The Global Handwashing Partnership

Step three: Habit formation

Handwashing habit formation means converting handwashing from a behavior that people must think about and decide to undertake (intention and decision making) into one that we automatically undertake in response to cues.  Habitual handwashing does not involve the decision-making parts of our brain. When handwashing becomes a habit, social norms, emotional drivers, and other decision making processes take a back seat as the process in the brain evolves from motivation to automation. Read more about habit formation for handwashing in The Science of Habit: Creating disruptive and sticky behavior change in handwashing behavior. 

In the paper, Dr. David Neal explains six key principles for turning handwashing into a habit.  These can be integrated into handwashing behavior change programs to drive handwashing sustainability:

1.  Ensure a stable, supporting environment: Habits are triggered by environmental cues. To form a handwashing habit, environmental cues must be immediately and consistently available. Having to search for soap and water, for example, require a high level of motivation, rather than facilitating automation.
2. Leverage Context: There are key moments where people are particularly open to developing new habits. For example, changes to the physical/action environment, like new motherhood, or starting school, prompt a whole range of new habits, and handwashing can be effectively integrated here. Alternatively, handwashing can ‘piggy back’ on pre-existing habits, for example if people already check their appearance in the mirror, a mirror could be attached to a handwashing station to create an automatic link where one habit cues the other.
3. Eliminate Friction: Choice is the enemy of habit. Reducing choice, simplifying actions, and diminishing perceived effort all support habit formation. For example, reduce complexity of handwashing instructions, and ensure easy accessibility.
4. Provide “ownable” cues: Cues can trigger handwashing behavior, whether it be posters, colored footsteps on the ground leading from the latrine to the handwashing station, or some other cues, visual or otherwise, customized to local settings. Using ‘if x then y’ reminders can be helpful, for example visual reminders show people how their hands remain unclean if they don’t wash their hands effectively.
5. Encourage practice: Help form procedural memory not just by explaining how to wash hands, but by actively having people do so, for example group handwashing at school. The act of handwashing itself can lead to future habit formation. 
6. Promote meaning and motivation: People believing there is a deep and meaningful purpose behind their habits strengthens their habits. For example mothers who believe they are keeping their children healthy may be more likely to sustain good handwashing habits.

The Global Handwashing Partnership and the USAID/WASHPlus Project co-hosted a webinar on this topic featuring behavioral scientist Dr. David Neal. Watch this webinar here.