R-SHOT

To stop Zika in its tracks, households and communities in affected areas need to make the proper and consistent cleaning of large standing water storage containers a habit. Changing habits and attitudes can be very difficult, and most personnel in the field do not have the tools for identifying and creating vector control habits.
CCP and Catalyst Behavioral Sciences created the R-SHOT (Rapid Strategic Habit Optimization Tool) to change Zika-related behaviors. It is a simple field tool combining use of local data with evidence-based principles and theory-driven analysis to recommend the optimal habit formation and motivational tactics for changing behaviors in households.

Zika Grand Challenge
USAID’s Bureau for Global Health issued a $30 million Grand Challenge calling upon the global innovator community to generate cutting-edge approaches to fighting the current Zika outbreak—and to strengthen the world’s ability to prevent, detect and respond to future infectious disease outbreaks.

From nearly 900 submissions, USAID selected 26 potentially game-changing solutions to be funded for accelerated development, testing, and deployment. The projects include efforts focused on vector control, personal and household protection, vector and disease surveillance, diagnostics, community engagement, and unmanned aerial vehicles.

Zika is a communicable disease transmitted by the Aedes aegypti mosquito, which is native to Latin American and Central American countries and is also responsible for the transmission of dengue and chikungunya. The female Aedes mosquito bites mostly during the day and breeds in clean, standing water often found in water storage containers in and around people’s homes. Zika can also be transmitted through sexual contact. While Zika is not a new virus, the outbreak that started in 2015 was the largest ever reported and spread rapidly throughout the Americas.
Zika causes relatively mild, flu-like symptoms in infected adults, but the outbreak in 2015 initially coincided with a rise in reported cases of microcephaly in newborns. It is now understood that Zika infection in fetuses and infants before birth can cause a distinct pattern of birth defects, which may or may not include microcephaly, known as Congenital Zika Syndrome (CZS). A cure or vaccine for Zika does not exist, so current preventative measures focus on vector control and awareness of risk and risk reduction behaviors. Learn more about Transmission at the Center for Disease Control.
Since there is no cure or vaccine for Zika, preventing infection at the household level is key. To successfully combat and prevent Zika and other vector-borne diseases, individuals and communities must create and maintain new habits around vector control (e.g. elimination of potential breeding sites) that persist over time.

Specifically, the R-SHOT has been developed to identify the behavioral drivers of a water container cleaning practice known as the “Untadita” method. In the life cycle of the Aedes aegypti mosquito, it typically takes 7-10 days for the mosquito egg to transform into a flying mosquito. The Untadita method works by destroying and removing the mosquito’s eggs from typical water storage containers typically found in households. Weekly application of the Untadita method to water storage containers will break the life cycle of the mosquito.

Vector control personnel lack simple but valid tools that allow them to determine the most important drivers of behavior and habit formation in order to tailor messages in a scientifically robust manner. In the case of Zika, this means successfully inserting vector control behaviors into patterns of daily/weekly life that are, themselves, highly routine and habitual (e.g., household cleaning routines, work patterns, meal preparation, hygiene habits, etc.).

The R-SHOT is programmed to analyze data quickly, identify behavioral determinants that are most strongly related to the desired outcome behavior in a particular community and provide recommendations about strategic messaging that is most likely to result in behavior change. In Honduras, the outcome behavior is “Untadita,” a regular ovicidal practice for household water storage containers that, when done correctly, reduces the breeding of Aedes mosquitoes.
The R-SHOT consists of three elements:

1. A theory-based behavior change and habit formation survey, administered using a digital tablet, to gather data on 25 known drivers plus common demographic variables
2. A predictive online algorithm to automate multiple logistic regression analysis of the data from the electronic survey
3. A digital dashboard to display the results of the analysis and provide strategic recommendations for a behavior change communication program

Theory informed
Theories and constructs used to identify relevant drivers of behavior and habit include Ideation (an integrated psychosocial model that combines cognitive, emotional and social variables that predicts behavioral outcomes) and a model of Habit Formation (derived from Behavioral Economics and theories of unconscious decision-making that include framing, situational cues, incentives and other variables).

The R-SHOT applies an algorithm developed by the Johns Hopkins Center for Communication Programs and Catalyst Behavioral Sciences to predict the most significant drivers of routine ovicidal cleaning of water storage containers with a well known and effective practice called the Untadita method. For the Untadita method to be effective, it must be applied to water storage containers on a weekly basis in order to break the life cycle of the Aedes aegypti mosquito.

The R-SHOT prototype proof of concept is a breakthrough in rapid strategic analysis and interpretation of behavioral data. CCP is actively seeking future partnerships to develop and test the R-SHOT for additional behaviors and in new contexts. All inquiries should be sent to Sean Maloney at sean.maloney@jhu.edu.