Social And Behaviour Change Is Primary Enabler For Hand Hygiene

By: Dr Deepak Gupta

Ensuring keeping hands clean is among the most critical strategies to mitigate sickness and the spread of pathogens. Many diseases and conditions are perpetuated by not regularly washing hands with soap and clean running water.

Human or animal faeces remain a significant source of germs like E.Coli, Norovirus and Salmonella, which are the lead causal factors for diarrhoea. The absence of thorough hand hygiene can lead to high-intensity respiratory infections like Hand-Foot-Mouth disease and Adenovirus. Such pathogens find their place on hands when individuals use the toilet or while changing a diaper. Transfer of germs on hands can take place subconsciously, such as during the handling of raw meat that may carry invisible animal faeces. Transmission of pathogens takes place when people touch a certain object that might carry germs because another person may have coughed or sneezed on it.

Cultural Ethos; Yet Gaps

Most religions recognise the importance of handwashing and personal hygiene, which are inherent to their respective faith practices. Faith-based leaders can be important torch-bearers in promoting hand-washing practices among their respective communities. Issues such as ABHR (alcohol-based hand rub) have to be cautiously, but emphatically pursued through a consultative dialogue with stakeholders like religious leaders. When the Muslim Scholars’ Board of the World League was asked to examine ABHR, it clarified that “alcohol may be used as an external wound cleanser, kill germs and in external creams and ointments”. Multiple studies have demonstrated that health practices, when contextualised within the gamut of religious approval and when culturally compliant can significantly contribute to improved health-related behaviour.

Global Perspective

However, the perceptions and processes related to washing hands vary widely in countries and communities. Socio-cultural and economic factors are associated with handwashing methods. Good practices early in life may help improve child development. It is proven that handwashing education and access to soap in schools help in improving attendance. However, across rural communities in developing countries, the effectiveness of handwashing practices remains rather weak.

Children Worst Hit

It’s documented that if children and young people avoid washing their hands regularly, it harms them. As per CDC (US) data, 1.8 million children under the age of five die annually from diarrhoeal diseases and pneumonia, which are the top two killers of children. In the context of diarrhoea management, handwashing with soap can safeguard about 1 out of every 3 children who fall sick with diarrhoeal diseases, whereas one out of five children falls prey to respiratory infections like pneumonia. It’s a proven fact that washing hands with soap and water removes germs more effectively. However, it is discouraging that the global rate of handwashing after using the toilet is 19%.

Infections via Healthcare Workers

Many epidemics and most recently the ongoing pandemic have established how healthcare-associated infections are the most prevalent adverse events of clinical care. It poses a reasonable threat to patient safety and throws a substantial challenge to governments and health systems. For more than two decades, clinical protocols for hand hygiene have assumed greater significance and, therefore, various interventions were introduced and examined to improve adherence among healthcare workers. Yet, the airborne or aerosol-based pathogens managed to cause havoc, including within the environs of healthcare institutions.

India on the Move

Bringing about a marked positive change in hand hygiene behaviour has been an uphill task. Research demonstrates that conventional approaches and conceptual frameworks geared to addressing handwashing behaviour changes (behaviour change communication or BCC) are considered time and labour-intensive. These have been dependent on education-based message dissemination. However, recent research has brought about a strategic shift to emotional and motivational drivers of handwashing, such as nurture, disgust and social recognition and affiliation. Yet, such interventions remain ‘resource intensive’.

India has successfully undertaken one of the largest behavioural change programmes in the world with the relentless implementation of the Swachh Bharat Mission, India’s flagship WASH (water, sanitation and hygiene) programme. Interventions by NGOs have adopted partnership and community-based approaches to foster increased awareness, promote positive practices, develop capacities of providers and health workers, and strengthen BCC. Conventionally, the BCC approach is restricted to educational messages through awareness-generation mode. Nonetheless, research shows that associating higher health risks with the lack of handwashing practices does not lead to or sustain the intended change in behaviour.

Behaviour change interventions based on hand hygiene need to reckon with the strong inherent connection between multiple factors, such as emotions, social settings, individual habits, poverty, and individual and community attitude. Therefore, an overarching integrated approach, which comprises interpersonal, mid-media and intensive media, including vibrant digital/social media, can serve as catalytic change agents in promoting handwashing.

(Dr. Deepak Gupta is a senior consulting advisor in strategic communication and programmes with the United Nations System in Asia.)

Disclaimer: Views expressed in this article are personal.