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What prompts people to wash their hands and how can we use behavioural design to increase hand washing? Here is what we have learnt so far.
In response to the proliferating COVID-19 pandemic, globally, governments and NGOs alike have put hand hygiene (along with mask usage and social distancing) at the forefront. Drawing from previous successes like the prevention of diseases like cholera and diarrhoea, there are lessons to be adapted.
The Hygiene and Behaviour Change Coalition (HBCC) partnered with BRAC and the Behavioural Insights Team (BIT) to identify and address the existing barriers that prevent people in Bangladesh from frequently washing their hands.
First and foremost, people need access to handwashing facilities, and so 1,000 hand-washing stations were set up across the country by the end of 2020, equipped with foot-pedals to dispense water and soap, and simplified instructional posters on how to wash hands properly. However, setting up the stations is only half the answer: how can it be ensured that people actually use the stations?
Read more: Equipping households for better hygiene: What BRAC is learning
Understanding and nudging behaviour
The process of designing, prototyping and iterating behavioural nudges began with this question: what prompts people to wash their hands?
The goal was to understand and impact the journey of a user’s interaction with the stations. This was achieved through small scale pilots of the interventions, followed by the collection and analysis of quantitative and qualitative data on what the users think. This feedback was then used to iterate further and pilot again.
Design, prototype and iterate for impact
One of the major priorities for the design plan was to make the stations stand out in key locations where crowds gather. A bright magenta was used for the central poster/instructional banner placed on stations, and with feedback, the pedals were coloured bright orange. The overall colour scheme, combined with additional nudges, made the stations stand out in busy environments.
Read more: Is COVID-19 over(rated)?: 4 ways BRAC is helping people to continue safe hygiene practices
Some stations located in certain areas were less noticeable than others, as water supply was not always available adequately in all areas. For those locations, signposts were set up at regular intervals leading up to the stations, to help users discover them. This is an example of the aforementioned iterative process; initially, the plan was to paint footprints on the roads leading up to the stations. However, upon prototyping in context, it was found these prints lost visibility very quickly due to dust and dirt accumulation. This led to putting up road-side signposts pointing towards the direction of the station instead.
This was a unique approach to signage-style nudges and was noted to be more visible and easily-recalled. Multiple signposts, with the iconography of a hand pointing forward and a text description, made it clear that the posts led to the nearest station. The continuing magenta colour scheme, especifically for the iconography, made the signposts easier to stand out and created a visual link with the stations to which the posts led.
“Our goal was to understand and impact the journey of a user’s interaction with the stations. This was achieved through small scale pilots of the interventions, followed by the collection and analysis of quantitative and qualitative data on what the users think. This feedback was then used to iterate further and pilot again.”
Another innovative nudge that was implemented was the scoreboard. At certain points an unhelpful descriptive norm could set in due to momentary lower numbers of users. To remedy this prospect, message boards were set up at select stations, at certain times of the day, to record and display the number of people washing hands. Since cricket is an extremely popular sport in Bangladesh, the scoreboard was designed with a cricket metaphor, with usage numbers represented as “runs” scored by the community by washing hands.
The board also had a section for community members to provide feedback about the stations. According to Tanzim Rahman, senior manager of campaign at BRAC Communications and one of the lead designers behind the materials, this was at the core of the design philosophy. He adds: “The key feature of the nudges used here was the fact that they were all informed by local insights. Several initial designs were updated according to feedback received during the pilot phase. Overall precision, effectiveness and accessibility for end-users is what drove all the planning and design choices made here.”
What is next?
It is essential to test what works when trying out new interventions in the face of a crisis like COVID-19. Both qualitative and quantitative data are being collected to test which of the interventions described above encourage people to wash hands at the stations more frequently, including attaching clickers to the foot pedals to directly count every time each station is used.
More specifically, a randomised controlled trial is being used to compare two “packages” of the interventions: one which uses only “low labour intensity” interventions (eg, mirrors and signposts) that do not require staff to be present day-to-day, and another which uses “high labour intensity” interventions (eg, promoters handing out free soap and masks) which require staff to be present. This will generate knowledge which can be later drawn on by water, sanitation and hygiene (WASH) practitioners when designing similar interventions. The results are expected to arrive in autumn this year.
Within the broad array of work done regarding hand-hygiene and COVID-19, the adaptive, user-centred and behaviourally-informed approach that has been undertaken represents a unique opportunity. One that will cause on-the-ground impact and establish a roadmap for others to use when trying to intervene at scale towards creating safer, healthier communities.
Kazi Ashfaqul Huq is a Project Coordinator for BRAC-HBCC with the BRAC Social Innovation Lab. A.T.M. Ridwanul Haque is a senior sector specialist for the BRAC Water, Sanitation and Hygiene Programme. Dan Brown is a senior advisor with the Behavioural Insights Team.
The Behavioural Insights Team, also known as The Nudge Unit, exists to improve people’s lives and communities. They work in partnership with governments, local authorities, businesses and charities, often using simple changes to tackle major policy problems.
Social Innovation Lab (SIL) is a knowledge and experimentation hub at BRAC, the world’s largest NGO. We test, prototype and support scaling new ideas to solve the most complex social problems, to support BRAC by capitalising on emerging opportunities and catalysing innovation throughout the organisation. To find out more about SIL, visit: https://innovation.brac.net/
The BRAC Water, sanitation and hygiene (WASH) programme brings water, sanitation and hygiene services to hard to reach communities throughout Bangladesh, helping millions of people to break the cycle of water contamination and live healthier, more productive lives.