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Maybe this will make you wash your hands

Mitesh Mudaliar
Saturday, July 28, 2012

The World Health Organisation reports that washing one's hands with soap after visiting the loo, after changing children's nappies and before preparing and serving food can reduce diarrhoeal disease related deaths by up to 50 per cent.

But getting people into a habit of washing hands, it turns out, is surprisingly hard.

Despite their best intentions, hand wash campaigns over the years have had little effect in Fiji. Outbreaks of typhoid and other diarrhoeal diseases continue unabated in rural isolated communities. It must be acknowledged that past hand wash campaigns based on the 'Just do it, its good for you' premise have been, for the most part, a failure.

The main reason why such campaigns fail is because we are attempting to 'sell' a 'behaviour' that is not a social norm. It is difficult for people to understand why the sudden need to wash their hands.

It's difficult for children who learn hand washing at school to continue the practise because the message is not re-inforced back home. Mom and dad don't bother washing their hands why should I?

It is quite easy even for people who are aware of the importance of handwashing to fall back to status quo because the message is not re-inforced enough.

Furthermore, people often fail to see the link between hand-washing and disease prevention.

I did a demonstration once at a school where I got a student to rub some sparkly material on his hands and then instructed him to go around the class shaking everyone's hands.

At the hand of the exercise I got the group together and told them to look at their hands.

They were quite surprised to see little sparkly material on their hands. I then told them that this is exactly how infection is spread by dirty hands, and they were all, quite literally, shocked.

Washing one's hand is new behaviour, and the competing behaviour is not washing one's hands, which is a norm. So, how do we change something we've done (or not done) for ages?

Behaviour change is difficult. But it's not impossible - especially if it becomes a habit. One just has to look at the success of commercial products to understand just how easy it can be to 'sell' a habit if you press the right buttons.

Take Coca Cola (or Coke) for example, there is hardly a product more successful than Coke. Or the bottled spring water products. The success of commercial 'habits' is due almost singularly to one word. That word is 'Marketing'.

In fact commercial marketing is so successful that it sometimes influences us to buy products we don't even need. How do they do this? By 'manufacturing' new habits around their products.

Take for example bottled water. A few years ago few people consumed water outside of normal meals. Today it is habitual for office workers to sip bottled water all day.

So, is it possible to 'manufacture' a hand wash habit? The answer is yes!

Dr. Val Curtis, director of the Hygiene Center at the London School of Hygiene and Tropical Medicine, had spent years trying to persuade people in Ghana to wash their hands habitually with soap.

In Ghana almost all households have a bar of soap, but only four per cent of adults washed their hands with it. To improve this statistic, Dr. Curtis turned to commercial marketers from Procter and Gamble, Colgate-Palmolive and Unilever for support in designing a new campaign by manufacturing a hand wash habit.

They began by researching the reasons for failure of previous campaigns and found that Ghanaians associated flush toilets as something that is clean - compared to pit toilets - and therefore did not associated toilet visitations as something that can contaminate their hands.

However, the study also revealed an interesting paradox: Ghanaians used soap when they felt that their hands were dirty - after cooking with grease, for example, or after travelling into the city.

This hand-washing habit, studies showed, was prompted by feelings of disgust.

So the trick, Dr. Curtis realised, was to create a habit wherein people felt a sense of disgust that was cued by the toilet.

That queasiness, in turn, could become a cue for hand washing. And a social marketing campaign was mounted on this premise.

The message was not that 'handwashing is good' but rather that 'visiting the toilet makes your hands dirty'. Once people got a grasp of the latter, handwashing came as a natural solution.

The campaign had the intended effect. Within the space of a year, Ghanaians surveyed by members of Dr. Curtis's team reported a 13 per cent increase in the use of soap after the toilet, and 41 per cent increase in handwashing before meals.

Dr. Curtis's attempt in Ghana is exemplary. It demonstrates that we need to 'think outside the box' when it comes to behaviour change. Perhaps its time to change the tack of our hand wash campaigns and focus on 'a visit to the toilet leaves your hands covered with nasty bugs that can make you, and others, terribly sick'. I can imagine the TV commercial selling this message and already see people running for soap and water.

nMitesh Mudaliar is a Health Protection Officer and a Drinking Water Assessor in Christchurch, New Zealand. He has several years of sanitation and hygiene programme management experience particularly with WHO (South Pacific) and other local and regional NGOs in Fiji. The views expressed here are his and not of this newspaper.

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