How to get people to wash their hands

How to get people to wash their hands

If you've been following international news recently, you've likely been inundated with the message: ‘Wash your hands!’ But not everyone is tuned in to public health messages, nor is such information always effectively communicated to vulnerable communities. And although the global pandemic will eventually pass (fingers crossed!), the need for good hygiene practices will not. So what interventions get people to wash their hands more?

Simply telling people to wash their hands does seem to induce more people to do so — but it also appears to only be a short-term behavioral change.

The strategy that most consistently improved hygiene behavior like hand-washing and latrine usage, at least in low-and middle-income countries, seems to be a ‘community-based approach,’ which involves joint decision-making about sanitation issues.

Now, these findings are definitely not from the context of a pandemic. People are probably washing their hands more anyway, because they don't want to get sick. And the community meetings mentioned in the previous paragraph would be very unwise at this moment. (As I type this, any such gathering would be banned in my state.) Nonetheless, there may be insights that we can derive that also are salient in the current situation.

Our evidence comes from one systematic review which combines the results from numerous studies around the world. This approach provides stronger evidence than relying on a single case, where idiosyncratic issues can affect program outcomes. The review, which 3ie funded, includes data from 70 studies on a variety of sanitation programs from low-and middle-income countries, primarily in South Asia and Sub-Saharan Africa.

The review shows that in low-and middle-income countries, community-based approaches have been effective at getting people to wash their hands with soap, in addition to encouraging latrine usage and reducing open defecation.

So what is it about these approaches that make them effective? They typically involve people being invited to meetings to discuss and share in decision-making on sanitation issues. These meetings are often combined with the provision of infrastructure (like latrines or water pumps) or household supplies (like disinfectant tablets or water-storage containers). They also tend to take place over longer time periods, often several months. Often the meetings are led by a trained facilitator, and it seems the programs are more effective if that facilitator comes from the community itself.

While the in-person meetings should be avoided during the current crisis, some measures could be implemented to mimic many of the ingredients of the community-based approach. Water and soap could be made available at key locations, along with a community facilitator who could explain the importance of handwashing, demonstrate proper technique, and encourage social distancing in the line-up.

The review finds that promotional campaigns have short-term effects on hand-washing behavior but that these changes are not sustainable in the long term.

Furthermore, it finds that incorporating elements of psychosocial theory into sanitation interventions and messaging is a promising approach. These interventions specifically address behavioral factors, like knowledge, feelings, and social pressure, based on psychosocial theory. For example, do people know that soap kills germs? Do they feel that they have any control over whether they get sick? Is there social pressure in the community to wash hands? One framework that incorporates these elements is the Focus on Opportunity, Ability and Motivation (FOAM) approach. Thus far, these approaches have primarily been studied in small-scale interventions, so the next step will be to see how they scale up.

While we've been discussing these approaches one at a time, they can also be implemented simultaneously. The 3ie-funded review's authors conclude that combining different strategies is likely to be more effective than any single approach.

For more information about this review, the full 3ie-funded study and a shorter summary are here .Beyond these studies, hundreds of other systematic reviews and thousands of impact evaluations are available in our newly-updated Development Evidence Portal.

2020hindsightThis blog is part of our campaign 2020 Hindsight: What works in Development. Learn more about the campaign and read past blogs here.

Comments

My observation – in low income countries, here in Africa , the more affluent society , before COVID 19, people washed hands but not effectively. It was a routine and now people have learnt to give more time and care to washing hands clean . Some even simply washed only fingertips before or after food but now they are spending good deliberate effort to wash hands clean. As for those in the villages or slums have yes learnt how to wash hands as well thank God due to messages from leaders at all levels and PEER pressure. Their limitation is water. They do not have sufficient water to spend on washing hands well. However they are making great effort . What happens post COVID 19 is what is not well known right now. Rose -Uganda

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Authors

Paul-Thissen Paul ThissenEvaluation and Communication Specialist

About

Evidence Matters is 3ie’s blog. It primarily features contributions from staff and board members. Guest blogs are by invitation.

3ie publishes blogs in the form received from the authors. Any errors or omissions are the sole responsibility of the authors. Views expressed are their own and do not represent the opinions of 3ie, its board of commissioners or supporters.

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Authors

Paul-Thissen Paul ThissenEvaluation and Communication Specialist

About

Evidence Matters is 3ie’s blog. It primarily features contributions from staff and board members. Guest blogs are by invitation.

3ie publishes blogs in the form received from the authors. Any errors or omissions are the sole responsibility of the authors. Views expressed are their own and do not represent the opinions of 3ie, its board of commissioners or supporters.

Archives