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Developing Effective Messages for Better Nutrition and Hygiene in Tonkolili: The TIPs Method

What is TIPs?

SPRING/Sierra Leone recently used Trials of Improved Practices (TIPs)—a qualitative research methodology—to select improved WASH (water, sanitation, and hygiene) and nutrition behaviors in consultation with household members.

The TIPs approach allows researchers to pretest behaviors at the household-level before they are widely promoted. By focusing on behavior (what people do), rather than on knowledge (what people know or believe), TIPs provides an in-depth understanding of—

  • families’ preferences and capabilities
  • the barriers and enablers they encounter in trying new behaviors.

How Did We Use It?

In May of 2016, SPRING/Sierra Leone conducted TIPs research with 24 selected households in two chiefdoms in the Tonkolili District.

Step 1

Created and prioritized a menu of evidence-based behavioral options on—

  • handwashing with soap at critical times
  • clean home/play environment, including safe disposal of feces
  • appropriate complementary feeding of children 6-23 months.

Step 2

Conducted three household visits to—

  • interview, observe, and understand the household’s context and current behaviors
  • counsel and negotiate 1-2 new behaviors that the household is willing to try
  • follow-up to understand which behaviors households were able to adopt and the most important barriers and enablers to the suggested behaviors
  • solicit suggestions from participants about how to modify and promote the behaviors.

Step 3

Used the dialogue and data from the visits to develop messages for the target audience that were—

  • tailored
  • contextually appropriate
  • pretested.

What Did We Discover?

Most-accepted interventions:

  • Creating handwashing stations
  • Prioritizing soap for handwashing

Reasons individuals gave for adopting this behavior:

  • TIPs team members explained the behavior and construction to participants.
  • Large water bottles needed to construct handwashing stations are readily available.

Least-accepted intervention:

  • Keeping children in a fenced-in, clean play space to protect them from contact with animal feces
    • Out of the households interviewed, 14 were counseled on this behavior.
    • 5 of those households were interested in trying the behavior, but none had built an enclosure by the follow-up visit.
    • Many households preferred to continue the practice of periodically sweeping the home environment instead, which provides a crucial insight for the design of a more effective WASH 1,000 intervention.


Although the TIPs methodology does not provide statistically representative information about the larger target population, it is an effective way to pretest new behaviors to better understand the factors that may impede or facilitate households’ adoption of a new behavior.

This methodology engages household members in dialogue and involves them as partners in designing the interventions that work best in their lives to achieve positive health outcomes for themselves, their families, and communities.

Developing Effective Messages for Better Nutrition and Hygiene in Tonkolili: The TIPs Method