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The Global Handwashing Partnership

If crisis disrupts your life – how does your handwashing behavior change? Understanding drivers of handwashing behavior in emergency settings

July 11, 2018

Editorial note: This post continues our series of case studies on ways our partners are contributing to the Sustainable Development Goals. Read on to understand how researchers are understanding what motivates people to wash their hands in emergencies. 

By Sian White, Research Fellow, London School of Hygiene and Tropical Medicine

In emergency settings, handwashing with soap is critical to prevent the spread of disease. However, literature reviews and practitioners acknowledge that handwashing promotion in emergencies is often not grounded in evidence and is insufficient to result in behavioural shifts. In an emergency many of the determinants of handwashing behaviour (e.g. social networks, physical infrastructure, etc.) are disrupted, and we know little about how behavioural adaptions are made in these contexts.

The London School of Hygiene and Tropical Medicine, Action Against Hunger and CAWST received funding from USAID’s Office of Foreign Disaster Assistance to conduct qualitative research in Iraq and the Democratic Republic of Congo (DRC) to explore handwashing determinants.


The research in Iraq documented an increase in handwashing in the wake of conflict and displacement in two camps and two communities. Through qualitative research and a Barrier Analysis, we found that people were motivated to wash their hands by an increased perceived risk of disease; a heightened sense of disgust towards their surroundings; and a desire to re-establish familiar routines in attempt to reclaim agency and normalcy within their lives. The influence of social networks and norms decreased due to separation from ‘valued others’ and because the psychological toll of the crisis led to less sociality.

The research fieldwork in DRC took place in urban and rural sites during a cholera outbreak. Although cholera is feared, it was so widespread that fear was insufficient to motivate handwashing behaviour. Extreme poverty and hunger impaired people’s ability to remember to wash their hands. It also resulted in soap being a highly valued, luxury product which was prioritised for laundry and bathing. The absence of a place to wash hands was also a major barrier to handwashing practice.

Knowledge of the health benefits of handwashing was high in both settings but had no bearing on handwashing behaviour. Attractive and easy-to-use handwashing facilities were critical for enabling practice (although rarely available), and were the most important factor for enabling practice. In emergencies, hygiene programs must also consider the psychological state of the population, and help to facilitate agency and dignity. These findings will be used to inform Wash’Em, a set of software that will enable the design of rapid, evidence-based and context specific handwashing programs.

Learn more about Wash’Em at Photo courtesy of LSHTM. 


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