Handwashing promotion is an important part of hygiene projects, but handwashing should not only be promoted in WASH programs. Given the impact of handwashing on global health and development, handwashing can and should be integrated into WASH, health, nutrition, education, and other related sector programming.

Steps to Promote Handwashing Behavior Change

Promoting handwashing requires behavior change. The process of changing handwashing behavior generally following these steps:

Picture2Step2Step3 Step4

To learn about the four steps, click on the corresponding icon above. You can also read background information on behavior change, recommendations
for handwashing promotion at the program level, and find additional resources on this
page.

Introduction to Handwashing Behavior Change

Changing behavior requires an individual or community to be aware of proper handwashing behavior; then to be knowledgeable and able to act; motivated and ready to change. Finally, they need to attempt and sustain the new or improved behavior, as well as promote it to others. Practitioners can facilitate this journey by delivering the right information, skills, and motivation to begin and/or permanently instill the new behavior.

Factors that determine if a person washes their hands include knowledge about when and how to wash hands, social norms driving handwashing at critical moments, the presence of a fixed handwashing station with soap and water, and the presence of emotional motivators (e.g., disgust, odor, and in some instances, nurture). Research also tells us that handwashing behavior change takes time, and a one-off intervention may not be sufficient to achieve lasting habit formation or behavior change.

Despite the wide range of behavior change theories and models available, handwashing behavior change interventions often fail to use them. Using behavioral theories or frameworks in the design and implementation of behavior change interventions can result in improved long-term behavioral outcomes. There is no evidence at present that one behavior change model is better than any other, but there is evidence that using a behavior change theory leads to better outcomes. Some key factors in handwashing behavior change include knowledge, psychological factors, unconscious factors, and habit formation.

Knowledge

Knowledge is a basic element of most handwashing promotion programs. Traditionally, handwashing knowledge interventions have focused on educating people about the link between handwashing and disease prevention.
Research has shown that many people are not aware of this link.

While educational activities can increase knowledge, they do not always result in sustained handwashing habits. Even when people know the reasons and critical times to wash their hands; and have access to handwashing stations or soap and water; handwashing is still practiced inconsistently. Knowledge is necessary, but by itself, it is not sufficient to drive consistent and correct handwashing.

Based on the drivers of handwashing behavior, from local research to current global knowledge, behavior change communications initiatives and frameworks can be used to shift knowledge into action for sustained behavior change.

Psychological factors

Psychological factors, including emotional drivers, are very important for driving handwashing behavior change. Research has revealed four powerful, crosscutting motivators: disgust (for example, about having feces on hands), nurture, comfort, and affiliation with others. In some cases, beauty and the desire to aspire to and affiliate with more affluent segments of society motivates hygiene behavior. In many cases, motivators like these have been found to be more effective in getting people to wash their hands than fear of poor health or being sick. The SuperAmma Campaign is one example of successfully using emotional drivers to change handwashing behavior.

Unconscious factors

People can be motivated to wash their hands without necessarily being aware of it. Factors that influence an ‘automatic’ reaction in an individual are referred to as unconscious factors. Nudges, or small cues in the environment that influence us to wash our hands, are one example of a behavior change tool that uses unconscious factors. Several small studies have found that nudges (for example, mirrors or painted paths to handwashing stations) can help increase handwashing rates. To learn more about unconscious factors and nudges, read our FAQ: Using Nudges to Increase Handwashing with Soap.

Effective behavior change programs often leverage both psychological and unconscious factors. Our webinar, Understanding Drivers for Handwashing Behavior Change, provides examples of how researchers have used both types of drivers to increase handwashing behavior.

Habit formation

For handwashing to be effective, the behavior must be practiced consistently and sustained over time. One way to support this is to help handwashing become a habit—a consistent behavior that is performed with little conscious thought or planning. Habit science studies how habits are developed and sustained, what triggers them, and how they can be changed. It draws upon drivers of handwashing behavior, the physical environment, and other factors to help sustain long-lasting, or ‘sticky’, handwashing behavior change. For more information on habit science and its application to handwashing, read The Science of Habit: Creating disruptive and sticky behavior change in handwashing behavior. Read our handwashing habit formation fact sheet to learn more about how to encourage habit formation.

Summary & Recommendations

Address both the physical (hardware) and psycho-social (software) components of handwashing behavior change.

Program developers should consider addressing both the physical and psychosocial aspects of the enabling environment to support successful behavior change. These are often referred to as ‘hardware’ and ‘software’. This approach should address determinants of handwashing within the enabling environment, including inequities and barriers to access that prevent individuals from washing their hands.

Use simple, effective messages.

Use straightforward messages that are easy to understand and clearly link to the desired behavior. For example, rather than promoting all the health benefits of handwashing, practitioners may choose to focus on the benefits that are shown to be most relevant or effective in their communities. Some programs may choose to focus on a smaller subset of critical times for handwashing. One example would be to promote handwashing at various food-handling times in the context of a nutrition intervention.

Leverage appropriate drivers.

Any handwashing behavior change program should leverage locally relevant drivers of handwashing behavior. Formative research is critical to understand which drivers are most important in your context. Nurture, beauty, disgust, and aspiration are all potentially powerful drivers of handwashing behavior—as are unconscious drivers and habits.

Measure results and share findings.

Evaluating programs, and sharing the learning from findings, are critical to improving handwashing promotion programs at scale. Tools for monitoring and evaluating programs may be found here.

Learn More

The Global Handwashing Partnership offers resources that can help guide handwashing promotion projects. Visit our Resource Library to find our free distance learning course, findings from our behavior change Think Tanks, webinars, and information on behavior change theories and models.

Have more questions? Contact us!