Water, Sanitation and Hygiene

Handwashing with Soap

Family members wash hands with soap at 4 critical times [after defecation, after changing diapers, before food preparation and before eating]

Handwashing with soap could decrease diarrheal diseases and pneumonia among children under five by more than 50%.1The effect of handwashing on child health: A randomized controlled trial.
The Lancet, 366(9481): 225-33.
Luby, S. et al.
2004 
  This is a habitual behavior that must be practiced multiple times a day.

Key Points from Global Research

  • Enabling construction and use of household handwashing stations can improve access to water and soap for household members.
  • Using emotional messages can motivate individuals to wash their hands more readily than using messages focused on disease transmission.
  • Visual cues can provide helpful reminders for habitual behaviors like handwashing and can increase the visibility of handwashing behaviors in communities.

Behavior Profile Sample: Handwashing with Soap

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating country-specific Behavior Profiles.

CREATE Country-specific Behavior Profiles

Improve maternal and child survival
Family members wash hands with soap at 4 critical times [after defecation, after changing diapers, before food preparation and before eating]
Among households where place for handwashing was observed, percentage of households with soap and water. Soap includes soap or detergent in bar, liquid, powder or paste form.

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?
  1. Construct or purchase handwashing station
  2. Maintain handwashing station with soap and water at all times
  3. Wash hands under clean, running water and air dry

Click on any box
        to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.  
        of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.
Structural
Accessibility: Often, families lack readily available water and secured soap for handwashing
Social
Family and Community Support: Extended family members do not reinforce handwashing, especially among younger children
Norms: Handwashing at all critical times is not regularly practiced or reinforced by communty members
Internal
Attitudes and Beliefs : Many family members believe that it is disgusting not to wash hands after defecation or before handling food
Attitudes and Beliefs : Family members often view handwashing as a form of nurturing for children
Knowledge: Many are unaware of the diseases transmitted by hands
Knowledge: Family members forget to wash hands at the critical moments

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Establish financing schemes for soap and handwashing stations
Community
Community Leaders: Promote hand washing at community events and public locations like schools, maintain a handwashing station in own household, and find ways to create reminders for handwashing at home or in the community
Community Leaders: Support local soap and handwashing station marketing efforts
Household
Family Members: Encourage and assist children to wash their hands as a way of avoiding ingestion of feces

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Policies and Governance: Monitor and ensure availability of low-cost soap and handwashing stations for the most vulnerable
Systems, Products and Services
Products and Technology: Develop locally appropriate handwashing stations and train families how to construct stations themselves
Products and Technology: Integrate soap storage into handwashing station designs that reduce the risk of spoilage or theft of the soap
Quality Improvement: Train providers to promote handwashing with caregivers
Demand and Use
Advocacy : Support community leaders with tools to make handwashing behavior public, including installation of HW stations in public locations and publicly tracking the behavior
Communication and Mobilization: Use media channels to highlight the risks of not washing hands with soap and promote the benefits of handwashing with soap behaviors (not washing hands after defecation and before eating means eating feces)
Communication and Mobilization: Create context disruptions and visual cues in the community and household to provide reminders for handwashing

Global Status of Accelerator Behavior

Among households where place for handwashing was observed, percentage of households with soap and water. Soap includes soap or detergent in bar, liquid, powder or paste form.

Demographic and Health Survey, Rapid Survey on Children, The DHS Program Indicator Data API, The Demographic and Health Surveys (DHS) Program, UNICEF Multiple Indicator Cluster Surveys

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