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Use Good Feelings to Improve Hygiene

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A young child washing her hands


Diarrhea is the second leading cause of children’s death worldwide, according to the World Health Organization.


Changing people’s feelings about washing their hands with soap improves hygiene, which in turn reduces diarrhea.


Washing your hands with soap helps prevent the spread of germs that cause diarrhea. Yet many people in the world do not regularly wash their hands with soap. For instance, health researcher Adam Biran and his colleagues documented that less than 2% of the villagers they studied in rural India washed their hands after defecating or wiping children’s bottoms, and before preparing or eating food.

To increase handwashing in these villages, Biran and his colleagues tested a novel idea. They randomly assigned 14 Indian villages to one of two conditions. In the handwashing-is-desirable condition, seven villages took part in 25 days of community activities that associated washing hands with soap with cultural ideals like nurturance and belonging. The campaign also linked poor hygiene with negative emotions like disgust.

The campaign featured two cartoon characters: SuperAmma, a nurturing mother who teaches her son to wash his hands with soap, and a comical male character with disgusting habits. These characters starred in videos, posters, skits, songs, and games. Over the course of the campaign, people who pledged to wash their hands with soap earned rewards such as SuperAmma stickers and badges, as well as recognition on a public display.

The other seven villages were randomly assigned to a control condition and were not a part of the handwashing campaign.

Six months later, the researchers discovered that their handwashing-is-desirable intervention increased healthy handwashing (i.e., washing with soap after toileting and before handling food) to 37%--an increase of 36 percentage points. In comparison, villages in the control condition did not improve their handwashing habits.

Together, these results show that changing emotions about handwashing can improve hygiene. 

Why This Works

People avoid doing things that are considered disgusting, but will make a point of behaving in ways that are seen as desirable. Public health campaigns can link desired and undesired behaviors to these emotions to promote better habits. 

When This Works Best

This campaign succeeded largely because it appealed to values that were important in these rural Indian villages, such as belonging and nurturance. For future interventions to succeed, they must likewise take into account what matters to people within a community.

The Original Study

Biran, A., Schmidt, W. P., Varadharajan, K. S., Rajaraman, D., Kumar, R., Greenland, K., ... & Curtis, V. (2014). Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial. The Lancet Global Health2(3), e145-e154.

In the Press

The New York Times "Warning: Habits Might Be Good for You"

Related Topics

Economic Development Health


Text by Christina Chwyl

Photo CC by MIKI Yoshihito