Making waves against the norm:Making waves against the norm:

Abigael Ati, MAAbigael Ati, MA

Maria Elena Figueroa, PhDMaria Elena Figueroa, PhD

Robert Ainslie, MARobert Ainslie, MA

Aman Tirta ProgramAman Tirta ProgramBloomberg School of Public Health Johns Hopkins University - Bloomberg School of Public Health Johns Hopkins University -

Center for Communication ProgramsCenter for Communication Programs

introducing chlorine-based PoU water introducing chlorine-based PoU water treatment technology in Indonesiatreatment technology in Indonesia

Presenter DisclosuresPresenter Disclosures

(1)(1) The following personal financial relationships with The following personal financial relationships with commercial interests relevant to this presentation commercial interests relevant to this presentation existed during the past 12 months:existed during the past 12 months:

Abigael Wohing Ati

NO RELATIONSHIP TO DISCLOSE

INDONESIAINDONESIABinjai

Tangerang

Bantaeng

Maros

BoilingBoiling:: the main drinking water treatment methodthe main drinking water treatment method

% of households that boil their drinking water

0

50

100

BinjaiBantaengMarosTangerang

People boil…People boil…

• To make water safe to drink: To make water safe to drink: to kill germsto kill germs to get rid of lime to get rid of lime believed to have no side-effect like believed to have no side-effect like

chemical substancechemical substance

• To serve better drinks:To serve better drinks: warm or hot drinkswarm or hot drinks tastes bettertastes better

boiling is believed as…boiling is believed as…

A tradition: “our parents, our ancestors A tradition: “our parents, our ancestors boiled their drinking water, and so do we. boiled their drinking water, and so do we. It’s a tradition”It’s a tradition”

Practical!Practical!

For smart people: “people here are smart For smart people: “people here are smart and knowledgeable, they know that water and knowledgeable, they know that water needs to be boiled”needs to be boiled”

““there are ways that are as there are ways that are as good as boiling to make good as boiling to make

drinking water safe”drinking water safe”

agree 40.36%

disagree 41.73%

neutral18%

Percentage of households with Percentage of households with E.coli contaminated boiled, E.coli contaminated boiled,

ready to drink water ready to drink water

0

10

20

30

40

50

60

70

Household drinking water

%

TangerangMaukBinjaiBantaeng

1.25% sodium hypochlorite solution 1.25% sodium hypochlorite solution

Air RahMatAir RahMat

muRAH (economical)muRAH (economical)

Mudah (easy)Mudah (easy)

sehAT (healthy)sehAT (healthy)

Promoting Air RahMatPromoting Air RahMat

Traditional and Traditional and non-traditional non-traditional distribution distribution schemescheme

Community Community mobilization mobilization

AdvocacyAdvocacy

Mass media advertisement Mass media advertisement Experiential marketingExperiential marketing

Can the new product replace Can the new product replace boiling boiling

an existing, culturally an existing, culturally accepted behavior? accepted behavior?

The benefits of Air RahMat attract The benefits of Air RahMat attract people to trypeople to try• It’s economicalIt’s economical• It’s practical It’s practical

Media ads enhanced the credibility of Media ads enhanced the credibility of the productthe product• Registered/approved productRegistered/approved product• Accountable/credible manufacturerAccountable/credible manufacturer

We found that…We found that…

Theory of normative social behavior Theory of normative social behavior

Social approvalSocial approval

Injunctive NormsInjunctive Norms

Descriptive norms Behaviors

Normative Mechanism

• Benefits to oneselfBenefits to oneself• Benefits to othersBenefits to others• Anticipatory socializationAnticipatory socialization

Outcome ExpectationsOutcome Expectations

SimilaritySimilarityAspirationAspiration

Group IdentityGroup Identity

definitionsdefinitions

Descriptive norms:Descriptive norms: belief about the belief about the prevalence of a behaviorprevalence of a behavior

Injunctive norms:Injunctive norms: perception about the perception about the expectation of influential others for the expectation of influential others for the individuals to comply with a behavior, and individuals to comply with a behavior, and the social sanctionsthe social sanctions

Outcome expectation:Outcome expectation: belief that certain belief that certain behavior will lead to benefits to self and behavior will lead to benefits to self and othersothers

Group identity:Group identity: perceived similarity perceived similarity between the individuals and the referentbetween the individuals and the referent

I am convinced, I am going to I am convinced, I am going to continue treating water with AR!continue treating water with AR!

AR is:• Is easy to use• Reduces daily

expense• Reduces workloads

But needs to adjust, by drinking it daily

If I don’t use AR:•Will make husband upset

•Peers will talk down about me

AR users:• has refrigerator • Community

health cadres• Identify self as

more knowledgeable and care about health

OK, I experienced the benefits, OK, I experienced the benefits, but…but…

I use AR =

I don’t boil: • Husband and children

refused to drink • People will call me

stupid

AR is:•Economical•Practical

But boiling is :•Needed. Family members like hot drinks

•Practiced since I became a mother, no need to learn

•Natural, better than chemical substance

Boilers:• Smart mothers• Preserve

tradition

Social network of women Social network of women in Kayu Agungin Kayu Agung

conclusionconclusion

Boiling has been a tradition all over Boiling has been a tradition all over IndonesiaIndonesia

Promotion about the benefits of using Air Promotion about the benefits of using Air RahMat attracts people to tryRahMat attracts people to try

In areas where the normative mechanism In areas where the normative mechanism works in favor of the new water treatment works in favor of the new water treatment technology, people are more likely to technology, people are more likely to continue treating their drinking water with continue treating their drinking water with Air RahMat Air RahMat

Injunctive norms and group identity play a Injunctive norms and group identity play a stronger role in influencing behavior than stronger role in influencing behavior than does outcome expectationdoes outcome expectation

ACKNOWLEDGEMENTACKNOWLEDGEMENT

We would like to thank: We would like to thank: Our study participants in Binjai, Bantaeng, Our study participants in Binjai, Bantaeng,

Maros and TangerangMaros and Tangerang Institute for Public Health and Water Institute for Public Health and Water

Research (IPWR)Research (IPWR) USAIDUSAID

• For more information about Aman Tirta Program, go to http://For more information about Aman Tirta Program, go to http://www.jhuccp.org/asia/indonesia/aman_tirta.shtmlwww.jhuccp.org/asia/indonesia/aman_tirta.shtml

• For more information about Air RahMat go to For more information about Air RahMat go to http://www.airrahmat-indonesia.comhttp://www.airrahmat-indonesia.com

We gathered data through…We gathered data through…

Qualitative studyQualitative study• in 4 intervention areas (Binjai, Bantaeng, in 4 intervention areas (Binjai, Bantaeng,

Maros, and Tangerang)Maros, and Tangerang)• Focus group discussions with women and men Focus group discussions with women and men

(age 20-40, have children <5 years of age, (age 20-40, have children <5 years of age, users and non-users of Air RahMat)users and non-users of Air RahMat)

• In-depth interviews with formal and informal In-depth interviews with formal and informal leaders (the head of village, midwives, health leaders (the head of village, midwives, health cadres, women’s club activists, etc)cadres, women’s club activists, etc)

Social network study (census in Social network study (census in intervention areas)intervention areas)• in 2 communities in Tangerangin 2 communities in Tangerang