The rate of handwashing shot up from just one per cent to 37 per cent in just six months

One of the most effective public health interventions and the most elementary hygiene ritual — washing hands — can help prevent diarrhoea that annually kills 8,00,000 children aged below five years. Yet, surveys show that handwashing remains at best “suboptimal” across the world, whether in India, Ghana, China — or even in parts of the developed world such as the U.K. where access to water, soap and indeed information about the health benefits is rarely a problem.

But thanks to a public health campaign launched in May 2011, the rate of handwashing shot up from just one per cent to 37 per cent in six months in villages in Andhra Pradesh. The campaign, which was carried out by researchers from the London School of Hygiene and Tropical Medicine and St John’s Research Institute, Bangalore, succeeded in doing so by changing an entrenched health behaviour using an unconventional approach — emotional drivers.

The use of emotional drivers is very different from the conventional health risk messaging that public campaigns often tend to use, suggests a paper published today (February 27) in The Lancet Global Health journal evaluating the hand wash campaign “SuperAmma” in Chittoor district.

Through skits, animation films and posters, researchers experimented with four emotions like nurturing (“the desire for a happy, thriving child”) and disgust (“the desire to avoid and remove contamination”), to encourage people to wash their hands with soap before eating and cooking and after using the toilet or cleaning a child.

As part of the cluster-randomised community trial, 14 villages were selected, each with a population of 700–2,000 people, a state-run primary school, and an anganwadi. All households had a water standpipe within a few metres of their house. Open defecation was the norm in all the villages.

Half the number of villages were chosen for the intervention programme and the remaining seven were assigned as a control group (without a campaign) to assess the project’s effectiveness.

The team created a fictitious character called ‘SuperAmma’, “a forward thinking rural mother” to help communicate their message in schools and to the community.

Six months after the campaign was launched, evaluations showed a 37 per cent increase in handwashing rates in the intervention villages (these rates sustained for 12 months), while the rates remained fairly unchanged in the control group (which saw a 4 per cent increase), establishing that the campaign had achieved its goals.

Handwashing with soap was higher among children than in adults at the end of the study period; it was much the same in men and women, and did not differ significantly by socioeconomic status, the evaluation found. And interestingly, the rates were almost identical in households with and without water access within their compound.

While efforts to change hand washing behaviour have so far used information about health benefits and risks, and have met with little success, the role of emotional drivers has not been adequately explored, says the paper.

Co-author and researcher with St John’s Research Institute, Kiruba Sankar Varadharajan, told this Correspondent that the absence of information is not necessarily the problem, it is the reluctance to change a habit or adopt a new one: “Almost every one we spoke to seemed to know why it was necessary to wash their hands, and the link between washing hands and disease. Much like the way a smoker knows the health risks, but might continue to smoke. They just need the right kind of push.”

Every year, diarrhoea kills around 800,000 children under five years old, and handwashing with soap could prevent perhaps a third of these deaths, co-author Val Curtis, from the London School of Hygiene and Tropical Medicine, says in a press release from The Lancet Global Health.