The Water and Sanitation Program (WSP)has supported the Global Scaling up Handwashing Project inPeru, Senegal, Tanzania, and Vietnam. The project has testedwhether innovative promotional approaches to behavior changecan generate widespread and sustained improvements inhousehold hygiene practices. The implementation phase of theproject ended in June 2011. The project has a significantlearning objective, an important component of which is toascertain the key factors that influence behavior change.These are known as behavioral determinants. Studies such asa formative research study conducted in Kenya in 2007 havefound that while knowledge around hand-washing tends to behigh, practice rates are low. This finding is illustrativeof the knowledge-behavior gap encountered by anti-smokingand condom-use initiatives, among others, and reflects thecomplexity of human behavior. More specifically, FOAM(Focus, Opportunity, Ability, and Motivation) was developedto inform the design of formative research, interventions aswell as monitoring to increase the effectiveness of itsbehavior change program. A key feature of the project is itsmonitoring and evaluation component, which includesrandomized control baseline and end-line studies,longitudinal surveys, periodic implementation surveys, and acomprehensive management information system (MIS) thatenabled continuous monitoring and improvement. Thesecomponents have been used to measure and track keyindicators such as diarrhea incidence. This Learning Noteaims to highlight key findings from two studies, the impactevaluation baseline study conducted in Peru in 20074 and a'doer/non-doer' study conducted in Senegal in 2010.
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