Radical new approach to behavior change for public health

Behavior Centred Design (BCD), devised by Dr. Robert Aunger and Professor Valerie Curtis of the London School of Hygiene & Tropical Medicine, offers both a theory of change for behavior and a practical process for designing and evaluating interventions. The authors believe BCD could become the foundation for an applied science of behavior change.

Underpinned by reinforcement learning, a fundamental theory of the dynamics of behavior change, BCD also incorporates theories about the evolution of behavioral control and human motivation, and a revised version of 'behavior settings' theory which helps explain the relationship between individuals and the environment.

These theories suggest that, in order to change specific behaviors, interventions must create surprise, revalue the target behavior and facilitate performance of the changed behavior by modifying the environment in which it takes place.

BCD involves a process for designing such interventions that follows five steps: Assess, Build, Create, Deliver, and Evaluate.

First, the programme designers assess what is known about the target behavior, the target audience and the context of the intervention. Then, they build a hypothetical theory of change, and, with the help of a team of creative professionals, use it to create surprising and inventive strategies and materials that have maximum effect on the target behavior. Finally, they set up and deliver the intervention to the target population, then evaluate both the outcomes and process of the intervention.

So far, BCD has been applied successfully to a number of health behaviors, ranging from handwashing and food hygiene, to child and maternal nutrition in countries including India, Nepal and Indonesia. It has also been used in the design and marketing of bathroom, soap and food products, and is currently being applied to new challenges such as creating demand for sanitation and HIV prophylaxis.

The authors said: "As interest grows in behavior change as a route to curing the world's ills, much work still needs to be done to develop this applied science, both in the science and in its application. BCD can be employed to tackle many of the small-and large-scale behavior change challenges that we face across the globe."