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Handwashing Behaviour Change: Research on the Frontlines

October 15, 2019

By: Teklemarian Ayalew, Action Against Hunger Ethiopia and Astrid Hasund Thorseth, London School of Hygiene and Tropical Medicine

Photo Credit: LSHTM

Promotion of healthy hygiene practices in emergencies works best when it is based on scientific evidence and adapted local contexts. However, gaps in the scientific literature regarding health interventions in humanitarian crises makes it challenging to design and implement robust, evidence-based programs. Conducting research in the midst of complex humanitarian crises is challenging. Funds, resources, time, and capacity are limited and stretched.

Action Against Hunger and the London School of Hygiene and Tropical Medicine are currently collaborating on two pilot studies on handwashing behaviour change interventions in Borena Zone, Ethiopia. Located on the southern border of Oromia Region, the area is in a current state of emergency due to drought, recurring cholera outbreaks, and conflict on multiple fronts. Since 2017, the crisis has led to more than 100,000 people fleeing their homes to the district of Moyale, where our research is being conducted.

The first pilot study aims to investigate if the use of guiding stories could act as an emotional motivator to change behaviour, an approach that has been proven to be effective in non-emergency settings. The story was developed by behaviour change specialists and illustrations were adapted to reflect the way nature, households, and people look like in southern Oromia. The intervention was implemented through small community events that grouped 2-5 households together. As a control, traditional hygiene promotion sessions, grounded in educational hygiene messages, were shared in another village.

The second pilot study explores additions to the handwashing station, such as a mirror or a nicer type of soap to determine if they can make handwashing more desirable and more likely to be practiced. These interventions were added to a basic hygiene kit consisting of normal body soap, laundry soap and a handwashing facility and distributed to 400 households in four villages (100 households in each village) in Moyale District. The three intervention arms received the standard kit with the addition of a mirror, liquid soap or a nice bar soap while the control arm received the basic kit.

How can mirrors make handwashing more desirable?

Behaviour change frameworks theorizes that, in addition to software interventions (e.g. health promotion messages), disruptive hardware interventions (e.g. modified handwashing stations) and visual prompts are required increase frequency of handwashing with soap. The visual cue of a mirror by the handwashing station may therefore attract people to the handwashing station and therefore increase handwashing frequencies. The use of a nicer bar soap or liquid soap is found to be more attractive to use in non-emergency settings than a low-quality bar soap and might make handwashing more desirable.

Filling the gap

Data collection for these ongoing studies are expected to start in October 2019. Hygiene behaviour will be assessed through structured observations and household surveys. Focus groups will be conducted to understand people’s perceptions about the interventions. The findings will be of practical use to humanitarians as they will clearly indicate whether or not these interventions are likely to be cost-effective for crises contexts. As technical advisors in humanitarian organizations, what we learn will help us to improve the efficiency of our hygiene programs, benefiting vulnerable populations in crisis and contributing to our goals of “Clean hands for all”.

Category: Community Forum

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