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The Global Public-Private Partnership for Handwashing

2015 Regional Handwashing Think Tank, Senegal: Emotional Motivators, Behavioral Settings and the Science of Habit

Published: April 19, 2016

On an annual basis, the Global Public-Private Partnership for Handwashing convenes a Handwashing Think Tank where hygiene experts from civil society, government, research institutions, and the private sector gather to take stock of the best, identify the gaps, and articulate the way forward for hygiene behavior change.
At the 2015 Regional Think Tank held in Dakar, Senegal, the PPPHW explored three big ideas in handwashing: emotional motivators, behavioral settings and the science of habit.

All presentations available for download here.

Big Idea 1: Emotional motivators

To explore how emotional motivators can be used to drive forward hygiene behavior change, Katie Greenland (London School of Hygiene and Tropical Medicine) presented research from LSHTM that demonstrated how emotions, including affiliation, disgust, and nurture, were used to drive sustained behavior change in Zambia, Indonesia, India, and Nigeria. She argued that behavior change interventions should employ motivational mapping and adopt powerful “levers” to enact change, and that there is a need to harness a greater “creative capacity”, and find new approaches toward formative research.

Big Idea 2: Behavior settings

To consider the impact of modifying behavior settings to drive handwashing behavior change, OmPrasad Gautam (London School of Hygiene and Tropical Medicine/WaterAid) described how modifying physical settings for handwashing behavior in his food hygiene project in Nepal triggered handwashing and achieved behavior change. Then Yolande Coombes, with the Water and Sanitation Program (WSP) at the World Bank, explained how principles of human-centered design can be used to help design handwashing stations that are attractive, affordable, and meet the unique needs of local populations.

Big Idea 3: The science of habit

David Neal, from Catalyst Behavioral Sciences, gave a presentation via video exploring how the science of habit can be used to drive handwashing behaviors. Based on his work in conjunction with USAID/WASHplus project, this presentation discussed six practical ways in which the science of habit can be leveraged for hygiene behavior change and integrated into handwashing programs. You can read more about this concept on our habit key topic page.

Bonus Idea: Scaling up hygiene

We delivered a follow-up discussion at AfricaSan two days after the Think Tank, examining the challenges of bringing hygiene improvement to scale, and presenting three components of scaling up: policy, partnerships, and integration. Katie Greenland (LSHTM) presented the equity argument for scaling up handwashing; Anila Gopal (Unilever) shared how Unilever scaled up their handwashing program to reach 254 million people; Ousmane Toure (National Institute for Research in Public Health, Mali) discussed how a food hygiene program in Mali was scaled up to other countries; Chimwemwe Nyimba (UNICEF Malawi) described the successful integration of handwashing into CLTS, and finally Hanna Woodburn (PPPHW) addressed how the Sustainable Development Goals have the potential to help scale up handwashing by driving government commitment, monitoring, and reporting.  This session supported the Think Tank input.

Big ideas from participants

We invited Think Tank participants to submit their own “big ideas” based on their in-country experience, and received responses from 25 participants representing twelve countries including ten African countries. The main themes put forth were around new ways to trigger behavior change; the importance of engaging young people in delivering change; the key barriers that need to be addressed (with a focus on hardware issues); the need for integration of handwashing programs with other sectors; and the need for better approaches to engage governments. Participants also emphasized that in many places the challenge of sustainable water and soap supply remains and that more local research is necessary to inform local approaches.

Think Tank participants also called for further research around ways to demonstrate the link between handwashing and diarrhea at the local community level; innovations in handwashing hardware (including zero-contact handwashing technologies, water-conserving devices, and accessible handwashing stations for the physically challenged including the visually impaired); costing of handwashing interventions; and local motivators, including feasibility of associating hygiene behaviors with religious practices.

Discussion

Think Tank presentations were followed by a rich period of questions and reflections. While these discussions covered the whole range of topics examined in the formal presentations, some commonalities included:

  • The sentiment that changing handwashing behavior is difficult, and so is changing handwashing programs. It can be a burden for practitioners to understand how best to translate the latest thinking into action to deliver more effective programs, especially at scale and in areas where traditional program protocols are already established;
  • A desire to learn more about how emotional drivers can be modified depending on context (such as age of audience, school setting versus the home, and variations in motivators according to specific local settings) for greater impact on handwashing behavior; and
  • The need to ensure active, whole family and community engagement in handwashing programs (rather than focus on mothers/caregivers of young children alone).
Conclusions

It is clear from the PPPHW AfricaSan Think Tank 2015 that while initiating handwashing behavior change is not a novel concept, there is still much to learn about how it can be made a habit practiced regularly. There is much to consider to ensure interventions are relevant, appropriate and impactful in different settings, and for different populations, over time. The Three Big Ideas put forth by the PPPHW resonated well with those working in-country on handwashing policies and programs.

There was recognition that we need to prioritize hygiene at all levels of program planning and implementation. This includes governments agreeing to hygiene indicators, program directors ensuring integration of the latest handwashing research into projects on the ground, and all of us driving further research to deliver the big ideas that will achieve the scale up of handwashing. The PPPHW’s first Africa-based Think Tank event will help focus the work of the PPPHW and others working in handwashing going forward.

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