The R-SHOT is rapid analysis tool that equips health teams in Honduras with the strongest drivers of behavior change to foster habit formation for Zika prevention at the household level. In a community-based proof of concept, the R-SHOT was shown to be nearly three times more effective than an intervention using existing materials that did not leverage drivers of behavior change and habit formation.

[subtitle subtitle_content=”Background”]

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.

A vector control worker discusses with household members about removing breeding sites from a pila in Honduras. © 2017 Brendan Bannon/USAID, Courtesy of Photoshare

[subtitle subtitle_content=”Why the R-SHOT?”]

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.).

Source: CDC Click on the image to enlarge

[subtitle subtitle_content=”What is the R-shot?”]

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 Untadita method
The Untadita method is an ovicidal cleaning practice for a common type of water storage container in Honduras. It includes five steps (as shown in the images to the right):

  1. Mix bleach and detergent in equal amounts
  2. Apply the mixture to the walls and corners of the water storage container above the waterline
  3. Wait 10 minutes
  4. Brush the walls of the water storage container using a circular motion
  5. Rinse out the water storage container and refill
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[subtitle subtitle_content=”How to use R-SHOT”][vc_tta_accordion]

The R-SHOT currently responds to the vector control conditions in Honduras. For organizations that would like to continue to use the tool in Honduras, please contact contact Sean Maloney at sean.maloney@gmail.com for access to the tool.

The questionnaire will need to be adapted to represent the geographical locations where the survey will be conducted. CCP recommends that users of the R-SHOT use a tablet/smartphone-based electronic data collection platform such as Dooblo. The questionnaire must be programmed to whatever platform is chosen.

To optimize the validity of R-SHOT results, it is necessary to collect data from a sample of households that are as representative of the targeted community as possible. R-SHOT works best with a sample of at least 200 households. Households should be chosen systematically using an unbiased selection process.

After the interviews are complete and the dataset containing at least 200 interviews is available, an error-checking step verifies that the data are ready to upload into R-SHOT in the appropriate format.

The R-SHOT will walk you through the analysis of your data. See the screenshots below for illustrative examples of the user interface.


Click on an image below to get a glimpse of what R-SHOT displays

R-SHOT shows how many households are in the sample
R-SHOT shows distribution of the different kinds of cleaning behaviors community members take.
R-SHOT shows the variety of behavior change drivers included in the questionnaire
R-SHOT identifies the important drivers of behavior change
R-SHOT provides illustrative messages that leverage the important drivers of behavior change
R-SHOT displays the community’s preferred communication channels

[subtitle subtitle_content=”The Future”]

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.