Have you washed your hands today? Beyond the widespread practice of social distancing, health officials recommend frequent hand washing, cleaning high-touch surfaces, and no face touching to help limit the spread of COVID-19. In light of these recommendations, behavioral scientists have compiled evidence-based strategies to increase hand hygiene. Complementary to these efforts, the EAST framework (Easy, Attractive, Social, Timely) can help practitioners adapt these strategies to their own contexts.
Make it Easy. Convenience and simple messaging are critically important to successful public health campaigns and can reduce the amount of effort required to follow hand hygiene recommendations. Hand sanitizer use increases substantially when freestanding dispensers are placed near hospital entrances and are easily visible (Aarestrup & Moesgaard, 2016; Cure & Van Enk, 2015), and automatic paper towel dispensers boost hand washing frequency (Ford et al., 2013). Simple posters with bright colors, step-by-step visual instructions, and minimal text are most effective to enhance knowledge of proper hand washing procedures.
Make it Attractive. Scents, colorful visuals, and rewards can unconsciously guide users to wash or sanitize their hands. In a hospital setting, a citrus smell more than tripled hand sanitizer use (King et al., 2016). In schools and universities, colorful stickers of arrows and footprints placed on the floors lead to more frequent hand washing (Blackwell et al., 2017; Dreibelbis et al., 2016). At home, children are four times more likely to wash their hands when toys are visibly embedded inside their soap (Watson et al., 2019).
Make it Social. Hand washing more than doubles when other people are watching. Normative messages and cropped photographs of human eyes increase hand washing and sanitizing behavior (Aarestrup & Moesgaard, 2016; Judah et al., 2009; King et al., 2016).
Make it Timely. It’s important to remind users at the right time. In the examples mentioned above, arrows and footsteps guided adults and children to the sinks immediately after using the toilet, and hospital visitors were reminded to sanitize their hands as soon as they entered the hospital and before visiting a patient.
Finally, using a combination of strategies instead of a single strategy has proven to be more effective at increasing hand hygiene (Gould et al., 2017; Huis et al., 2012; World Health Organization, 2009). For example, placing sanitizer dispensers near hospital entrances (Easy) increased compliance from 3% at baseline to 20%, but combining the placement strategy with a bright red sign (Attract) and a normative message (Social) increased compliance to 67% (Aarestrup & Moesgaard, 2016). As we start transitioning out of formal lockdowns, it is important to think about how you can promote hand hygiene behaviors in your home or your organization. Following these simple steps is a good start.
References
Aarestrup, S. C., & Moesgaard, F. (2016). Nudging hospital visitors’ hand hygiene compliance. INudgeYou.
Blackwell, C., Goya-Tocchetto, D., & Sturman, Z. (2017). Nudges in the Restroom: How Hand-Washing Can Be Impacted by Environmental Cues. https://doi.org/10.2139/ssrn.3007866
Cure, L., & Van Enk, R. (2015). Effect of hand sanitizer location on hand hygiene compliance. American Journal of Infection Control, 43, 917–921. https://doi.org/10.1016/j.ajic.2015.05.013
Dreibelbis, R., Kroeger, A., Hossain, K., Venkatesh, M., & Ram, P. K. (2016). Behavior change without behavior change communication: Nudging handwashing among primary school students in Bangladesh. International Journal of Environmental Research and Public Health, 13. https://doi.org/10.3390/ijerph13010129
Egan, M., & Mottershaw, A. (2020). Testing the efficacy of coronavirus messaging. The Behavioural Insights Team.
Ford, E. W., Boyer, B. T., Menachemi, N., & Huerta, T. R. (2013). Increasing Hand Washing Compliance With a Simple Visual Cue. American Journal of Public Health, 104(10), 1851–1856. https://doi.org/10.2105/AJPH.2013.301477
Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. The Cochrane Database of Systematic Reviews, 9, CD005186. https://doi.org/10.1002/14651858.CD005186.pub4
Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L., & Hulscher, M. (2012). A systematic review of hand hygiene improvement strategies: A behavioural approach. Implementation Science, 7, 92. https://doi.org/10.1186/1748-5908-7-92
Judah, G., Aunger, R., Schmidt, W.-P., Michie, S., Granger, S., & Curtis, V. (2009). Experimental pretesting of hand-washing interventions in a natural setting. American Journal of Public Health, 99, S405-411. https://doi.org/10.2105/AJPH.2009.164160
King, D., Vlaev, I., Thomas-Everett, R., Fitzpatrick, M., & Darzi, A. (2016). “Priming” hand hygiene compliance in clinical environments. Health Psychology, 35, 96–101. https://doi.org/10.1037/hea0000239
Service, O., Hallsworth, M., Halpern, D., Algate, F., Gallagher, R., Nguyen, S., Ruda, S., Sanders, M., Pelenur, M., Gyani, A., Harper, H., Reinhard, J., & Kirkman, E. (2014). EAST: Four simple ways to apply behavioural insights. The Behavioural Insights Team.
Watson, J., Dreibelbis, R., Aunger, R., Deola, C., King, K., Long, S., Chase, R. P., & Cumming, O. (2019). Child’s play: Harnessing play and curiosity motives to improve child handwashing in a humanitarian setting. International Journal of Hygiene and Environmental Health, 222, 177–182. https://doi.org/10.1016/j.ijheh.2018.09.002
World Health Organization. (2009). A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. https://apps.who.int/iris/handle/10665/70030
