Testing a Practitioner-Friendly Behavior Model in Pakistan, India, and Nigeria

Abstract

Background: There is increasing interest in using social and behavior change (SBC) for Health Systems Strengthening (HSS) in low-and-middle income countries (LMICs) but few good examples of how behavioral insights could inform the design, implementation, and evaluation of HSS interventions. Practitioners would benefit from a practical behavior model that may be applied across behaviors, in multiple social contexts. We test the Fogg Behavior Model (FBM), which has this potential, in 3 different social and economic contexts: Pakistan, India, and Nigeria.Methods: The study uses data from surveys of men married to women ages 15-49 in Pakistan, women ages 18-49 in India, and women ages 14-24 in Nigeria on condom use, iron folate use, and modern contraceptive use, respectively. The FBM states that behavior happens when motivation, ability and a prompt occur in the same moment. In other words, both motivation and ability must be present for behavior to occur. We tested the hypotheses that both respondents with a) high motivation AND high ability and b) high motivation OR high ability were more likely to adopt a behavior than respondents with low motivation AND low ability. Multivariate logistic regression was used to test these hypotheses.Results: In all 3 contexts, compared to respondents with low motivation AND low ability, both respondents with high motivation AND high ability and respondents with high motivation OR high ability were significantly more likely to adopt the behavior examined. Statistically significant differences remained after adjusting for a range of socio-economic and demographic variables.Conclusions: These findings provide empirical support for the FBM. The study demonstrates the utility of the FBM as a practitioner-friendly behavior model that may be applied across different social and behavioral contexts and assist in the design, implementation, and evaluation of HSS interventions.

Drivers of COVID-19 Vaccine Uptake amongst Healthcare Workers (HCWs) in Nigeria

“…We also found that HCWs with high motivation AND high ability had a nearly 4-times higher odds ratio of being fully vaccinated compared with HCWs with low motivation AND high ability (aOR = 3.48, p < 0.05). Consistent with previous studies [13,17], there was no statistically significant difference between the effect of high motivation AND low ability and the effect of low motivation AND high ability on being fully vaccinated. As mentioned, previous studies have found three levels of effects: (1) high motivation AND high ability; (2) high motivation AND low ability OR low motivation AND high ability; (3) low motivation AND low ability.…”

“…The magnitude of the effects of motivation and ability on vaccination uptake is consistent with findings observed in studies examining the adoption of other preventive health behaviors [13,14,17] and suggests that the FBM provides a robust framework for studying vaccine uptake among HCWs in an LMIC. The FBM provides a practitionerfriendly framework for measuring changes in the drivers of behavior using a limited number of variables.…”

“…A cross tabulation between the motivation and ability binary variables provides 4 possible combinations of motivation and ability: high motivation AND high ability, high motivation AND low ability, low motivation AND high ability, and low motivation and low ability. Previous studies have found 3 distinct levels of effects: (1) high motivation AND high ability; (2) high motivation AND low ability OR low motivation AND high ability; (3) low motivation AND low ability [13,17]. The hypotheses we tested in this study are consistent with these 3 levels of effects.…”

“…The FBM is precise in defining the components of motivation and ability: Motivation comprises anticipation (i.e., hopes or fears), sensation (i.e., pleasure or pain), and belonging (i.e., social acceptance or rejection); ability comprises time, money, physical effort, mental effort, routine, and social norms [15,16]. A recent study has shown that single item measures of motivation and ability are powerful predictors of behavior [17]. This provides the opportunity to use only two survey questions to identify drivers of behavior among Nigerian HCWs.…”

Identifying Drivers of COVID-19 Vaccine Uptake among Residents of Yopougon Est, Abidjan, Côte d’Ivoire

“…?") [30], but we have argued that those results do not provide sufficient nuance to inform the design of activities to address low motivation. Instead, as described above, this project developed and applied scale items to measure each of the six FBM motivation factors.…”