Published: October 23, 2018 / Published by Global Handwashing Partnership
This learning page provides background and additional resources from the Global Handwashing Partnership, on the science of habit and its intersection with handwashing.
For handwashing to be effective it must be performed regularly. In short, it must become a habit.
Initiating handwashing behavior is a key component of many handwashing behavior change programs–but unlike many other health interventions, handwashing is not a one-off activity. Handwashing with soap needs to be practiced consistently to be effective. All too often, handwashing behavior change is temporary, and relapse occurs. Achieving sustained handwashing behavior change is one of the great challenges that face those who promote handwashing.
Two different parts of the brain are involved in driving handwashing behavior.
The neocortex is the decision-making part of the brain that initiates behaviors driven by attitudes, intentions, social norms, rational beliefs, and emotions. Often handwashing behavior change programs focus on the neocortex. It is this part of the brain that we seek to engage in initiating handwashing behavior through social norms and emotional motivators, along with environmental cues.
The basal ganglia is the part of the brain that automatically drives behaviors that are determined by habit. This part of the brain does not rely on motivation or decisions, but rather activates handwashing behavior in response to environmental cues, turning handwashing into an automatic long term behavior. Handwashing behavior change programs often fail to activate this brain system, despite the fact that it is the basal ganglia that maintains handwashing behavior in the long term.
Before handwashing can be turned into a habit, the following factors need to be in place:
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 GHP’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 may be observing 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 have been incorporated into a handwashing promotion campaign. This campaign found that emotional drivers were able to substantially increase handwashing with soap.
For people to wash their hands they must have access to the so-called determinants of handwashing—a functional handwashing station with soap and water in stable physical locations convenient for the critical moments of handwashing. If handwashing stations are visible, accessible, and situated in an appropriate location, they serve as environmental cues to remind people to wash their hands.
A good location for a handwashing station, for example, would be immediately outside a latrine, so people will see it when they leave the latrine (thus at a critical moment for handwashing) and must walk past it to return to the home.
Handwashing stations are less likely to be used and won’t serve as an environmental cue if they are hidden or not near a location where activities happen that should be associated with handwashing. Environmental cues don’t necessarily have to consist of handwashing stations. They could, for example, include signage reminding people to wash their hands, or eyes painted on a handwashing station to remind people their handwashing behavior is being noticed in the context of handwashing being a positive social norm.
Handwashing habit formation means converting handwashing from a behavior that people must think about and decide to undertake (intention and decision making) into a procedure that we automatically undertake in response to cues, without involving the decision-making parts of our brain (habit). 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. While there may be a general anticipation of reward, this is diffuse and is not associated with individual handwashing episodes.
There are seven key principles for turning handwashing into a habit, developed by Dr. David Neal. These can be integrated into handwashing behavior change programs to drive handwashing sustainability:
Given the importance of habits to a behavior such as handwashing, the GHP and GHP Steering Committee Partner the USAID/WASHplus Project, co-hosted a webinar on this topic featuring behavioral scientist, Dr. David Neal. Watch this webinar here.
If you would like to receive regular updates from the Global Handwashing Partnership, please subscribe to our mailing list or follow us online.
© 2017 The Global Handwashing Partnership (GHP).