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Summary: Biomedical health interventions now have global reach and interact in complex and often poorly understood ways with traditional medical rituals that precede biomedicine. People often experience biomedical practices and treatments as rituals because they are very similar from an experiential perspective.1 Yet the global public health community often views ritual practices of communities as obstacles to adopting new health-promoting behaviors. The lack of engagement with the biomedical and traditional medical rituals of local populations has obscured understanding the critical functions of these behaviors, limited the potential to leverage ritualization to increase behavioral uptake, and stymied social and behavioral change efforts. Our large-scale, mixed methods research with Community Health Workers (CHW) in Bihar, India, has shown that understanding the rituals of a community provides critical insight into their identities, norms, values, and goals. We propose that health interventions should be informed by, and build upon, knowledge of health rituals. A deep understanding of existing beliefs and behaviors will allow local health ''influencers'' such as CHW to encourage new and modified rituals that integrate the best of biomedical and traditional health practices in ways that preserve their meaning and shared purpose. Funding: Grants INV-008582 and INV-016014 to C.L. from The Bill & Melinda Gates Foundation funded this manuscript.

Ritualized actions are common in daily life, and prevalent across cultures. Adults have been shown, under experimental conditions, to treat objects subjected to ritualized action as special and different relative to objects subjected to non-ritualized action. Similarly, children as young as 4, are sensitive to ritualized actions-frequently reproducing such actions at high fidelity. The current cross-cultural experiment attempts to extend existing findings among two culturally distinct groups of children with regard to object-directed rituals. We predicted that children's preference for a reward would be influenced by ritualized action (but not non-ritualized action). Over two trials we presented children in Australia (N = 93; mean age = 6.03 years, SD = 2.07 years) and Vanuatu (N = 109; mean age = 6.13 years, SD = 1.96 years) with two identical rewards, which was either subjected to ritualized action or non-ritualized action. Contrary to previous findings among adults, ritualized action did not influence children's preference for a reward. We frame the current results in the context of socially relevant group rituals, and discuss the implications for both wider theory and methods. We conclude with a call for pre-registered replications.