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Despite the importance ofbehaviours in promoting health and wellness, persuading people to adopt and sustain healthy behaviours remains a significant public health challenge. Considerable progress has been made in developing and testing theories about the personal, social, environmental and structural drivers of behaviours. However, theorizing about behaviours themselves has remained elusive, as evidenced by the absence of a widely accepted taxonomy of behaviours. By carefully examining the nature of behaviours, practitioners and researchers can identify the most effective ways to promote behavioural change. We propose attribute-centred theorizing as an approach for defining behaviours based on their relevant properties, which can then assist in developing a taxonomy of behaviours and theorizing about them. Behaviours differ because of their underlying properties; for example, some behaviours are addictive, others are publicly observable and others are expensive. Addictiveness, privacy and cost are therefore three (of the many) attributes relevant for theorizing about behaviours. We describe a framework for operationalizing attribute-centred theorizing, which includes generating behavioural attributes, verifying and testing those attributes, and constructing a behavioural matrix to inform campaigns or interventions. We illustrate this framework using the examples of Guinea-worm disease and cardiovascular diseases. The benefits of our approach include the ability to inform intervention development and the ability to generalize across different behaviours; however, more research on converting the behavioural matrix into actual policy is needed.

The aim of this study was to develop and test a model of prosocial prevention behavior during COVID-19, termed the Moral Norms Activation Model (MNAM). This model examines how moral norms, influenced by awareness of consequences, predict prosocial prevention behaviors, such as mask-wearing, and the role of perceived severity and collective orientation as moderating factors. We conducted a survey during the early months of the COVID-19 pandemic with a nationally representative sample of U.S. adults ( N = 8,778). The survey measured awareness of consequences, moral norms, anticipated guilt, perceived severity, collective orientation, and self-reported mask-wearing behavior. A series of regressions was used to test the proposed model and interactions. Findings supported the MNAM, demonstrating that awareness of consequences was a significant direct predictor of moral norms. These moral norms, in turn, predicted prosocial prevention behavior, mediated by anticipated guilt. The moderating effects of perceived severity and collective orientation were also significant, reinforcing the strength of the association between moral norms and behavior in individuals with high collective orientation and greater perceived severity. The results highlight the critical role of moral norms and anticipated guilt in promoting prosocial health behaviors during a collective health crisis. The MNAM provides a novel framework for understanding how individual psychological processes contribute to public health behaviors. These findings suggest that public health campaigns emphasizing moral responsibility and awareness of consequences could enhance compliance with preventive measures.

The purpose of this study was to describe social norms and salient social identities related to breastfeeding intentions among African American mothers in Washington, D.C. Five focus groups were held with 30 mothers who gave birth to a child between 2016 and 2019. Two coders conducted pragmatic thematic analysis. This study demonstrated that women hold different identities relevant to making infant feeding decisions, with mother being primary and race/ethnicity, age, and relationship status factoring into how they define themselves. Mothers drew their perceptions of what is common and accepted from family, friends, the “Black community,” and what they perceived visually in their geographic area and heard from their health care providers. Mothers believed breastfeeding to be increasing in popularity and acceptability in African American communities in Washington, D.C., but not yet the most common or accepted mode of feeding, with some variability by socioeconomic status group. Implications for public health communication and social marketing are discussed.

Background: Across the globe, there are successful health innovations that could help improve public health in US communities at lower cost and with higher effectiveness than standard practice. However, which factors should be considered to heighten the likelihood of successful transfer of global health ideas to the US still warrants more empirical investigation.Objective: This study aimed to develop a conceptual framework delineating important factors to be considered for successful introduction of global health innovations to US communities, based on diffusion of innovations literature and case studies of global health innovations that have been adopted in US communities.Methods: Five global health innovations adopted in US communities were selected based on expert panel recommendations and a review of academic and gray literatures. These innovations had diverse origins (Columbia, Mexico, South Africa, Sweden, and Wales) and exhibited various means of achieving desired health outcomes. We conducted archival research and 27 interviews (42 interviewees) with leaders and stakeholders of the five innovations to identify important factors for the transfer of global health innovations to the US.Findings: Six factors were determined to be important for global health innovation adoption in the US: (1) innovation attributes, (2) linking agents, (3) inter-organizational partnerships, (4) scale up strategies, (5) implementation processes and outcomes in US communities, and (6) policy and social context. These factors correspond well to factors emphasized in the diffusion of innovation literature, although the importance of some sub-factors (e.g., stigma regarding the origin of innovations) diverged from the literature.Conclusions: Based on our findings, we developed the Designing for Diffusion Framework for Global Health Innovations. The framework provides a comprehensive picture of factors that can be facilitators or hindrances for moving a global health innovation to the US to help smooth the diffusion process for better adoption and implementation in US communities.

We link the reciprocity model of Falk and Fischbacher (2006) with the theory of normative social behavior to study how financial incentives crowd out intrinsic motivation in both the short and long runs. Using data from a lab-based repeated public goods game, we find strong evidence in support of the reciprocity model and crowding out effects both when the payment is in place and after it stops. When the payment program is in place, subjects become less sensitive to reciprocity, perceive less kindness in others’ contributions, and care less about others’ welfare. The overall decrease in motivation to reciprocate reduces the effectiveness of the payment program by almost 50%. About 20% of the crowding out effect persists after the payment stops, and the reciprocity mechanism explains over three quarters of the long-run crowding out effect.

ObjectivesTo design and test the psychometric properties of four context-specific norm-related scales around handwashing with soap after toilet use: (1) perceived handwashing descriptive norms (HWDN); (2) perceived handwashing injunctive norms (HWIN); (3) perceived handwashing behaviour publicness (HWP); and (4) perceived handwashing outcome expectations (HWOE).DesignScale items were developed based on previous work and pilot tested in an iterative process. Content experts and members of the study team assessed the face validity of the items. The psychometric properties of the scales were assessed in a cross-sectional study.SettingThe study was conducted in communal housing compounds in Abidjan, Côte d’Ivoire.ParticipantsA convenience sample of 201 adult residents (≥16 years old) from 60 housing compounds completed the final questionnaire.Outcome measureConfirmatory factor analysis was used to assess the goodness of fit of the global model. We assessed the internal consistency of each scale using Cronbach’s alpha (α) and the Spearman-Brown coefficient (ρ).ResultsThe results of the psychometric tests supported the construct validity of three of the four scales, with no factor identified for the HWOE (α=0.15). The HWDN and HWP scales were internally consistent with correlations of ρ=0.74 and ρ=0.63, respectively. The HWIN scale appeared reliable (α=0.83).ConclusionWe were able to design three reliable context-specific handwashing norm-related scales, specific to economically disadvantaged community settings in Abidjan, Côte d’Ivoire, but failed to construct a reliable scale to measure outcome expectations around handwashing. The social desirability of handwashing and the narrow content area of social norms constructs relating to handwashing present significant challenges when designing items to measure such constructs. Future studies attempting to measure handwashing norm-related constructs will need to take this into account when developing such scales, and take care to adapt their scales to their study context.

Despite the importance of behaviours in promoting health and wellness, persuading people to adopt and sustain healthy behaviours remains a significant public health challenge. Considerable progress has been made in developing and testing theories about the personal, social, environmental and structural drivers of behaviours. However, theorizing about behaviours themselves has remained elusive, as evidenced by the absence of a widely accepted taxonomy of behaviours. By carefully examining the nature of behaviours, practitioners and researchers can identify the most effective ways to promote behavioural change. We propose attribute-centred theorizing as an approach for defining behaviours based on their relevant properties, which can then assist in developing a taxonomy of behaviours and theorizing about them. Behaviours differ because of their underlying properties; for example, some behaviours are addictive, others are publicly observable and others are expensive. Addictiveness, privacy and cost are therefore three (of the many) attributes relevant for theorizing about behaviours. We describe a framework for operationalizing attribute-centred theorizing, which includes generating behavioural attributes, verifying and testing those attributes, and constructing a behavioural matrix to inform campaigns or interventions. We illustrate this framework using the examples of Guinea-worm disease and cardiovascular diseases. The benefits of our approach include the ability to inform intervention development and the ability to generalize across different behaviours; however, more research on converting the behavioural matrix into actual policy is needed.

[...]the availability and quality of data can vary greatly across sectors and, even where data exist, key challenges linked to data sharing and integration must be addressed. [...]a One Health approach to surveillance provides unique opportunities to monitor not only threats, but also the preconditions for health and determinants of healthy and sustainable systems, thereby supporting resilient ecosystems and health-promoting environments. Infectious diseases A One Health approach to infectious diseases must address not only zoonotic diseases of pandemic potential, but also neglected tropical diseases and the effect of infectious animal diseases on the health of livestock, wildlife (terrestrial and aquatic animal, plant, and insect species), companion animals, food systems and nutrition, antimicrobial use, livelihoods, and economic development. Non-communicable diseases Non-communicable diseases have traditionally received little attention within One Health research and practice, which this Commission seeks to change. A One Health approach to non-communicable diseases enables a systematic understanding and equitable approach to addressing the shared risk factors (eg, environmental pollutants, unhealthy diets, and climate change) and other determinants of health and wellbeing across species and throughout the socioecological system.

We link the reciprocity model of Falk and Fischbacher (2006) with the theory of normative social behavior to study how financial incentives crowd out intrinsic motivation in both the short and long runs. Using data from a lab-based repeated public goods game, we find strong evidence in support of the reciprocity model and crowding out effects both when the payment is in place and after it stops. When the payment program is in place, subjects become less sensitive to reciprocity, perceive less kindness in others' contributions, and care less about others' welfare. The overall decrease in motivation to reciprocate reduces the effectiveness of the payment program by almost 50%. About 20% of the crowding out effect persists after the payment stops, and the reciprocity mechanism explains over three quarters of the long-run crowding out effect.

A growing literature examines conditions under which financial incentives for behavior change can undermine “crowd out” or reinforce (“crowd in”) other sources of motivation for the behavior in question. Some of this literature points to a potential role of social norms, but it has not attempted to quantify that role. We present an interdisciplinary model from economics and communication science that measures the effects of financial incentives on social norms and their joint effects on behavior, including after incentives have ended. In a framed field experiment with Tibetan herders in Qinghai, China, we find that a temporary payment for participation in a patrol against illegal wildlife trapping reinforces a perceived injunctive norm that this conservation behavior meets with social approval. This norm remains heightened even after the payment has ended, continuing to positively influence the decision to participate in anti-trapping patrols in the experiment. This finding suggests that, under certain circumstances, a carefully framed incentive for conservation behavior can support injunctive norms in favor of conservation behavior.