Virtual Reality (VR) applications based on real-world contexts, such as training, healthcare, and entertainment, rely on varying degrees of replication of real settings. However, there is a lack of systematic design support for determining which elements of a setting to retain or modify. We propose Behavior Setting Map (BSM), a contextual analysis tool to help VR designers understand and transform real-world settings into virtual ones. In a two-stage study, we piloted and iterated BSM with 30 student designers and 24 individuals in the early stages of content design for real-world VR applications. The evaluation results provide empirical insights into participants’ perceptions of BSM, suggesting that the tool was perceived as easy to use and useful in supporting early-stage VR content design through a structured, guided, and visualized approach, accommodating designers with varying levels of experience. Additionally, we discuss the design opportunities and potentials of BSM in a wide range of Extended Reality applications.

Including social norms in multi-component sustainable global development interventions can help people break harmful feedback cycles and achieve sustainable intentional social change. To this purpose, we offer here a series of reflections for those embarking on social norms change in low-resource settings. We also highlight several opportunities for future research and programmatic efforts to be deployed in these settings, which can also enhance the field of norm change more generally and support the design of cost-effective programs targeting global development initiatives.

Establishing a limited set of motives characteristic of the human species has been a goal in psychology since the beginning of the discipline. This paper uses a network-based analysis of previously published psychometric data to establish the existence of a pre-defined set of human motives. The set was derived by using evolutionary theory to identify what sorts of goals humans need to achieve to survive and reproduce in the niche our species evolved to fill. The analysis reported here is based on responses obtained from an on-line sample of 510 representative residents of the United Kingdom to 150 items. Analysis shows that all fifteen of the identified motives can be isolated, that they show expected relationships to one another (based on common functionality), and that differences in attentiveness to motives by gender reflect traditional gender-based role-play during human evolution, while differences by age are consistent with expectations from life history theory. The reduced set of 45 items identified by a genetic algorithm-based analysis could form the basis of a psychometric scale. Knowing the set of motives behind goal-directed behaviour should prove a significant boon to a wide variety of psychological applications, including human relations, educational strategies, marketing and behaviour change.

Breastfeeding is a cost-effective intervention vital to child health, yet rates remain suboptimal, especially in fragile settings. Primary care providers are critical to improving breastfeeding outcomes but face multilevel barriers. While hospital-based interventions have shown success, adaptations to primary care are limited, and understanding of the mechanisms driving provider behavior change remains insufficient. In Kosovo, where exclusive breastfeeding is declining alongside increasing infant mortality, we piloted a behavioral science intervention to improve primary care provider practices. A before-and-after design (baseline June-July 2019; endline June-July 2021) using mixed-methods assessed changes in provider behavior, maternal experience, and the institutional environment across five municipalities. Validation compared maternal reports with clinical observations. The intervention targeted provider behavior with emotionally engaging activities, job aids and institutional strategies, and was co-designed with system actors. Data sources included direct observation of consultations, exit interviews with mothers, provider interviews and facility assessments. Across 609 consultations with matched exit interviews, we recorded a 14.9 percentage point increase in the mean frequency of breastfeeding-friendly clinical behaviors by providers (95% CI: 6.4-23.4) and a 13.3 percentage point increase in interpersonal behaviors (95% CI: 5.2-21.3) after versus before intervention. Gains were strongest for providers explaining ability to breastfeed (+39.0 points), inviting mother to ask questions (+21.8 points) and explaining follow-up required (+18.7 points). Gaps between observer and maternal reports narrowed across most indicators, indicating stronger alignment between care delivered and perceived. Mothers reported greater confidence and better care experiences. Providers' knowledge and attitudes improved and shifts in leadership engagement and facility norms were seen, though broader system integration was limited. A behaviorally informed, co-designed intervention can measurably improve breastfeeding counseling behaviors and maternal experiences in Kosovo's primary care settings. Findings underscore the value of targeting deeper behavioral drivers, not just knowledge gaps, within fragile health systems.

Objective: This study tested a ‘wise’ intervention (quick prompt of a specific psychological mec) in acute care hospital units to improve nurses’ hand hygiene compliance (HHC). Design: A multiple baseline design in two medical-surgical teaching hospitals in the United States. Measurements: Hand hygiene data was collected using an electronic compliance monitoring system with sensors placed in doorways and on corresponding soap and alcohol-based hand rub dispensers. The outcome measure was the proportion of opportunities in which HH was undertaken by staff per week in each unit. Intervention: A quick-and-easy psychological prime to reinvigorate professional identity. Methods: Interrupted time series analysis using a quasi-Poisson regression model with statistical process control charts for each unit. Results: A statistically significant increase in HHC rates that was sustained for months post-intervention. However, the patterns by unit were not statistically significant once temporal trends were considered. Other factors, such as the unit type and the use of incentives could have impacted the results. Conclusions: These analyses suggest that the aggregate impact should not be taken as evidence of intervention effectiveness. This study therefore cannot be considered to have provided a strong foundation for use of a ‘wise’ intervention, despite its relatively small financial, logistical and psychological cost.

Experts are concerned about the impending arrival of tipping points in the global climate’s ability to accommodate increasing levels of CO2 and methane in the atmosphere, at least partly due to human activity. The resulting environmental degradation and loss of biodiversity are likely to be devastating to civilized ways of life. This paper presents an individual-level decision-making model that can alleviate some of the cognitive paralysis that results from being faced with such a global-scale existential crisis as but one individual among billions. It achieves this by simplifying and organising the kinds of trade-offs that are required to identify the individual’s most productive course of action from among many alternatives. Choices between whether to engage in forced choice over organisational practices they might control (e.g., a business mission) versus social influencing (e.g., via a social media presence) versus changes in lifestyle are central. It shows that those with control over the behaviour of others will likely bear greater responsibility. Easier decision-making should increase levels of pro-environmental activity.

Background In circumstances where vaccine hesitancy is high, like in Tanzania in 2021, measures to control the spread of COVID-19 infection through non-pharmaceutical interventions, specifically mask-wearing, hand-washing and physical distancing, become crucial. This study was undertaken to inform the development of a context-adapted communication campaign to control COVID-19 in Tanzania.Focus of the Article The study examines the effectiveness of three different behaviour change campaign ads created as part of the same control effort, and two of them by the same creative process, with the same creative team, at roughly the same time, in altering behavioural propensities for relevant target behaviours, including the washing of hands, the wearing of masks and social distancing, and key participant attitudes, such as the sense of obligation to others.Research Question The main research question was: what are the effects of behaviour change campaign ads on propensities for engaging in COVID-19 target behaviours? We also examined behavioural attitudes and consumer appreciation of the ads (believability, likeability, relevance and surprise). The purpose of the study was to provide empirical evidence on the effectiveness of different messaging logics, in order to help improve future campaigns.Methods We designed a controlled survey experiment where participants were randomly assigned to receive one of the three campaign ads. These were called: the "Setting" campaign, which was designed using a theory-based Behaviour Centred Design (BCD) approach and produced with local partners; the "Password" campaign, which was the result of a substantial investment by a major international consortium; and the "Balance" campaign, a local adaption of "Password"; as well as an educational public service announcement, which served as an active control. An SMS survey was administered online to 2080 participants in Tanzania in 2022 to evaluate the potential effectiveness and consumer appreciation of the campaigns.Results The results showed that the most costly campaign, "Password", did not perform better than the other campaigns on any test. In particular, "Password" was not more effective than the theory-based "Setting" campaign on any single behavioural indicator or exposure variable. The "Setting" campaign was more effective than other ads on the expected qualities of appreciation (surprise, believability). However, the educational announcement achieved higher average response levels than all of the narrative-based treatments on measures of consumer appreciation, such as likeability, believability and relevance.Recommendations for Practice This study supported the proposition that a campaign specifically designed to elicit particular kinds of psychological responses could do so. It showed that a theory-based campaign, produced locally and at low cost, can compete on standard marketing values with high-quality creative processes and production values.

People are spending more and more time interacting with virtual objects and environments. We argue that Roger Barker’s concept of a ‘behaviour setting’ can be usefully applied to such experiences with relatively little modification if we recognize subjective aspects of such experiences such as presence and immersion. We define virtual behaviour settings as virtual environments where the partly or fully digital milieu is synomorphic with and circumjacent to embodied behaviour, as opposed to the fragmented behaviour settings of much-mediated interaction. We present two tools that can help explain and predict the outcomes of virtual experiences—the behaviour setting canvas (BSC) and model—and demonstrate their utility through examples. We conclude that the behaviour setting concept is helpful in both designing virtual environments and understanding their impact, while virtual environments offer a powerful new methodological paradigm for studying behaviour settings. This article is part of the theme issue ‘People, places, things, and communities: expanding behaviour settings theory in the twenty-first century’.

This paper describes a process evaluation of a 'wise' intervention that took place in six acute care units in two medical-surgical teaching hospitals in the United States during 2016-2017. 'Wise' interventions are short, inexpensive interventions that depend on triggering specific psychological mechanisms to achieve behaviour change. This study sought to increase the hand hygiene compliance (HHC) rates before entering a patient's room among nurses. The intervention centred on the use of threat to professional identity to prompt improved HHC. Through questionnaires administered to intervention participants and the implementation facilitator, together with independent observation of intervention delivery, we examined whether the steps in the Theory of Change occurred as expected. We found that aspects of the implementation-including mode of delivery, use of incentives, and how nurses were recruited and complied with the intervention-affected reach and likely effectiveness. While components of the intervention's mechanisms of impact-such as the element of surprise-were successful, they ultimately did not translate into performance of the target behaviour. Performance was also not affected by use of an implementation intention as repeated performance of HHC over years of being a nurse has likely already established well-ingrained practices. Context did have an effect; the safety culture of the units, the involvement of the Nurse Managers, the level of accountability for HHC in each unit, and the hospitals themselves all influenced levels of engagement. These conclusions should have implications for those interested in the applicability of 'wise' interventions and those seeking to improve HHC in hospitals.

Through Tanzania's National Sanitation Campaign, we study the effectiveness of two common elements of behavior change campaigns: endorsements from celebrities and testimonials. Using four experiments in Tanzania in early 2021 as part of the national campaign, we find that including endorsements and testimonials in text messages sent to individuals significantly increases self-reported hygiene behavior. These results mask important heterogeneity based on the source of endorsement or framing of the testimonial and provide insights into cost-effective approaches for changing behavior at scale.

Over nearly fifty years, Big History has evolved as an interdisciplinary approach, connecting cosmic, geological, biological, and cultural phenomena into a unified narrative of increasing complexity. This paper critically examines various theoretical frameworks within Big History, focusing on their scientific soundness. While progress has been made, challenges persist in establishing a theoretical core and achieving consensus. Commonalities exist, such as the recognition of a trend toward increasing complexity, the division into temporal eras and periods, and the acknowledgment of unique dynamics defining these phases. However, a consensus on the best foundational principles and canonical periods remains elusive. The paper suggests three strategies for theory development: employing cross-disciplinary theories, generalizing discipline-specific theories, or inventing novel theories. Each approach requires further refinement and empirical testing to contribute to consensus building. Big History is argued to have utility based on its ability to contextualize events within a broader framework, but more ambitious rationales and empirical work may be necessary for skeptical audiences. Despite ongoing theoretical debates, immediate progress can be achieved through empirical endeavors, contributing to the discipline's reputation.

Background Irrigated rice cultivation in sub-Saharan Africa not only brings more malaria vectors to nearby communities, but also greater malaria risk. To aid the implementation of mosquito control in rice-growing communities, it is necessary to understand how farmers understand, view and manage their responsibility in mosquito generation and whether they are interested in coordinating to minimize it. Methods Qualitative methods (observation grids, semi-structured in-depth interviews and focus group discussions) were used to reveal the perceptions of mosquitoes and their control in two irrigated rice farming communities in central Côte d’Ivoire near the M’bé and Lokapli irrigation schemes. Results All rice farmers viewed mosquitoes as severe nuisances, and most acknowledged that they caused djèkouadjo (malaria) and were less numerous during harmattan (dry season). Many study participants believed that mosquitoes originated from grasses and stagnant water around villages. Only those living closer in proximity (~ 1 km) to the paddies believed that mosquitoes came from the bas-fonds (irrigated lowlands). However, they did not associate mosquito production with rice cultivation. Some farmers believed that there were more mosquitoes in recent years than historically because of the dam construction, but remarked on the importance of the dam (and bas-fonds) for their livelihood. Many farmers were not convinced that mosquito control could occur at farm-level. Conclusions To enhance accountability amongst rice farmers, there is a need for greater awareness on the rice-mosquito link, and emphasis that the link does not imply a trade-off between food production and health. Training should not only be directed towards farming communities, but also agricultural and health extension workers. Future riceland mosquito control methods must focus on improving crop productivity and address collective action problems that may occur.

Current theories in moral psychology do not agree about the kinds and range of offenses that people should moralize. In this study, a new approach to defining the moral domain, Human Superorganism Theory (HSoT), is presented and tested. HSoT proposes that the primary function of moral action is the suppression of cheaters in the unusually large societies recently established by our species (i.e., human 'superorganisms'). It suggests that a broad range of moral concerns exist beyond traditional notions of harm and fairness, including actions that inhibit functions such as group-level social control, physical and social structuring, reproduction, communication, signaling and memory. Roughly 80,000 respondents completed a web-based experiment hosted by the British Broadcasting Corporation, which elicited a suite of responses to characteristics of a set of 33 short scenarios representing the areas identified by the HSoT perspective. Results indicate that all 13 superorganism functions are moralized, while violations of scenarios falling outside this area (social customs and individual decisions) are not. Several hypotheses derived specifically from HSoT were also supported. Given this evidence, we believe this new approach to defining a broader moral domain has implications for fields ranging from psychology to legal theory.

In 2017, Tanzania was one of the countries in the world with the lowest proportion of households having access to improved toilets. Between 2017 and 2021, the government launched a national sanitation campaign under the brand Nyumba ni Choo. The objective of this paper is to assess the impact of one component of this campaign, "direct consumer contact" events, on the coverage of improved household latrines in Tanzania. Secondary data from both the National Sanitation Management Information System (NSMIS; https://nsmis.moh.go.tz/) and internal project reports were used to extract data on coverage and dates of events, respectively. Regression estimation models were used to estimate impact at ward and regional levels. The study used quarterly panel data from all 26 regions between 2017 (baseline) and 2020 (endline) for estimation purposes. The study shows that direct consumer contact events had a significant positive effect on the rate at which households subsequently improved their toilets at both small and large scale in Tanzania. On average, the rate of household latrine improvement increased by 12.91% at ward level and 14.17% at regional level. These results testify to the importance of designing an effective behavioral change campaign to achieve significant improvements in sanitation coverage.

Handwashing with soap is a widely advocated public health measure, but seldom practiced, partly because it is often difficult (especially outside of rich Western country contexts) to make both soap and water readily available in relevant situations. This study used both Behaviour Centred Design and Human Centred Design to guide development of a novel hand cleansing technology appropriate for the context of post-toilet hand cleansing in resource-poor societies. Extensive prototyping and field testing resulted in the pilot production of 'tab' soap, a small but durable single-use, decomposable substrate embedded with soap. It can be produced in dispenser roll or tear-off formats. With this affordable solution, one may use soap without worrying about contamination pretty much anytime and anywhere. A small-scale field test showed that all poor households in rural and peri-urban areas in Tanzania included in the proof-of-concept study (N = 12 households) would use the product reliably over the medium term. Tab soap awaits full-scale production and marketing but could make hand cleansing a more popular practice around the world.

Universal access to hygienic sanitation is a Sustainable Development Goal for international development. However, many countries are liable to miss this target by the deadline of 2030. As provision and subsidy are prohibitively expensive, promotion is the tactic commonly taken by governments and stakeholders in many countries, even though it is often not effective at generating significant changes in sanitation coverage. A recent 5-year programme used an international consortium made up of organizations' experts in consumer research, creative communication, programme management and event implementation, media monitoring and programme evaluation, to achieve significant increases in the coverage of improved sanitation facilities throughout Tanzania, using adaptive programming. A number of lessons, outlined here, can be drawn from this experience which are likely to be applicable to promotion efforts in other countries and contexts and which can hopefully help countries to reach their sanitation targets. These lessons include the use of motivation and targeted expertise rather than reliance on training, the use of the theory of change to guide development processes, targeting of high-level government support, collaboration with private sector actors, testing and refreshing of messaging, continuous monitoring of on-ground conditions, use of multiple modes of outreach and branding of all programme outputs.

Promotion appears to be the least effective but is nevertheless often the only available, means to achieve increased access to sanitation services, especially at scale, in lower-income countries. A cursory examination of the history of past and present approaches to sanitation promotion, including sanitation marketing, community development, community-led total sanitation and public health, shows that they have a variety of features and characteristics which make them distinctive. Unfortunately, rigorous evaluation has not kept pace with this proliferation of approaches, so it is difficult to recommend any one approach over the others, based on empirical performance in a range of circumstances. However, I argue that a 'hybrid' approach which exhibits a number of salient features from all of the previous approaches is likely to be a good bet. I present a recent example of such a hybrid programme which proved to significantly increase the rate of improved sanitation coverage through promotion (without subsidy of any kind) at scale in Tanzania. I suggest other sanitation promotion programs may want to think about adopting similar practices in their own programming going forward.

Few case studies exist in the public health or design literatures showing how to create national scale messaging campaigns in low-income countries using design processes. In this paper, we describe how we used Behaviour Centred Design to develop Nyumba ni choo, the Tanzanian National Sanitation Campaign. The process involved multiple iterations of ideation and filtration by professional creatives, government staff, academics and sanitation specialists to create a branded mass communication campaign, which was refreshed annually. The campaign was based on the insight that Tanzania is modernizing rapidly, with people upgrading their homes, but leaving their outside toilets in a 'traditional' state. Built around the 'big idea' that a household is not fully modern without a good-quality, modern toilet, the campaign employed reality TV shows, live engagements and mass and digital media postings, all targeted at motivating both the government and general population to improve toilets. The campaign has made toilets a topic of national conversation and has led to a major uptick in the rate of toilet building. Efforts to improve public health-related behaviour can be enhanced by using systematic approaches that build on available evidence, understand behaviour in its common settings, employ psychological theory and engage creative expertise.

Background: HIV pre-exposure prophylaxis (PrEP) is highly effective and could reduce the persistent high HIV incidence among young South African women. Demand creation is needed to increase PrEP uptake of this novel prevention technology. Theoretically-grounded formative research (FR) could identify factors to include in a demand creation campaign to motivate young South African women to seek PrEP. Methods: Thirty-four household visits with young women (aged 16–32) were conducted in a township near Cape Town using Behavior Centered Design (BCD), investigating behavior contexts, the social and family environments and psychological processes, using qualitative and interactive tools, such as forced choice dilemmas, ranking games, daily script elicitation and network- and community drawings. Results: The FR generated findings concerning a wide variety of topic areas and identified a range of opportunities as well as challenges for the successful implementation of PrEP promotion in this population. Potential challenges were young women underestimating the consequences of acquiring HIV; taking medicine to prevent a disease (which was an unfamiliar concept) and young women having few responsibilities, making health care seeking and daily pill-taking with PrEP challenging. Potential opportunities that could be leveraged for PrEP demand creation were young women’s desire for trust and emotional closeness in relationships and the limited existing roles for young women, which could provide room for creating new aspirational roles that would motivate young women to take PrEP. Conclusion: A theory-based and context-specific approach to FR led to a broad understanding of the lives and influences on young South African women and generated a comprehensive set of opportunities for intervention.

Abstract The COVID-19 pandemic has revealed an urgent need for a comprehensive, multidisciplinary understanding of how healthcare systems respond successfully to infectious pathogens—and how they fail. This study contributes a novel perspective that focuses on the selective pressures that shape healthcare systems over evolutionary time. We use a comparative approach to trace the evolution of care-giving and disease control behaviours across species and then map their integration into the contemporary human healthcare system. Self-care and pro-health environmental modification are ubiquitous across animals, while derived behaviours like care for kin, for strangers, and group-level organizational responses have evolved via different selection pressures. We then apply this framework to our behavioural responses to COVID-19 and demonstrate that three types of conflicts are occurring: (1) conflicting selection pressures on individuals, (2) evolutionary mismatches between the context in which our healthcare behaviours evolved and our globalized world of today and (3) evolutionary displacements in which older forms of care are currently dispensed through more derived forms. We discuss the significance of understanding how healthcare systems evolve and change for thinking about the role of healthcare systems in society during and after the time of COVID-19—and for us as a species as we continue to face selection from infectious diseases.