Handwashing behaviour change

Understanding what triggers consumers to change their daily habits lies at the heart of making sustainable improvements to hygiene behaviours.

Our approach

Our Lifebuoy brand has brought together decades of experience in running handwashing programmes. This has helped us devise a methodology that aims to achieve sustained behaviour change.

Our approach seeks to get people to wash their hands with soap at the five key occasions that have the biggest public health impact: after going to the toilet, before breakfast, lunch and dinner and while having a bath.

Five Levers for Change

Lifebuoy has used Unilever’s Five Levers for Change methodology to develop a series of interventions to ensure that people understand why handwashing with soap is important. At the same time, it enables them to practise this new habit over a period of time and rewards them for sticking with it.

The model sets out five principles, which, if applied to behaviour change interventions, will have a positive and lasting impact.

The first step is to gather insights about the people we want to influence, then ask: What are the barriers that stop them from adopting a new behaviour? What are the triggers we could use to encourage them to start? What are the ways to help them make it a habit?

We then take these insights and consider how to create the behaviour change that is needed, using the five levers.

This is how the five levers have been used in Lifebuoy’s handwashing intervention:

Visibly clean is not necessarily clean: (lever 1: make it understood)

One of the key elements of Lifebuoy’s behaviour change approach is the ‘glo-germ’ demonstration. This counters the common misconception that ‘visibly clean’ is ‘hygienically clean’. When held under ultra-violet light, ‘glo-germ’ powder illuminates the germs left behind on hands washed only with water. This makes it clearly understood that handwashing with soap provides greater protection against germs than washing with water alone.

Mother & child interaction: (lever 2: make it easy)

As part of our programmes we encourage interaction between children and their mothers. This helps to ensure that new habits start and stick. For example with our school programmes, mothers play a role in tracking their child’s hand washing compliance via a daily sticker chart. This is important in helping to reinforce the behaviour in the home environment as well as at school.

Pledging: (lever 3: make it desirable)

Studies show that people who commit to a future action in public are more likely to deliver on this commitment. Our school programme uses the Classroom Soap Pledge, where children pledge to wash their hands on the five occasions that matter, for the duration of the programme. This is done in class so that peer pressure and teacher approval makes the behaviour more likely to happen. Pledging is also an important part of our activities during Global Handwashing Day.

The use of aspirational comic book characters in our schools programmes and local celebrities in our campaigns is also key. When well-known celebrities like Wassim Akram (Pakistan cricketer) or Yvonne Chaka Chaka (South African pop legend) emphasise the importance of handwashing with soap for a healthy nation, people are encouraged to practise the habit and emulate the behaviour of people they admire.

Positive reinforcement: (lever 4: make it rewarding)

Lifebuoy understands the power of the positive influences to motivate social change. Positive reinforcement runs throughout the school programme – a strong rewards system makes mothers and children feel good for taking positive steps in changing their habits.

21 days’ practice: (lever 5: make it a habit)

Habits build up over time through repetitive behaviour. This is why practising handwashing with soap for a minimum of 21 days is a critical element in our programmes. Our classroom materials – comic books, posters, quizzes and songs – all work over 21 days to remind students about the message of handwashing at key occasions. A 21-day compliance diary is also used to record handwashing behaviour over the course of the intervention.

The ripple effect

Past studies show that if we can reach one child through a school programme, that child will go home and influence the behaviour of his or her whole family.

We apply this multiplier effect to calculate our total reach for our schools programmes.

We have not yet applied this multiplier effect to our rural outreach programmes such as Khushiyon Ki Doli (KKD) in India as we are collecting evidence about the household impact of this kind of intervention.

Clinical trials prove effectiveness in India

Our schools programme takes lessons from a scientific study conducted in Mumbai, India during 2007 and 2008. To assess whether using soap at the right times could reduce the incidence of sickness in families, Lifebuoy conducted a clinical trial involving 2,000 families. Half the families were supplied with soap along with regular education about the importance of washing hands with soap at five key occasions during the day. The other half continued with their normal hygiene practice, acting as a control group.

The trial revealed that the use of soap increased by as much as ten times among those that had received hygiene education. This led to a 25% reduction in the number of incidences of diarrhoea among children aged five. The trial also showed a 19% reduction in acute respiratory infections, a 46% reduction in eye infections and 40% more children attended school every day.

On-going monitoring of our programmes

We put the monitoring and evaluation of behaviour change at the heart of our handwashing programmes. We have greatly advanced our understanding through our partnerships and innovative measurement techniques.

Smart sensor technology

Our smart sensor technology is now widely regarded as the best way of measuring handwashing behaviour. By placing a smart sensor inside a soap bar, researchers can gather accurate data unobtrusively during handwashing trials. They can then monitor the extent to which different types of awareness-raising initiatives actually lead to changes in behaviour in people’s homes.

Quantitative diary studies

Another effective way of evaluating our impact is through quantitative diary studies. Mothers and children use the diaries to track everyday behaviours over a period of time. This provides a clear record of long-term shifts in behaviour patterns. In Indonesia, we conducted a quantitative study with TNS, a market research company, to assess impact when the programme is run at scale. We found that handwashing with soap at key occasions increased significantly after the school hygiene promotion programme. Soap use increased from 53% to 75%. This increase was sustained at the same level more than six months after the programme ended.

In addition, we monitor the business results of our health and hygiene interventions. Our handwashing progamme in Indonesia has contributed to sales growth of 17.5% in 2012. In India, our rural outreach programme has increased Lifebuoy soap consumption by 11% in a region running the programme compared to static consumption in a comparable region.