Department Environmental Social Sciences

Commitment-enhancing interventions promote arsenic-safe water consumption in Bangladesh

Project description

Naturally occurring arsenic in drinking water poses a threat to human health. Many safe water alternatives to contaminated shallow wells have been installed in Bangladesh. However, these are often not being used. This project aimed at improving the effectiveness of an information intervention to promote the use of existing safe water options with theory-based and evidence-based behaviour change techniques. The commitment-enhancing techniques (reminders, implementation intentions and public commitment) led to up to 50% increased behaviour change compared to information alone. The behaviour change effect was mediated by increasedcommitment strength.



Geogenic contamination of drinking water, such as arsenic, is associated with chronic disease and increased mortality. Nowhere is the issue as severe as in Bangladesh, where millions of wells are contaminated. Approximately 20 million Bangladeshi are at risk of drinking water with elevated arsenic relative to the national standard of 50 micrograms per litre. Although safe water options (e.g. deep wells) are often in walking distance, and well-sharing among neighbours with safe wells has been encouraged, many people still drink water from contaminated or untested wells.

The main goal of this project was to promote safe water consumption with theory-based and evidence-based behaviour change techniques (BCTs). Specific objectives were:

  • To assess current water consumption practices and the behavioural factors associated with these practices.
  • To design, implement, and evaluate theory-based and evidence-based BCTs to promote safe water consumption.

Step 1 & 2: Identify, measure, and determine behavioural factors of safe water consumption:

  • A baseline survey about safe water consumption practices and its behavioural determinants was conducted in 710 households in November and December 2010 in several villages of Manikganj and Monoharganj districts, Bangladesh.
  • Manikganj has lower rates of contaminated wells, wherefore sharing of neighbouring arsenic-safe shallow wells was promoted. In Monoharganj, where there are almost no safe shallow wells, the use of available arsenic-safe deep wells was promoted.
  • The behavioural factors influencing the use (vs. non-use) of arsenic-safe water options were specified by means of a logistic regression. The strongest associations were found for commitment strength to use safe water options and the descriptive norm (perceptions of how many others collect safe water). 

Step 3: Select behavior change techniques (BCTs) and design behavior change strategies to promote safe water consumption:

  • Three BCTs expected to promote the key factors of safe water consumption (commitment strength and the descriptive norm) were selected. These were (1) reminders, (2) implementation intentions (imps; a concrete plan, when and where to collect safe water), and (3) public commitment. 
  • The BCTs were combined into three interventions with information about arsenic – reminders+information, imps+reminders+information,
  • public_commitment+imps+reminders+information - and compared to information alone.

Step 4: Implement and evaluate behavior change strategies:

  • The interventions’ effectiveness was assessed through two before-and-after cluster-randomised controlled trials (one in each district).
  • The interventions were delivered by trained health promoters of our partner organisations.
  • A follow-up survey on safe water consumption practices, behavioural determinants and the interventions’ evaluation was conducted in April 2011, with the same households as at baseline. 


  • Up to 65% switching to arsenic-safe wells was observed in the intervention groups compared to up to 18% well-switching in the information-only group.
  • The behaviour change effects increased when more commitment-enhancing BCTs were added.
  • The intervention effects on behaviour change were evoked through increases in commitment strength.
  • There were unclear results about public commitment. Whereas the intervention that included this BCT was the most effective to promote switching to deep wells, this intervention was not more successful than information alone for promoting sharing of neighbouring safe wells.

Commitment-enhancing interventions can substantially increase the effects of information to promote safe water consumption.


Inauen, J.; Mosler, H.-J. (2014) Developing and testing theory-based and evidence-based interventions to promote switching to arsenic-safe wells in Bangladesh, Journal of Health Psychology, 19(12), 1483-1498, doi:10.1177/1359105313493811, Institutional Repository
Inauen, J.; Tobias, R.; Mosler, H.-J. (2014) The role of commitment strength in enhancing safe water consumption: mediation analysis of a cluster-randomized trial, British Journal of Health Psychology, 19(4), 701-719, doi:10.1111/bjhp.12068, Institutional Repository
Inauen, J.; Tobias, R.; Molser, H.-J. (2013) Predicting water consumption habits for seven arsenic-safe water options in Bangladesh, BMC Public Health, 13, 417 (10 pp.), doi:10.1186/1471-2458-13-417, Institutional Repository
Inauen, J.; Hossain, M. M.; Johnston, R. B.; Mosler, H.-J. (2013) Acceptance and use of eight arsenic-safe drinking water options in Bangladesh, PLoS One, 8(1), e53640 (10 pp.), doi:10.1371/journal.pone.0053640, Institutional Repository
Johnston, R.; Hug, S. J.; Inauen, J.; Khan, N. I.; Mosler, H.-J.; Yang, H. (2014) Enhancing arsenic mitigation in Bangladesh: findings from institutional, psychological, and technical investigations, Science of the Total Environment, 488(1), 477-483, doi:10.1016/j.scitotenv.2013.11.143, Institutional Repository
Inauen, J.; Mosler, H.-J. (2016) Mechanisms of behavioural maintenance: longterm effects of theory-based interventions to promote safe water consumption, Psychology & Health, 31(2), 166-183, doi:10.1080/08870446.2015.1085985, Institutional Repository