The Behaviour Centred Design (BCD) approach is a five-step process for designing behaviour change interventions: (1) Assess, (2) Build, (3) Create, (4) Deliver and (5) Evaluate. BCD interventions aim to achieve behaviour change by creating surprise, prompting a re-evaluation of the behaviour and disrupting the environment in which the behaviour is practised.
BCD interventions use three working principles. First, an intervention has to gain the participants’ attention. To achieve this, the intervention should be perceptible and surprising. Second, an intervention has to prompt participants to perceive the target behaviour as the best possible option. To achieve this, participants are prompted to re-evaluate the behaviour. Third, the intervention should disrupt the environment in which the behaviours are practised, for example by modifying the physical environment, setting reminders or making the environment more enabling of the new behaviour.
To design interventions that follow these principles, BCD has developed a five-step process. In the Assess step, programme designers review and compile the existing evidence about the practices and determinants of the behaviours of interest, define the target behaviour to be changed and hypothesise a potential theory of change for the intervention. In the Build step, formative research is conducted to better understand the practices and determinants of the target behaviour, develop a robust theory of change and a creative brief that forms the basis of the Create step. In this step, a creative team develops concepts for the intervention which are further developed in an iterative process of feedback from programme designers. Once the intervention concept is agreed upon, intervention materials are developed in an iterative process of design, feedback and pre-testing. In the subsequent Delivery step, interventions are implemented and monitored. The final Evaluation step considers both the outcomes (behaviour change) and the process of change (the psychological, social and physical change mechanisms of the campaign). The BCD approach has been used for several hygiene and nutrition behaviours but could also be used for other public health programming, product design and more.
The BCD research tools and methods place a particular emphasis on non-cognitive approaches rather than talk-based methods. For data collection, BCD therefore recommends tools such as videoing T.30, Observation T.28, and photographs and interventions such as Cues and Nudges T.9. The following tools of this Compendium could be used for the BCD approach:
The BCD approach can be used in a wide range of contexts because the formative research carried out during the Assess and Build steps tailor the intervention to the context and target audience. The BCD working principles are drawn from behavioural science and its overall procedure has been corroborated through various evaluation studies. BCD is useful in gaining new insights and developing innovative ideas for addressing persistent challenges in hygiene; it can also be used for product design. A further strength is its iterative sequences between formative research, design and testing. However, the full approach requires close collaboration between several teams - the programme designers, field researchers, creative designers and members of the target audience. It requires considerable human resources and intensive field work. It takes time. BCD is therefore less suitable for acute emergency response and resource-limited settings.
Each step of the BCD approach is best implemented by a specialised individual or team (librarians, qualitative researchers, creative designers, monitoring and evaluation specialists). BCD provides a framework for collaboration between these disciplines; that requires training for each of the team members. Steps A to B can be implemented within a few weeks. Implementing the other phases largely depends on the resources available and the campaign design.
The effectiveness of BCD to design behaviour change campaigns in the development context has been corroborated for various target behaviours and contexts, such as handwashing with soap (HWWS) in India, various hygiene behaviours in Zambia, food hygiene in Nepal and breastfeeding in Indonesia. The SuperAmma campaign in India, for example, achieved 19% HWWS (as compared to 4% in the non-intervention control) six weeks after the intervention and 37% HWWS (as compared to 6% in the control) six months after the intervention. After one year, handwashing rates were still at 29%.
Collaborate with creative professionals and rely on their expertise for the design step
Test campaign ideas early and frequently. This indicates what might or might not work early in the process
Do not skip any of the five steps. Each step is required and adds important information to the design process
Do not attempt to conduct all the steps yourself. A strength of BCD is its ability to integrate professionals with diverse expertise. Do not waste the collaborative potential of the approach
The SuperAmma campaign in India aimed at HWWS for mothers and their children. It included a meeting with the village chairman, village and school event, a Public Commitment T.37 by mothers through a ceremony and public display of their names, a public commitment by local leaders through a display of their pictures, meetings with pre-school teachers and animated films and skits highlighting the clean and exemplary behaviour of SuperAmma. The campaign prompted participants to revaluate HWWS as an activity associated with being a nurturing mother. The environment was ‘disrupted’ by installing eye-spots in handwashing areas. Surprise was created by presenting the whole campaign as a special event.
To achieve behaviour change through creating surprise, disrupting the environment and prompting re-evaluation
Aunger, R., Curtis, V. (2016): Behaviour Centred Design: Towards an Applied Science of Behaviour Change, Health Psychology Review 10(4). Pages 425-446
Biran, A., Schmidt, W. et al. (2014): Effect of a Behaviour-Change Intervention on Handwashing With Soap in India (SuperAmma): A Cluster-Randomised Trial, The Lancet Global Health, Vol. 2(3). Pages 145-154
Greenland, K., Chipungu, J. et al. (2016): Theory-Based Formative Research on Oral Rehydration Salts and Zinc Use in Lusaka, Zambia, BMC Public Health 16:312
Gautam, O., Schmidt, W. et al. (2017): Trial of a Novel Intervention to Improve Multiple Food Hygiene Behaviors in Nepal, American Journal of Tropical Medicine and Hygiene 96(6). Pages 1445-1456
White, S., Schmidt, W. et al. (2016): Can Gossip Change Nutrition Behaviour? Results of a Mass Media and Community-Based Intervention Trial in East Java, Indonesia, Tropical Medicine and International Health 21(3). Pages 348-364