title: Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh.
abstract: Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing traditional handwashing infrastructure, and at multiple time periods following targeted handwashing nudges (1 day, 2 weeks, and 6 weeks). No additional handwashing education or motivational messages were completed. Handwashing with soap among school children was low at baseline (4%), increasing to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. Results indicate that nudge-based interventions have the potential to improve handwashing with soap among school-aged children in Bangladesh and specific areas of further inquiry are discussed.
authors.affiliation: Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK 73019, USA. rdreibe@ou.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Dreibelbis
authors.affiliation: Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Suite 4100, Norman, OK 73019, USA. akroeger@ou.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Kroeger
authors.affiliation: Save the Children-Bangladesh, House# CWN (A) 35, Road #43, Gulshan 2, Dhaka 1212, Bangladesh. kamal.hossain@savethechildren.org.
authors.forename: Kamal
authors.initials: K
authors.lastname: Hossain
authors.affiliation: Save the Children-USA, 2000 L Street NW, Suite 500, Washington, DC 20036, USA. mvenkatesh@savechildren.org.
authors.forename: Mohini
authors.initials: M
authors.lastname: Venkatesh
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, 237 Farber Hall, Buffalo, NY 14214, USA. pkram@buffalo.edu.
authors.forename: Pavani K
authors.initials: PK
authors.lastname: Ram
mesh_terms: D000293:Adolescent; D001296:Audiovisual Aids; D001459:Bangladesh; D002648:Child; D003142:Communication; D003657:Decision Making; D005260:Female; D006235:Hand Disinfection / Q000379:methods*; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009042:Motivation; D010865:Pilot Projects; D040242:Risk Reduction Behavior; D012424:Rural Population; D012574:Schools; D013334:Students / Q000523:psychology*
keywords: behavior change; environmental nudges; handwashing