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Resource details

Promoting change in environmental health behaviour

Author(s): Cave, Ben  |  Curtis, Valerie  |  Woodfield, Julie (ed)

Publisher: LSHTM | WEDC
Place of publication: London and Loughborough
Year: 2000

Series: WELL Studies in Water, Sanitation and Environmental Health Task 165
Collection(s): WELL


Although health education is promoted as a major factor in preventing ill health and disease, there is little evidence of its actual impact in terms of changing people's behaviour. This is a review of the literature (between 1987 to 1999) which focuses on the potential effectiveness of the various approaches to environmental health promotion and evaluation in developing countries, and the appropriate expectations and targets for change in health behaviour. The target audience is DFID staff, their local project partners in government and NGOs, and consultants involved in environmental health promotion programmes.


Environmental health programme planners need information about the effectiveness of health promotion activities on behaviour change and on ways in which its impact can be maximised. Behaviour change intervention ideally involves the repeated delivery to target groups of a limited number of attractive messages using appropriate channels; target audiences then need to absorb and comprehend these messages, which motivate them to change aspects of health-related behaviour. Measuring behaviour change is not a straightforward process and health impacts are often small and difficult to detect.


Of the 31 articles chosen for review, only five conformed to Loevinson's (1990) methodological criteria for assessing the rigour of health education or promotion interventions.

The main findings from this are:

  • None of the five studies identified as methodologically sound shows a clear impact on behaviour. Of the 11 of the 31 demonstrating reasonable rigour, only two showed a clear and major impact on behaviour (one involving hand washing intervention and the other smoking).
  • All other papers with any rigour showed little or no impact on behaviour. On average about five per cent of reported results will be a result of statistical chance.
  • Studies which report negligible effects on behaviour are much less likely to be written up and published.
  • Social marketing as an extension of commercial marketing makes great claims of success, although only one scientific evaluation appeared in this review.
  • One contributory factor to poor results of health promotion may be that interventions are too short and evaluations are too early to show a clear impact.

This review appears to raise legitimate grounds for doubt about the value of health promotion. However, some interventions have demonstrated major behavioural change and cannot be discounted. The design of interventions and evaluations should include the development of feasible and practical replacement behaviour; removing any constraints to behaviour change prior to intervention and predefining explicit, measurable behaviour change outcomes from the outset. There are implications for planners and policy makers who need to be aware that success in effecting behaviour change is seldom evidenced, but that cost-effective interventions are possible, especially in large scale programmes.

Behaviour  |  Health education  |  Hygiene