Nudge, Don’t Shove: A Case for Reflexive WASH Behavioral Change, Part I

About the author: Stephanie Tam specializes in behavioral approaches to sanitation and hygiene in international development, with a focus on how cultural practices mediate the impact of technology in operations and maintenance. A graduate of the Harvard Graduate School of Design, she has been working on human behavior through the lenses of performance studies and behavioral economics, and thanks Dilip Soman at the Rotman School of Management at the University of Toronto for support on this current project. She is deeply invested in monitoring the socioeconomic impact of WASH projects, and has worked with various NGOs, human rights advocates, anthropologists, environmental engineers, and urban planners to develop technologies, infrastructure and behavioral practices that empower the under served in a measurable and accountable way.  Stephanie can be contacted via her website, Linkedin, or Academia.


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We were taught in the schoolyard that shoving is unacceptable behavior, yet dominant approaches to changing sanitation and hygiene practices in developing countries do exactly that – forceful pushing that takes away the time and space for a person to decide which direction they want to go. Take for example Community-Led Total Sanitation (CLTS): it’s effective in compelling compliant behavior because it leaves people with no choice to act otherwise lest they face shaming and even stoning (Chatterjee 2011; Ngozo 2010; Devine 2009). However, bullying comes at a price. We know that bullied children suffer mental health effects for years afterwards, yet there have been no studies on the long-term mental health effects that CLTS leaves upon those who have been “saved” from open defecation. Sometimes WASH gets too caught up with its most immediate goals and loses sight of its overarching aim of improving well-being – a well-being which includes mental health, as difficult as it may be to observe and measure.

I want to propose another way of changing habitual behaviors that can be just as effective, but without the collateral damage of brute force. By no means am I suggesting that we parachute soap and toilets onto communities and then leave people to figure out how to incorporate them into their daily lives, but I am arguing that we treat our target audience as decision-makers. Like all decision-makers, they have bounded self-control when it comes to following through with earlier decisions, and their judgments flicker with their mood, the weather, and a plethora of other contextual noises. This is where behavioral economics’ documentation of behavioral biases comes in. As fickle as our behaviors may be in relation to our conscious intentions, they respond systematically to certain environmental conditions, i.e. they have predictable biases. Through different combinations of biases, behavioral economists test out how to make certain behaviors easier to perform by subtly changing the context. These changes influence what neuroscientists call the reflexive cognitive system: a knee-jerk reaction that outstrips the slower reflective system we commonly call consciousness or analytical thought (Lieberman 2002). Instead of shoving people into sanitation and hygiene practices, we can create an environment that enables people to perform behaviors that they themselves have chosen.

People have difficulty carrying out what they consciously choose to do because their habits are engrained in muscle memory, and are performed spontaneously by the reflexive system. Hand washing and defecation are done automatically, and are already completed by the time a person even thinks to check their behavior. This is why solely educating communities on the benefits of hygiene and sanitation has limited effectiveness (Curtis 2009; Torres 2004). People do not perform behaviors simply out of ignorance, but out of bounded self-control.

This is not to say that we can dispense with WASH education altogether. Knowledge is important for people to be able to make choices about their behaviors, even though knowledge may not translate into actually carrying out those behaviors. However, we need to contextualize the impact of WASH education among the financial and social stresses that already take a heavy cognitive toll upon the poor. Mani et al.’s recent study concludes that poverty impedes cognitive capacity (Mani 2013). The kind of cognitive capacity that the study assessed belongs to what neuroscientists identify as the inherently slower reflective system that our automated reactions already easily beat out, making it even less likely for interventions targeting this slower reflective system to succeed. Since processing new information is done through the same reflective system, WASH education’s effect is extremely weak. Moreover, to continually belabour the reflective system with WASH information consumes precious cognitive resources and leaves people with even less capacity to process other aspects of survival such as getting out of debt or making arrangements for their children’s schooling [see Figure 1]. By instead targeting the larger cognitive resources of a person’s automated reflexive system (Evans 2008), we can avoid achieving WASH goals at the expense of other concerns that are equally important in ensuring a person’s well-being.

Accounting for environmental effects is not a new concept in WASH projects, but behavioral economics works at the level of automatic reactions rather than causal reasoning. For example, the Water Sanitation Program’s SaniFOAM framework breaks down behavioral determinants to opportunity, ability and motivation (Devine 2009). While its analysis of opportunity and motivation encompasses availability, social norms, product attributes, emotional drivers and willingness to pay – all of which are concerns for behavioral economists -, it seeks out intentional reasons for observed behaviors. Behavioral economists, on the other hand, argue that intentionality has little to do with how we actually act.

Take for instance this SaniFOAM finding: “In Tanzania, surveys have found that people prefer a water closet because it is easy to clean, modern, and durable. Those who preferred VIP latrines reported ‘no smell’ as the main reason” (Devine 6). The very method of survey-taking assumes that preferences are rooted in conscious thought, even though studies show that all sorts of subconscious factors strongly influence decisions (Kahneman 2011). Although people give well-reasoned answers justifying their toilet preferences, we have to ask how the survey question was framed and what people felt were at stake when they answered. Indeed, Curtis et al. argue that hygiene and sanitation surveys generate distorted information because people tend to be embarrassed about reporting “irrational” motivations and try to give what they think is the “right” answer to interviewers (15-17).

A project using SaniFOAM would assume that as long as people are given easy to clean, durable, and ventilated toilets, they will be more likely to use them. Behavioral economists, on the other hand, would look at impractical attributes irrelevant to the function of a toilet and come up with a different list of attributes that attract toilet use. They could include things like people’s mood when they first encounter the toilet, the color and size of the toilet, or the feel of the toilet. These are not influences that register consciously, nor can they be ascertained simply through observation. Observers could be unaware of numerous factors that are at play in an observed phenomenon, resulting in flawed formative research. What’s needed instead is empirical testing with, say, different colored toilets so that we can determine what color will predispose a certain community to use toilets. This kind of testing takes up a lot more time, money, and energy than surveys do, but front-loading investments this way does pay off. Empirical testing gives interventions more predictability because they have already been “reality tested”, and behavioral economics interventions often consist of very small, easy to implement moves that yield dramatic results.

Nudging takes a lot of time to craft and perfect, but I believe that an alternative to brute shoving is well worth the time and energy. By extrapolating from existing behavioral economics studies, WASH can begin to formulate its own behavioral tools. In Part II, I will review more specific behavioral economics principles that lend themselves to WASH projects.

Works Cited:

Chatterjee, Liz. “Time to acknowledge the dirty truth behind community-led sanitation.” The Guardian. 9 June 2011

Curtis, Valerie, Lisa O. Danquah and Robert V. Aunger. “Planned, motivated and habitual hygiene behaviour: an eleven country review.” Health Education Research 24.4 (2009): 655-673.

Devine, Jacqueline. “Introducing SaniFOAM: A Framework to Analyze Sanitation Behaviors to Design Effective Sanitation Programs.” Water and Sanitation Program Working Paper. October 2009

Evans, Jonathan St. B. T. “Dual-Processing Accounts of Reasoning, Judgment, and Social Cognition.” Annual Review of Psychology (2008) 59: 255-278

Kahneman, Daniel. Thinking, Fast and Slow. Canada: Doubleday, 2011.

Lieberman, Matthew D. et al. “Reflection and Reflexion: A Social Cognitive Neuroscience Approach to Attributional Inference.” Advances in Experimental Social Psychology 34 (2002): 199-249

Ngozo, Claire. “Catapults against cholera.” The Daily Times. 25 February 2010. Lifestyle p. 5

Torres, Marco Polo et al. “Combining Hygiene Behaviour Change with Water and Sanitation: A Pilot Project in Hato Mayor, Dominican Republic”. February 2004

Nudge, Don’t Shove: A Case for Reflexive WASH Behavioral Change, Part I
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