Assessing emotional motivators for handwashing with soap in emergencies: results from three Asian countries

Sonya Sagan; Foyeke Tolani; Marion O’Reilly; Aarti Daryanani; Arathi Unni

doi:10.3362/1756-3488.17-00024

Assessing emotional motivators for handwashing with soap in emergencies: results from three Asian countries

Sonya Sagan | Foyeke Tolani | Marion O’Reilly | Aarti Daryanani | Arathi Unni

This paper examines how emotional motivators can be used to promote handwashing with soap (HWWS) among mothers affected by an emergency. The impact of using emotional motivators along with other behaviour determinants for behaviour change in development settings has been well documented; however there is limited evidence for the use of motives for HWWS in emergency contexts. Oxfam, in partnership with Unilever’s Lifebuoy soap and Unilever’s Chief Sustainability Office (CSO), collected data in three countries affected by crises – Nepal (2015), Pakistan (2014), and the Philippines (2015) – to determine motivating factors and barriers around HWWS among mothers. Methods used for the assessment included household survey, structured observation, key informant interview, focus group discussion, and behavioural trials. Post-emergency handwashing knowledge and practice was also measured along with the most effective communication channels to reach the target group. The findings reveal that all mothers were motivated by affiliation and nurture; additionally, in Nepal and Pakistan mothers were motivated by purity and mothers in the Philippines were motivated by handwashing drivers related to shame. Barriers to HWWS in emergencies relate to socio-cultural beliefs and the absence of handwashing hardware.

Aiello, A., Coulborn, R., Perez, V. and Larson, E. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372–81 <http://dx.doi.org/10.2105/AJPH.2007.124610>.

Aunger, R. and Curtis, V. (2014) ‘The evo–eco approach to behaviour change’, in D. Lawson and M. Gibson (eds), Applied Evolutionary Anthropology, pp. 271–95, New York, NY, Springer.

Aunger, R. and Curtis, V. (2016) ‘Behaviour centred design: towards an applied science of behaviour change’, Health Psychology Review 10(4) <https://doi.org/10.1080/17437199.2016.1219673>.

Biran, A., Schmidt, W.P., Wright, R., Jones, T., Seshadri, M., Isaac, P., Nathan N.A., Hall, P., McKenna, J., Granger, S., Bidinger, P. and Curtis, V. (2009) ‘The effect of a soap promotion and hygiene education campaign on handwashing behaviour in rural India: a cluster randomised trial’, Tropical Medicine and International Health 14(10): 1303–14 <http://dx.doi.org/10.1111/j.1365-3156.2009.02373.x>.

Biran, A., Schmidt, W.P., Zeleke, L., Emukule, H., Khay, H., Parker, J. and Peprah, D. (2012) ‘Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya’, Tropical Medicine and International Health 17: 1133–41 <http://dx.doi.org/10.1111/j.1365-3156.2012.03045.x>.

Biran, A., Schmidt, W., Rajaraman, D., Kumar, R., Greenland, K. and Gopalan, B. (2014) ‘Effect of a behaviour change intervention on HWWS in India (SuperAmma): a cluster randomised trial’, Lancet Global Health 145–54 <https://doi.org/10.1016/S2214-109X(13)70160-8>.

Blanchet, K., Ramesh, A., Frison, S., Warren, E., Hossain, M., Smith, J., Knight, A., Post, N., Lewis, C., Woodward, A., Dahab, M., Ruby, A., Sistenich, V., Pantulian, S. and Roberts, B. (2017) ‘Evidence on public health interventions in humanitarian crises’, Lancet 390: 2287–96 <http://dx.doi.org/10.1016/S0140-6736(16)30768-1>.

Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I.C.H. and Schmidt, W.P. (2010) ‘Water, sanitation and hygiene for the prevention of diarrhoea’, International Journal of Epidemiology 39(Suppl 1): i193–205 <http://dx.doi.org/10.1093/ije/dyq035>.

Connolly, M.A., Gayer, M., Ryan, M.J., Spiegel, P., Salama, P. and Heymann, D.L. (2004) ‘Communicable diseases in complex emergencies: impact and challenges’, Lancet 364(9449): 1974–83 <http://dx.doi.org/https://doi.org/10.1016/S0140-6736(04)17481-3>.

Contzen, N., De Pasquale, S. and Mosler, H.J. (2015) ‘Over-reporting in handwashing self-reports: potential explanatory factors and alternative measurements’, PLoS One 10(8): e0136445 <http://dx.doi.org/https://doi.org/10.1371/journal.pone.0136445>.

Douglas, M. (1966) Purity and Danger: An Analysis of the Concepts of Pollution and Taboo, London: Ark-Routledge and Kegan Paul.

Dreibelbis, R., Winch, P.J., Leontsini, E., Hulland, K.R., Ram, P.K., Unicomb, L. and Luby, S.P. (2013) ‘The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings’, BMC Public Health 13: 1015 <http://dx.doi.org/10.1186/1471-2458-13-1015>.

Gautam, O.P., Schmidt, W.P., Cairncross, S., Cavill, S. and Curtis, V. (2017) ‘Trial of a novel intervention to improve multiple food hygiene behaviors in Nepal’, American Journal of Tropical Medicine and Hygiene 96(6): 1415–26 <http://dx.doi.org/10.4269/ajtmh.16-0526>.

Greenland, K., Chipungu, J., Curtis, V., Schmidt, W.P., Siwale, Z., Mudenda, M., Chilekwa, J., Lewis, J.J. and Chilengi, R. (2016) ‘Multiple behaviour change intervention for diarrhea control in Lusaka, Zambia: a cluster randomised trial’, Lancet Global Health 4: e966–77 <http://dx.doi.org/10.1016/S2214-109X(16)30262-5>.

Humanitarian Innovation Fund, ELRHA (2016) WASH in Emergencies Problem Exploration: Handwashing Report [pdf], Cardiff: ELHRA <http://www.elrha.org/wp-content/uploads/2016/01/Handwashing-WASH-Problem-Exploration-Report.pdf> [accessed 7 January 2019].

Peterson, E.A., Roberts, L., Toole, M.J. and Peterson, D.E. (1998) ‘The effect of soap distribution on diarrhoea: Nyamithuthu Refugee Camp’, International Journal of Epidemiology 27(3): 520–4.

Phillips, R.M., Vujcic, J., Boscoe, A., Handzel, T., Aninyasi, M., Cookson, S.T., Blanton, C., Blum, L. and Ram, P.K. (2015) ‘Soap is not enough: handwashing practices and knowledge in refugee camps, Maban County, South Sudan’, Conflict and Health 9: 39 <http://dx.doi.org/https://doi.org/10.1186/s13031-015-0065-2>.

Ram, P.K. (2013) Practical Guidance: Measuring Handwashing Behavior – 2013 Update, Washington, DC: WSP.

Ram, P.K., Halder, A.K., Granger, S.P., Jones, T., Hall, P., Hitchcock, D., Wright, R., Nygren, B., Islam, M.S., Molyneaux, J.W. and Luby, S.P. (2010) ‘Is structured observation a valid technique to measure handwashing behaviour? Use of acceleration sensors embedded in soap to assess reactivity to structured observation’, The American Journal of Tropical Medicine and Hygiene 83(5): 1070–6 <http://dx.doi.org/https://doi.org/10.4269/ajtmh.2010.09-0763>.

Sagan, S. and Tolani, F. (2013) Handy-Wash Hand Washing Study: Trials of a New Hand-Washing Device in Liberia and South Sudan, Oxford: Oxfam Publication.

Steadman Group (2007) Formative and baseline survey on HWWS, Uganda: Water and Sanitation Program (WSP).

Vujcic, J., Ram, P. and Blum, L.S. (2015) ‘Handwashing promotion in humanitarian emergencies: strategies and challenges according to experts,’ Journal of Water, Sanitation and Hygiene for Development 5(4): 574–85 <http://dx.doi.org/10.2166/washdev.2015.009>.

Watson, J., Dreibelbis, R., Aunger, R., Deola, C., King, K., Long, S., Chase, R.P. and Cumming, O. (2018) ‘Child’s play: harnessing play and curiosity motives to improve child handwashing in a humanitarian setting’, International Journal of Hygiene and Environmental Health in press <https://doi.org/10.1016/j.ijheh.2018.09.002>.