing stations by enhancing the injunctive norm. Because they are constructed in public areas, the descriptive norm should also be enhanced. The authors of this article set out to test these assumptions in southern Ethiopia.

Research design

This article tested the change processes of two handwashing interventions, a public commitment intervention with reminder and an infrastructure promotion intervention with reminder. These conditions were compared to an education-only intervention. The interventions were developed to be theory-based and tailored to the target population.

Effectiveness of the interventions

Infrastructure-promotion with reminder and education, alone and in combination with public commitment with reminder, largely predicted changes in social-cognitive factors as expected. The interventions’ effects on handwashing were mediated by these social-cognitive factors. Motivational self-efficacy and social norms were enhanced, while impediments and forgetting were decreased.

Volitional self-efficacy

However, volitional self-efficacy was only affected by infrastructure-promotion with reminder in combination with public commitment. It is possible that the public commitment bolstered the infrastructure-promotion’s effect on volitional self-efficacy.

Food-related versus stool-related commitment strength

It seems that only food-related commitment strength, but not stool-related commitment strength, was affected by the interventions. This shows that these two types of commitment strength should be considered separately when designing an intervention.

Injunctive norm and commitment strength

Public commitment with reminder did not increase the injunctive norm and commitment strength. This difference may have been caused by the subjects not having to read their intentions to the group, but only pledge for themselves. The effect of the reminder in the form of the commitment sign (a headscarf) was also not found, likely because the subjects also forgot to wear the headscarf since they were not accustomed to it. When developing an intervention, the commitment signs need to be designed to ensure that they are made public and are seen as a request to engage in the target behavior.

Conclusion

This study shows that theory-based population-tailored interventions are more successful in changing handwashing than a standard education intervention. The interventions that were used successfully changed the critical social-cognitive factors in the target population. This emphasizes the importance of investigating interventions’ underlying change processes.

Bullet points

• Diarrhea is the main cause of death in children under the age of five worldwide. The most effective preventive measure for diarrhea is handwashing by the primary caregivers, especially after giving food or potential contact with stool.
• RANAS is the Risk, Attitudes, Norms, Abilities, Self-Regulation approach, a multi-theoretical framework to design water, sanitation and hygiene (WaSH) interventions in developing countries. The RANAS approach uses quantitative identification of the social-cognitive factors that determine the key behavior in the target population, and selects behavior change techniques (BCTs) expected to target exactly these factors for intervention development.
• This study shows that theory-based population-tailored interventions are more successful in changing handwashing than a standard education intervention. The interventions that were used successfully changed the critical social-cognitive factors in the target population. This emphasizes the importance of investigating interventions’ underlying change processes.

Tentamentickets

Exam

The exam consists of multiple-choice questions.

Study

Make sure you know what RANAS entails, which determinants of handwashing were found and which BCTs were selected to target those determinants. It is also important that you understand what the researchers expected to find and how their actual findings differed from those expectations. Pay attention to why the findings were different and what this means for potential interventions.

Spillover effects in environmental behaviors, across time and context: a review and research agenda

Environmental behavior Spillover effects in environmental issues

Individual changes in environmental behavior have been shown to make a difference, where government policy falls short. Education campaigns are relatively ineffective in producing behavior change, slightly more so than price incentives (or disincentives). In specific situations, goal setting, social norms, and prompts have had some success.

Spillover effects in environmental issues

The concept of spillover means that by engaging in one behavior, people will adopt a more pro-environmental orientation and will engage in other pro-environmental related behaviors. The precise definition is: the extent to which engaging in one behavior influences the probability of conducting a subsequent behavior. This can be very effective, but the downside is that it can also work in a negative direction, where people use one behavior as a rationale for not performing other acts. There are three types of spillover effect (not mutually exclusive):

• Spillovers across behavior: one behavior causes another behavior
• Spillovers across time: one behavior causes the same behavior to occur again in the future
• Spillovers across contexts: one behavior causes the same behavior again in a different context

Theoretical basis of positive spillovers

Following now are several theories that can explain the positive spillover effect.

Cognitive dissonance theory

This theory states that perceived incongruence between elements of cognitions or behaviors will lead to feelings of discomfort. This motivates dissonance reduction strategies, such as behavioral change. When someone behaves inconsistently concerning the environment, cognitive dissonance might cause them to change their behavior to be more consistently pro-environmental, especially if first pro-environmental behavior is relevant for the self-concept.

Self-perception theory

This theory predicts that people use their own behavior as cues when forming evaluative cognitions (attitudes, norms, values). Describing peoples past behaviors as pro-environmental is associated with stronger moral obligations and higher positive pro-environmental attitudes.

Action based learning

This is grounded in the assumption that beliefs about outcomes affect behaviors, and that increased learning about the outcomes of a specific behavior can extend to other behaviors. Buying energy effective light bulbs may influence beliefs about energy conservation in general and thus elicit positive spillover effects.

Theoretical basis of negative spillovers

While in positive spillovers a first behavior promotes a second that is more of the same, in negative spillover the first behavior creates permission for a second behavior that is the opposite of the first. For example, recycling might decrease the feeling of obligation for waste prevention when shopping.

Moral licensing: credits and credentials

In this concept, an initial moral action results in a subsequent immoral action. This can be explained by two hypothesis: moral credentials and moral credits. Moral credentials predicts that engaging in a behavior that is perceived as morally good will boost the self-concept. These positive emotions inhibit the influence of discomfort when conducting a perceived immoral behavior. Moral credits predicts that engaging in a behavior which is perceived as morally good creates room for perceived immoral behaviors. Think of this like a credit account, where you build up credit by being ‘good’, which you will then spend on behavioral transgressions.

Spillover across behaviors

Positive spillover across behavior

Positive cueing is a tool used to stimulate self-perception via framing of past behavior as ‘diagnostic’ of pro-environmental behavior. Reminding people of past pro-environmental behavior can therefore lead to increased pro-environmental judgments and intentions, mediated by self-identity. That means the first behavior must lead to a more pro-environmental self-identity to cause positive spillover.

Rebound effects

A rebound effect occurs when technological improvements create decreased costs, leading to increased demand. This means that improved efficiency of an appliance or technology causes more people to buy that appliance, which offsets the actual energy savings achieved. A direct rebound effect occurs like described above, for example when an energy efficient vehicle subsequently gets driven more often. An example of indirect rebound effects is if the money saved on household energy conservation is spent on a more extensive holiday, leading to increased rather than decreased environmental impact.

Negative spillover across pro-environmental behaviors

In one study that gave participants weekly information about water usage, increased energy consumption was found. This indicated that the intervention campaign stimulated a negative spillover effect of increased energy usage. The direction of spillover seems to depend on whether the first behavior serves as an identity signal. Positive spillover occurs more often when the first behavior was a high-cost behavior. When the first behavior is low-cost, negative spillover is more likely to occur.

Negative spillovers promoting environmental actions

So far, negative spillovers have been exemplified as a first pro-environmental behavior leading to subsequent pro-environmental inaction. Negative spillover could also go the other way: first an environmentally unfriendly behavior promoting a second environmental friendly behavior. When participants in a study are made mindful of a past transgression, they are more likely to engage in a second (similar) behavior that is pro-environmental.

Temporal spillover

In contrast to spillovers spreading between behaviors, in temporal spillover a behavior at time 1 will affect the same behavior at time 2. As in behavioral spillover, the effect may be positive or negative: people may feel like they are ‘a pro-environmental person’ and execute the behavior more often, or they may feel they have done their share and don’t execute the behavior again soon.

Post-decisional dissonance

This effect means that people who choose from two alternatives immediately have stronger attitudes towards the chosen alternative. This shows that engaging in behavior A in time 1 can affect people’s attitudes toward that behavior in a positive direction.

Contextual spillover

Contextual spillover occurs when a behavior A spreads from context 1 to context 2, for example a spillover effect of energy saving behavior between work settings and home settings. The effect is especially strong when similar equipment is used in both contexts and both have similar triggers. The support for negative spillovers between contexts is ambiguous, but there is consistent evidence for positive pro-environmental contextual spillovers.

Moderating factors for positive and negative spillover

Moderating the strength of spillover effect

Moderators for the strength of spillover effect are:

• Similarity in material content and process between contexts
• Similarity between two behaviors over time
• A high score on Personal Preference for Consistency (PFC)
• Pro-environmental self-identity
• Framing behavior in terms of self-transcendence or normative goals toward environment

Moderating positive vs. negative spillover effect

Positive spillover seems to induce PFC or stability, via a long term goal achievement, an abstract level of construal (recalling a distant moral action), or a rule-based mindset (ethical strategy of conforming to moral norms). Negative spillovers seem to be associated with the focus on outcome or a concrete action in the present.

Techniques for promoting positive spillover effects

In automatic techniques, researchers measure a first behavior or set of behaviors, and assume that merely conducting these behaviors will spread to additional behaviors, times or contexts. Intervening techniques use an active strategy to affect the mediating psychological constructs. Spillover effects induced by cognitive dissonance are likely unreliable, because it is easier to use small behaviors as justification than to change behavior to be more consistent. Targeting self-perception seems a more clear and stable way to promote positive spillover.

Conclusion

Cognitively based intervention techniques are most likely to elicit positive pro-environmental spillovers. This means techniques such as cueing seem to provide a stronger and more stable basis for pro-environmental behaviors to elicit positive spillover compared to automatic interventions. However, most studies use correlational evidence, so more research is needed to look at causal relationships. Often positive and negative spillover are studied in isolation, but psychological processes that may influence both should be varied in experimental settings.

Bullet points

• The concept of spillover means that by engaging in one behavior, people will adopt a more pro-environmental orientation and will engage in other pro-environmental related behaviors. The precise definition is: the extent to which engaging in one behavior influences the probability of conducting a subsequent behavior. Spillover can happen across behavior, across time, or across contexts.
• While in positive spillovers a first behavior promotes a second that is more of the same, in negative spillover the first behavior creates permission for a second behavior that is the opposite of the first. For example, recycling might decrease the feeling of obligation for waste prevention when shopping.
• Moderators for the strength of spillover effect are: similarity between contexts or behaviors, a high score on Personal Preference for Consistency (PFC), pro-environmental self-identity, framing in terms of self-transcendence or normative goals toward environment.
• Cognitively based intervention techniques are most likely to elicit positive pro-environmental spillovers. This means techniques such as cueing seem to provide a stronger and more stable basis for pro-environmental behaviors to elicit positive spillover compared to automatic interventions.

Tentamentickets

Exam

The exam consists of multiple-choice questions.

Study

It is important to have an understanding of the different kinds of spillover: positive/negative and behavioral/temporal/contextual, and what they entail. Also make sure you understand the theoretical basis for the concept of spillover. Finally, pay attention to the factors that moderate the strength of spillover effects.