TY - JOUR T1 - Behavior Change Fast and Slow: Changing Multiple Key Behaviors a Long-Term Proposition? JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 521 LP - 524 DO - 10.9745/GHSP-D-15-00331 VL - 3 IS - 4 A2 - , Y1 - 2015/12/01 UR - http://www.ghspjournal.org/content/3/4/521.abstract N2 - An intensive radio campaign in rural areas of Burkina Faso addressed multiple key behaviors to reduce child mortality, using a randomized cluster design. After 20 months, despite innovative approaches and high reported listenership, only modest reported change in behavior was found, mainly related to care seeking rather than habitual behavior such as hand washing. Various methodologic difficulties may have obscured a true greater impact. Analysis of the intervention after its full 35-month duration may reveal more impact, including on actual child mortality. Improving a number of key behaviors is essential to child survival efforts, and much of it may require strong and sustained efforts.See related articles by Sarrassat and by Murray.Human behavior is complex, often not completely rational, and profoundly influenced by social norms, structural constraints, opportunities, and habit. Yet we tend to approach behavior change interventions as discrete-in-time, “one-off” interventions. Of course some behaviors change remarkably readily. Think about the explosive adoption of cell phones globally. Or how use of plastic bags has plummeted in many jurisdictions in the United States (and in other countries), simply by adopting the “nudge” of levying a 5 cent charge on consumers.1Consider the reduction of smoking in the United States. It began with evidence emerging in the 1950s that led to a landmark US Surgeon General’s report in 1964.2 Efforts combatted tobacco industry assertions to try to deny and obscure the health effects and later were bolstered by recognition of tobacco as an addiction. Over the decades, evidence of the wide and varied harmful effects continued to mount. And when the harmful effects of secondhand smoke became recognized, it catalyzed a tipping point of strong social norms against smoking, since smoking could no longer be seen as harming only the smoker. All the while, public health initiatives … ER -