Handwashing Behavior Change Think Tank Survey Overview

Countries Represented
Australia Bangladesh Belgium Cambodia Czech Republic Gambia Germany Ghana India Indonesia Kenya Madagascar Nigeria Pakistan Philippines Sierra Leone Switzerland Tanzania Uganda United Kingdom United States

36 Respondents Five questions

Three questions represented here; remaining two used for planning purposes

Survey disseminated through email blast, Facebook, & Twitter posts

Q1: Which of the following topics are of most interest to you?

Topic Handwashing Hardware & Technology Handwashing Behavior Change at Scale Handwashing & Children Handwashing & Social Norms Determinants of Handwashing Handwashing & Sanitation Written-in Answers Group Handwashing before School Meals Advocacy for Institutions, both Private & Public BC in Handwashing Sports WASH & Nutrition Monitoring of Handwashing Behavior How Handwashing Relates to a Hygiene Mentality verses a Social Norm Number of Responses 16 30 20 20 17 20
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Q2: What element of handwashing behavior change do you find the most challenging?
Sustainability Supplies Of the behavior Access to safe water Handwashing at critical times Scarcity of water and soap Correctly practiced (i.e. taking time to Reusing handwashing water for multiple lather) people Creating a habit/making handwashing Handwashing without water (i.e. using clay second nature/tracking social norms or sand) For poor households Changing behavior Of the technology/facilities The most difficult is the mindset of people. Maintenance & funding (particularly They have money, logistics & everything maintenance at food prep areas) they need for handwashing. But since the Role of the private sector in sustainable, desire or the required motivation is not affordable handwashing station for there so they don't practice it. child feeding areas in rural households With specific populations Retrofitting healthcare clinics so HWWS Adult men possible between patient encounters Indigenous populations with cultural After project completion (Tippy-taps are perceptions gone after implementation!)

Q2: What element of handwashing behavior change do you find the most challenging?
Implementation/Promotion Challenges products commercially for rural households to buy and use as a HW station at the child Too many critical times feeding area Target the whole family instead of just mothers, particularly new mothers are Monitoring bombarded with many health messages Of handwashing behavior Practical application of HW Of social norms around handwashing In schools/group handwashing Other Children bringing HW home to make a Misconception about necessary water long-term impact temperature for HW Need simple, scalable models & technology for group handwashing Training methods that lead to long-term behavior change, across various cultures. Need Technology Low cost tap that will use the right amount of water, 20L bucket or gravity feed, and not be a medium for contaminants Private sector role in developing & sustaining

Q3: What questions about handwashing behavior change would you most like to ask an expert?
Soap & Water Since most people do not wash their hands for the recommended 20 seconds to effect physical removal of dirt and germs, might an antimicrobial version provide some benefit even if only used for 10 seconds? Is there any difference between using antiseptic soap and regular soap? How much does access to soap impact hygiene behavior? Is there any scientific difference that could justify that HWWS is the best way compared to using hand sanitizer? Are there products which can replace soap for HW? Are they efficient? How to get easy access to fragrance free soap products in a large workplace setting? Ash in our country is readily available to rural and most urban households. Can we promote "Handwashing with soap or ash"? Handwashing with soap - like boiling contaminated water - is the gold standard. Ash, sand/dirt, or alcohol sanitizer may be less effective, but how much less? Are they sufficient in a difficult situation where HWWS is impossible?

Q3: What questions about handwashing behavior change would you most like to ask an expert?
Soap & Water, Continued. How do we destroy the myth that handwashing water needs to be very hot in order to be effective? Do you know of a research paper that specifies ideal temperature range for hand washing? There is a need to address the access of water in some isolated communities. Some HW is a huge luxury. Sustainability, Scale, M&E How do you maintain high rates of HW? How do we sustain a HW behavior change amongst children, while also ensuring that this behavior is influenced at the family/community level? When does HW become second nature? How do we scale up HW in communities and institutions, both private and public? Are there any new and more rigorous methods available to evaluate HW interventions? How do we monitor a HW behavior change program? What verifiable indicators can we use to monitor HWWS at the household level?

Q3: What questions about handwashing behavior change would you most like to ask an expert?
Implementation & Behavior Change What are concrete examples of how a communication package/strategy worked in BC (steps involved, materials, messages)? How do you train a person to change their current behavior so they HW regularly? How can HW activities not trigger the cultural perspective of indigenous populations? What are the determinants of handwashing related with local wisdoms? What can be done to ensure that pastoralists will always wash their hands before eating and after defecating, especially when they are in the pastures far from homesteads? What specific school WASH programs were successful in changing behavior of students and staff? What is the importance of hand drying and how do I implement this in projects? How do I address the challenge of limited materials? What do we put in place to support sustainable behavior change despite change of supporting environments (i.e. lack of water, appropriate technology and prioritizing soap for HW in the home)? What are different HW BC theories and which has had the most success?

Q3: What questions about handwashing behavior change would you most like to ask an expert?
What Are Others Doing? Knowledge Sharing & Collaboration Is anyone working How can we broadcast an innovative handwashing program through your specifically with minority indigenous international network? populations? to change traditional parenting styles so Id like a comprehensive overview of the experience of many WASH organizations children are trained in the habit of and government agencies would be performing safe hygiene behaviors from appreciated - with a concrete training a young age (i.e. focusing on the older program, posters, diagrams, and optional infant, toddler, and pre-school ages)? steps. in the area of improved hygiene more generally (e.g. HW, facial cleanliness, What are key factors to success, challenges and lessons learned from PPP in HWWS and bathing with soap to prevent GIT, promotion? respiratory and skin diseases)?

Q3: What questions about handwashing behavior change would you most like to ask an expert?
Other Why does the sector continue to use negative, scary health messaging when it is proven that positive, aspirational communications are more effective? What policy decisions need to be prioritized by donors and governments to integrate the WASH and nutrition sectors to improve handwashing behavior and child feeding? How can/should CLTS deal with HWWS? How should policy makers be lobbied? Are there any low-cost design technology of HW practices that could be implemented in emergency situations?