September 19, 2016
No matter where a baby is born, their parents are united by a common hope: that their child will grow up to be healthy, successful, and happy. And yet, for too many, these dreams aren’t realized. In 2016, 5.9 million children died before celebrating their fifth birthday. For many, these deaths were preventable through simple measures. For instance, 9 percent of childhood deaths are caused by diarrheal diseases.¹ Almost half of these deaths could be prevented through one easy, effective behavior: handwashing with soap.² Handwashing doesn’t only prevent diarrhea; it is also effective against pneumonia, fights infections, and even plays a role in improving nutrition. Yet, despite these benefits, handwashing is not practiced regularly. Even when handwashing behavior change occurs, the adoption of improved practices is far too often temporary and relapse to poor hygiene practices occurs.³
Handwashing must be a habit.
This simple statement, about a simple behavior, is the rallying cry for Global Handwashing Day 2016. Habit formation is a “hot topic” in water, sanitation, and hygiene (WASH), but it is often misunderstood. This resource seeks to bridge that gap by providing basic information about habits and links to tools, so that, no matter where you live or work, you are better equipped to both adopt a good handwashing habit and help others do the same.
A large portion of our day-to-day behaviors is comprised of habits. In fact, around 45 percent of human behavior can be considered habitual.² A habit is a regularly repeated action that takes place in the same setting over time with minimal consideration or effort. Simply put, a habit is an automatic behavior that is perceived as second nature.4 They can be healthy or unhealthy and are developed over time.
Behaviors are complex. And so behavior change—and habit formation—is multifaceted. A few key components of habit formation include:
Social norms are rules that apply to certain situations. For example, a culture might have a social norm that requires guests to remove their shoes when they visit someone’s home. People abide by the rule if others do so and if the same is expected of them. These norms are created and governed by the community. A norm around handwashing before eating, for example, can help convert the practice into a habit. In 2014, the PPPHW’s Handwashing Behavior Change Think Tank discussed the importance of raising the visibility of handwashing to reinforce hygiene social norms. People are more likely to wash their hands if others observe them doing so.
Emotional drivers, such as disgust or a desire to nurture and care for others, are powerful motivators and can have a lasting impact on a person’s behavior and the development of good habits. The SuperAmma Campaign is one example of how these drivers can be incorporated into a handwashing promotion campaign. This campaign found that emotional drivers were able to substantially increase handwashing with soap.
To wash their hands properly people must have access to the so-called determinants of handwashing, such as a functional handwashing station with soap in a convenient location. When handwashing stations are visible and accessible they can serve as environmental cues to remind people to wash their hands. Nudges are one type of environmental cue that trigger an individual’s unconscious decision-making processes to prompt a desired behavior. Nudges, as seen in this proof-of-concept, are a great example of a low-cost innovation that can help develop a habit of handwashing.5 For instance, a nudge relating to handwashing could be a brightly-painted pathway leading from a toilet to a handwashing station.
These are just the basics. Read more about habit formation, and the science behind it, here.
Promoting handwashing as an ongoing healthy behavior is the objective of this year’s Global Handwashing Day’s theme: “Make handwashing a habit!” Habits aren’t formed in one day. But, Global Handwashing Day can serve as a catalyst for good, sustained handwashing behaviors.
Global Handwashing Day celebrants can help promote the habit of handwashing by:
Don’t stop with Global Handwashing Day! Handwashing promotion can, and should, continue throughout the year. For ideas on how you can continue to promote handwashing habit formation after October 15, this resource will help you go Beyond Global Handwashing Day.
This is a very brief overview on a significant and important topic. There are a number of more extensive resources that can help you—no matter where you live or work—improve handwashing habits. Here are some that we recommend:
The Science of Habit: Creating Disruptive and Sticky Behavior Change in Handwashing Behavior, 2015, D Neal et al, USAID WASHplus.
Dr. David Neal, from Catalyst Behavioral Sciences, published this paper exploring how the science of habit can be used to drive handwashing behaviors. Based on his work in conjunction with USAID/WASHplus project, this brief describes six practical ways in which habits can be leveraged for hygiene behavior change and integrated into handwashing programs. You can learn more about this concept in a webinar co-hosted by USAID WASHplus and the PPPHW detailing how habit theory can be harnessed to advance handwashing behavior, and a presentation delivered at the 2014 UNC Water & Health Conference illustrating how the habit-formation approach can help foster and encourage healthy habits through developing strategies in a way that allows handwashing behavior to be easily adopted.
Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh, 2016, R Dreibelbis, Journal of Environmental Research and Public Health. [Link]
Nudges are environmental cues that engage unconscious decision-making processes to stimulate behavior change. This proof-of-concept study discusses the impact of inexpensive, targeted nudges that promote handwashing with soap after toilet use in two primary schools in rural Bangladesh. The evidence from this study indicates that nudge-based interventions can be effective for improving handwashing with soap behaviors among schoolchildren.
Behaviour Centred Design, 2016, Environmental Health Group, London School of Hygiene & Tropical medicine. [Link]
In this resource, researchers at the London School of Hygiene & Tropical Medicine outline how the behavior centered design (BCD) approach can change a number of behaviors, including handwashing. BCD builds on evolutionary and environmental psychology and marketing best practices to design and test behavior change interventions. Additional tools found in this online resource include a peer-reviewed paper on the approach published in the Health Psychology Review, a practitioners guide to the BCD, formative research protocols, as well as a webinar explaining the approach.
Handwashing with Soap Toolkit – The Role of Enabling Products, 2016, WSP. [Link]
Access to and availability of handwashing hardware and supplies help with habit formation. This toolkit provides an introduction to the importance of enabling products for handwashing. It also provides specific country examples of how products and technologies can help foster a handwashing habit.
1. UNICEF. (2014). Levels and trends in child mortality. The U.N. Inter-Agency Group for Child Mortality. www.unicef.org/media/files/Levels_and_Trends_in_Child_Mortality_2014.pdf
2. Science of Habit: Creating Disruptive and Sticky Behavior Change in Handwashing Behavior. (2015). Neal, D., et al. http://www.washplus.org/sites/default/files/resource_files/habits-neal2015.pdf
3. The 2016 Global Handwashing Day Theme: Make Handwashing a Habit! (2016). The Global Public-Private Partnership for Handwashing. http://globalhandwashing.org/announcing-the-2016-global-handwashing-day-theme-make-handwashing-a-habit
4. Making health habitual: the psychology of ‘habit-formation’ and general practice. Gardner, B., et al. (2012). British Journal of General Practice. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505409/
5. Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh. (2016). Dreibelbis, R., et al. University of Oklahoma. Journal of Environmental Research and Public Health. http://www.mdpi.com/1660-4601/13/1/129
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