Hand hygiene - a change will do you good

28th of December 2015
Hand hygiene - a change will do you good

Trudi Osborne, marketing and communications manager at hand dryer manufacturer Airdri, explains how people not washing their hands properly, or at all, requires a new approach if we are to improve hand hygiene.

It is widely accepted that unclean hands are a major source of infection but surveys regularly show that a significant number of people continue to ignore the need to wash their hands regularly and especially after using the washroom.

People are creatures of habit and very resistant to change, even though we know that certain things are bad for our health.

A recent survey found that only 38 per cent of men and 60 per cent of women wash their hands after going to the toilet. So evidently, where hand hygiene is concerned, simply giving people information – such as the fact that around 80 per cent of diseases are transmitted by touch – is ineffective in influencing behaviour.

So how do we improve hand hygiene?

The importance of influencing behaviour in order to achieve positive change is becoming increasingly well accepted in many different spheres of life. Behavioural theories and models of behavioural change are used by those looking to influence people, to help identify the issues to consider and the initiatives and interventions that are most likely to result in successful outcomes.

The reasons why people don’t wash their hands vary. Some don’t believe it makes a difference, others are absent minded and just forget, some don’t like or trust the facilities available, while others just do not respond well to being told what to do and deliberately choose to ignore any exhortations and appeals.

Behaviour change theory suggests that in order for behaviour change to happen, certain circumstances need to occur. Not everyone will be in the same position but the circumstances include:

• Dissatisfaction with the current situation
• Having a positive image of the future
• Believing that it is possible to change
• Being subject to positive environmental pressures (normalisation)
• Having specific triggers for action
• Knowing what to do to change successfully

It is not sufficient just to have the information (to ‘know what to do to change’). The other motivational circumstances are also required. Working out how to meet these circumstances is an important part of any attempts to change people’s behaviour.

Take small steps

Nudge theory is a key part of behaviour change. This is the suggestion that it is easier and more productive to influence and persuade people through small, but important, alterations to their behaviour rather than attempting a complete overhaul. ‘Nudges’ direct us towards the larger end goal, but do not aim to get to the final destination in one step. By using nudges it is possible to overcome people’s inherent resistance to change, as it happens incrementally.

Another important behaviour change theory is ‘normalisation’. The theory suggests that people are more likely to change their behaviour if a large number of other people are behaving that way already. As a general rule we don’t want to be the outsider looking in. However at the moment, the surveys about washroom behaviour are all too often normalising not washing your hands; making the desired behaviour change increasingly less likely.

A further key area in behaviour change theory is ‘personalisation’. By making the change something that directly affects the person whose behaviour you are trying to influence you can trigger the circumstances that might lead them to want to change. If they believe they are responsible for making colleagues ill, will they still continue not to wash and dry their hands?

Making the issue personal by directly asking people about their behaviour can also be effective. Washroom surveys tend to monitor hand hygiene behaviour, or lack of it, rather than ask people what they do. Asking as opposed to telling, has been shown to increase the propensity to change.
Other key interventions that increase the likelihood of a change in behaviour are when people are:

• Encouraged to create their own goals
• Able to record their own progress and are given feedback
• Given frequent reminders of their goals
• Rewarded for success.

‘Change4Life’ campaign

Behaviour change techniques have already been used successfully in health situations. The UK’s Department of Health introduced the ‘Change4Life’ campaign which includes behaviour change elements. The campaign aims to get the British public exercising more and eating more healthily.
In this situation the campaign organisers found that before they could expect behaviour change on any significant scale, the following circumstances needed to be in place:

• Concern that weight gain has health consequences
• Recognition that families are at risk and desire to take responsibility for reducing that risk
• Knowledge of what is necessary
for change
• A belief that change is possible.
They therefore designed the programme to include the
following elements:
• Ask: use a variety of mechanisms (face to face, direct mail, online, telephony, interactive television, newspapers, point of sale) to get questions into the hands of as many families (with a bias towards at-risk families) as possible
• Benchmark: use mass media to bring the results to life and to tell people where they and their neighbours stand in relation to the nation
• Create practical goals: allow families (online, by telephone or by post) to select a behaviour to change, based on their own needs and aspirations
• Record: provide a mechanism for
the individual to record their own behaviour (and for a sub-set to provide that data to us)
• Remind: remind people of the goals they set, recognise achievement and incentivise further change
• Report back: tell the nation (via PR, follow-up programming).

After just one year a total of 413,466 families had signed-up to Change4Life (the target was 200,000) and 44,833 families were proven to still be interacting with Change4Life six months after joining (the target was 33,333). A tracking study found that over one million mums were already claiming to have made changes to their children’s diet or activity levels as a result of Change4Life.

All in it together

Manufacturers invest considerable amounts of time and money developing products, which are faster, quieter, smaller and more effective, to make washrooms more inclusive and help to increase levels of hand hygiene. Drying hands effectively after they are washed is a key component of effective hand hygiene. Damp hands are a haven for germs and can reportedly spread up to 1,000 times more bacteria than dry hands.

When designing our hand dryers we plan for all users, regardless of age or ability, to make sure there are no barriers to effective hand hygiene. This inclusive approach can help people get to a number of the circumstances that make behaviour change possible including: having a positive image of the future; believing that it is possible to change and knowing what to do to change successfully.

Technology and hygiene equipment alone cannot make people wash their hands more thoroughly and regularly, but they can play an important role alongside other efforts to influence people’s behaviour in the washroom.



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