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Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh
Open accessAbstract
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.
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“Studies assessing the impact of hygiene behaviour change interventions on hand washing practice demonstrate that presence of infrastructure alone is unlikely to sustainably improve hygiene behaviours [31,32]”
From Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey (2018) · cites this paper as [31]
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“All of the 13 publications that examined changes in WASH knowledge, attitudes and hygiene behaviours reported evidence of positive change among students in intervention schools including hand-washing with soap or sanitizer [8,16,29,30,31], improved knowledge of WASH-related diseases, and improved hygiene habits [7,13].”
From Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact (2019) · cites this paper as [29]
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“Improving hand hygiene in schools—alone or in combination with other water, sanitation, and hygiene interventions—has been shown to reduce pupil absence [9,18] and pupil illness [19,20].”
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Metadata
- Authors
- Dreibelbis, R., Kroeger, A., Hossain, K., Venkatesh, M., & Ram, P.
- Affiliations
- University of Oklahoma (US)
- Save the Children (BD)
- Save the Children (US)
- University at Buffalo, State University of New York (US)
- Corresponding author
- Dreibelbis, Robert
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2016-01-14
- Volume
- 13
- Issue
- 1
- Pages
- 129
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC4730520
- OpenAlex
- W2234246835
- Cited by
- 151
- References
- 31
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 10 · 2023: 10 · 2022: 10 · 2021: 28 · 2020: 33 · 2019: 15 · 2018: 6 · 2017: 7 · 2016: 6
- FWCI
- 11.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- University of Oklahoma
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- handwashing with soap, nudging, behavior change, behavior change communication, elementary school students, toilet use, environmental cues, hygiene practices, low-cost interventions, rural Bangladesh
- MeSH terms
- Adolescent, Audiovisual Aids, Bangladesh, Child, Communication, Decision Making, Female, Hand Disinfection, Health Promotion, Humans, Male, Motivation, Pilot Projects, Rural Population, Schools, Students, Health Behavior, Risk Reduction Behavior
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