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.