Feel It ’Til You Make It: Using Emotions to Change Practices on Hand Hygiene

Every year since 2008, Global Handwashing Day reminds everyone to practice handwashing as a simple, lifesaving deed. But while most people know they should wash their hands, how many of them really do it by force of habit?

Lotta Sylwander, Country Representative of UNICEF Philippines, raises a hand for hygiene with students during the Global Handwashing Day celebration at the Andres Bonifacio Elementary School. During the event, she shares: “Young children are often more open and willing to learn new behaviours than us adults. We should take advantage of this as an opportunity to instill good handwashing habits that will have lifelong benefits.” (©UNICEF Philippines/2018/Katrina Arianne Ebora)

It took an accident for Dea Marie Sanopao, now 12 years old and a student at the Andres Bonifacio Elementary School (ABES) in Pasay City, to really understand the importance of handwashing with soap besides what she learned from songs and stories in school.

She recalled, “When I was in Grade 1, part of my foot got stitched in a hospital. The nurse taught me how to properly wash hands before changing the bandage on my foot. It scared me a bit when she said my wound could worsen from infection if I touch it with dirty hands.”

But Dea may be a lot more aware than most children her age, or even most adults.

While most people know they should be washing their hands with soap, many studies have shown that people do not put this into practice. As a result, preventable diseases such as diarrhea and pneumonia are still among the top causes of deaths and illness of children under the age of five in the Philippines. And this gap between knowledge and practice is a common challenge across all countries. Ahead of this year’s Global Handwashing Day on October 15, experts from around the globe in fields like public health, behavioral change and design engineering, gathered in Manila for the 2018 Handwashing Behavior Change Think Tank.

During the three-day think tank, organized by the Global Handwashing Partnership (an international coalition of organizations, including UNICEF, dedicated to promoting handwashing with soap as key to global health and development), participants shared recent evidence on the impacts of handwashing on health and nutrition, took stock of best practices in promoting behavior change, and tinkered with new and tangible ideas or nudges that could bridge the gap between knowing why handwashing matters and actually making people want to wash their hands, especially at critical times: after using the toilet or changing a baby’s diaper, before preparing food, and before eating.

One major takeaway from the Think Tank, shared Louise Maule, Chief of Water, Sanitation and Hygiene (WASH) Section at UNICEF Philippines, is that “evidence and insights suggest that emotional drivers may influence handwashing behaviors more than rational ones, and may be more powerful motivators in making hand hygiene a habit.” Hence, activities and strategies that promote handwashing as something people can enjoy or that resonates with their life values and goals are showing promising results.

A child from a child development center in Mapanas, Northern Samar, enjoys using the WASH and Learn Facility that the parent volunteers helped build for the child development center, through the support of UNICEF and CHSI (©UNICEF Philippines/2018/Emmie Albangco)

For instance, in Mapanas, a rural town in Northern Samar, young learners were able to connect handwashing to enjoyable moments through WASH and Learn. Developed by UNICEF, in partnership with CHSI and local child development workers, WASH and Learn supports child development workers in integrating handwashing songs, stories, and other daily activities in their daily class program; while the low-cost, do-it-yourself and interactive group handwashing station is decorated with visuals containing basic learning concepts like letters, shapes, and numbers.

Adela Autor, a child development worker in Mapanas, could not hide her joy from being selected as among the recipients of the WASH and Learn package. “I’m fascinated not only with how easy it was to build the handwashing facility, but also with how the kids are having fun with using it,” she shared. “The visuals attract them to approach the handwashing station to wash hands and to happily point out the things they learned from the day’s session.” Despite challenges like limited water access in her village, support from parent-volunteers has made the facility sustainable.

Based on the feedback from pilot testing in Mabate and Northern Samar, the WASH and Learn package has now recently been adopted for national rollout by the National Early Childhood Care and Development (ECCD) Council.

Interestingly, shared Ms. Sylwander, “Even places that are better off are facing the same challenges. Handwashing with soap is also not a well-established habit even in major cities that have greater access to handwashing infrastructure and resources.” 
This shows, for instance, in how families decide on their spending priorities. Mrs. Elsa Floria, a Grade 6 teacher from Andres Bonifacio Elementary School, shares an observation: “Sometimes, parents aren’t motivated enough to model handwashing behavior because they themselves lack awareness of its links to fighting sickness and reducing absenteeism.”

In addition to the resources that the Department of Education (DepEd) is investing in improving water and toilet access in schools, the School Divisions of Puerto Princesa and Camarines Norte, with the support of UNICEF, are piloting the HighFive for Hygiene and Sanitation program (HiFive for HySan). This is a set of activities and tools that make good use of emotional nudges centered around disgust, affiliation and association to motivate grade school students to wash their hands with soap after toilet use and before eating.
Last Friday, October 12, the three-day Handwashing Think Tank culminated in a celebration of Global Handwashing Day at Andres Bonifacio Elementary School. This included demonstrations of how both WASH and Learn and HiFive for HySan could be taught in preschool and grade school settings, respectively.

Mrs. Elsa Floria, teacher at the ABES, makes a high-five with Dea Marie Sanopao, a Grade 6 student, after a teaching session to demonstrate Hi-Five for Hygiene and Sanitation. It is a set of activities and tools that make use of emotional nudges to motivate grade school students to wash their hands at critical times (©UNICEF Philippines/2018/Rupert Mangilit)

Mrs. Floria took on the HiFive for HySan demonstration that day. She introduced her students to Juanito, a character who began gaining friends after learning the benefits of washing hands before eating and after using the toilet. “It’s challenging because I introduced two skills at once — active listening and proper hand hygiene,” she said in an interview afterwards. “But I enjoyed preparing for the session because I taught them important health habits and basic learning concepts in one go.”

Dea was one of the students in the demo class. “It’s been a long time since we heard handwashing from songs and lessons we learn from school,” she shared. “I liked how the HiFive for HySan lessons opened my mind once more to why it matters, especially in fighting germs and keeping ourselves healthy.”

“Through Juanito’s story,” Mrs. Floria added, “and the embarrassment he experienced from his cavalier handwashing habits, I hope my students would realize how clean hands not only save lives, but also make them feel better about themselves.”

“Young children are often more open and willing to learn new behaviours than us adults,” said Ms. Lotta Sylwander, UNICEF Country Representative. “Working with children from an early age provides an opportunity to instill good handwashing habits that will have lifelong benefits, and can create ripples of change in handwashing behavior that also would make parents and caregivers realize the need for modeling and sustaining good handwashing behaviour in the home. In this way, parents can help to ensure that their children grow up to be healthy and strong, and can reach their full potential.”

By Rupert Mangilit

For more information about UNICEF’s work in the Philippines, visit www.unicef.ph.