Changing people’s behaviours towards hand washing in emergencies

Emergencies, Health, Water

Sonya Sagan is working on a global framework for promoting hand washing  with soap, using emotional motivators to encourage behaviour change.

In development contexts, hand washing programmes which focus on emotional motivators have been shown to be more impactful on behaviour than those which focus primarily on health. However there is limited documented evidence related to the use of emotional motivators to promote hand washing in emergency contexts. 

Hygiene promotion programmes in emergencies traditionally focus on the health benefits of hand washing as a key motivator but the long term efficacy of this approach beyond changes in awareness is not well understood.  

Oxfam in partnership with the Unilever Foundation and Lifebuoy Social Mission is currently working on a global framework for promoting hand washing with soap.

Gap in hand washing implies that knowledge is not enough to change behaviour

Mothers were selected as the programmes main audience because of their role as caregivers of children under five and key influencers at the household level.  The partnership draws upon Oxfam’s experience in complex emergencies and Lifebuoy’s social marketing know-how to better understand barriers and key motivators among mothers affected by crises and utilise these to develop a methodology and set of materials to promote behavioural change. The programme will be tested in Pakistan and the Philippines where extensive formative research has been
conducted with mothers in Jalozai, Peshawar and both an urban and rural area in Tacloban, Philippines.

Although the results of the formative baseline study in both contexts suggest high levels of knowledge and self-reported hand washing with soap, practiced among mothers before eating and after defecation, levels of practice (determined by structured observation) were shown to be significantly lower in all locations. This knowledge-practice gap implies that knowledge is not enough to change behaviour and calls into question the efficacy of the health education approach.

To bridge the gap, Oxfam and Unilever/Lifebuoy will attempt to address barriers and make use of important motivators in both contexts to promote behavioural change and develop hand washing with soap habits among mothers. The research findings suggest that key motivators for hand washing include nurture, affiliation or fitting-in, purity, comfort, disgust and  shame which are consistent with findings in other emergency contexts (Chad, Liberia, South Sudan, Haiti). At present, Lifebuoy and Oxfam are working together with an
advertising agency to develop an innovative strategy and materials which tackle crosscutting motives that could be applied, with minimal adaptations, to any humanitarian context.

The most powerful motivators might be that mothers want their children to be successful in life

Practical applications for hand washing programme implementers include the importance of defining a target audience and understanding barriers and motivators that dictate their actions. Although access to hardware can be a significant barrier, it is vital to understand other social, environmental and physical barriers that may be preventing the audience from practicing consistent hand washing with soap. 

In Pakistan for example, a significant barrier to the use of soap is based on a religious belief that washing hands three times with water alone renders them pure and clean for prayer and for having a meal. These beliefs are the strongest motivator for hand washing. It would be unheard of for a mother to offer prayer without first rinsing her hands. The challenge is to find a way to introduce soap into this routine, particularly at critical times. In the Philippines, a significant barrier to washing hands with soap after changing nappies is the belief that baby faeces are not
contaminated. 

Ultimately, the most powerful motivators might be that mothers want their children to be successful in life and by making sure they develop good hygiene and hand washing habits, they are ensuring them the best chance for success.

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Header image: As part of Oxfam’s cholera response in South Sudan, teams of public health volunteers have been teaching affected communities about the importance hand washing. Credit: Kieran Doherty/Oxfam

Body image: Synchronised hand washing event in the Philippines. Credit: Ferrie Jessa Gomez/Oxfam

Author: Sonya Sagan
Archive blog. Originally posted on Oxfam Policy & Practice.