Stepping up hand hygiene: How to make hand hygiene more accessible and inclusive

Evidence shows that regular and thorough handwashing can lead to better health outcomes for all, and organisations have been working for years to promote this key behaviour globally. Despite that, the habit of handwashing with soap still remains unpracticed across many contexts.

When the COVID-19 pandemic broke out, global health experts stressed the importance of handwashing with soap and how it can help prevent the transmission of diseases across communities. However, research has shown that over one billion people – almost half of whom are children – lack basic handwashing facilities with soap and water at home. A majority of this population belong to developing nations, such as Bangladesh.

Could installing handwashing stations in public areas help people to adapt to the life-saving habit of handwashing with soap?

As part of the FCDO-Unilever Hygiene and Behaviour Change Coalition (HBCC), BRAC in partnership with the BRAC Institute of Governance and Development (BIGD) and Behavioural Insights Team (BIT), set out to answer this question.

What’s being done?

We are aiming to install 1,000 public handwashing stations across Bangladesh, mostly in crowded locations such as mosques, markets, schools and bus stands, as part of our commitment to providing people with more access to hygiene facilities.

We ran a month-long pilot with a number of hands-free, foot-operated handwashing stations in Khulna division to monitor their feasibility, as well as collect feedback from the communities.

We incorporated the feedback on our design to make the handwashing stations more user-friendly, and maximise our chances of bringing about a positive social impact in the long run.

Designing the handwashing stations

The handwashing stations have been planned while keeping inclusivity at the heart of the design. One out of three sinks in each handwashing station is placed at a lower height than the rest, so that wheelchair users and children alike can use the station. They are equipped with foot-operated pedals for dispensing water and liquid soap, which reduces the spread of infectious diseases and saves water. The sinks are widely-spaced to allow the users to maintain social distancing while washing hands.

The stations are decorated with informative posters to promote handwashing using proper techniques. The poster design was influenced by findings from an online test run using four different kinds of posters, all recommending people to regularly wash hands with soap for 20 seconds. All four posters highlighted the four key steps of handwashing (washing palms, thumbs, in between the fingers, and the fingertips).

Followed by that, the poster was further vetted by our field staff, who recommended an additional step (of washing upto both wrists) to be included. Based on that feedback, the final version of the poster was designed, highlighting the five key steps to aid people to wash their hands more thoroughly.

During the pilot phase, a survey on community members who lived near the stations was undertaken. 90% of the respondents remembered the posters at the handwashing stations, indicating its effectiveness as a touchpoint to motivate people to wash their hands with soap and water.

Collecting user feedback – and building on them

During the pilot phase, the handwashing stations were thoroughly monitored. It was observed that while most users found it easy to operate and dispense soap and water for handwashing, certain stations had foot-pedals that were too firm and too high, making them difficult to operate, particularly for children and the elderly.

Incorporating the feedback, the height of the foot-pedals were reduced from 6-10 inches to four inches off-the-ground, and a spring mechanism was introduced to it so that even light pedal presses can operate the device.

Furthermore, the left and right pedals – for soap and water respectively – have been moved to the centre of the sinks to allow people to use their dominant foot to operate both pedals rather than have to shuffle and switch legs between washing, all in a bid to make the handwashing experience of the users easier.

Combining the technical with the qualitative: insights from interviews

As part of the pilot, a number of phone interviews and remote focus group discussions were conducted with both community members and on-the-ground staff living in the areas surrounding the installed stations.

These interviews revealed a gender gap in usage. Some stations were located in areas close to fish markets and mosques, which women are less likely to visit. In addition, some women reported feeling shy or uncertain about washing their hands in public. This was reflected in the data too: women comprised only 13% of total uses of the stations.

The gender gap in usage is hard to address because women spend considerably less time outside their homes than men, particularly in rural areas. However, moving ahead, we aim to modify signs which point to the stations to make it clear that they are intended for people from all genders and walks of life. In addition, BRAC will promote female participation through community engagement activities in the vicinity, to increase their usage of these public facilities.

When those surveyed were asked what they felt the value proposition of the handwashing stations was, peri-urban respondents tied the ability to wash hands while commuting outside with ensuring safety from COVID-19; whereas rural respondents appreciated the access to soapy water and indicated this made handwashing with soap both possible and convenient for them.

What’s next?

Our month-long pilot enabled us to pre-empt functional issues, iterate on the design, and identify barriers to usage which we can address through additional interventions in the full-scale roll out.

As we will roll out the full 1,000 stations in the upcoming weeks, we are now designing different nudges (environmental, social, etc) to test what works best in context to increase the number of usage for our handwashing stations.

Our pilot findings positively indicate installing handwashing stations in communities may enhance people’s habits of handwashing overall – whether it leads to making the habit of handwashing with soap overall a norm, remains yet to be seen.

Shafqat Aurin is an interaction designer with BRAC Social Innovation Lab. Tanvir Shatil is a research associate with BRAC Institute of Governance and Development (BIGD). Dan Brown is a senior advisor with the Behavioural Insights Team.