SuperAmma Promoting Handwashing with Soap in Rural India. Adam Biran, Val Curtis, Bob Aunger LSHTM.
-
Upload
jazmin-albin -
Category
Documents
-
view
217 -
download
0
Transcript of SuperAmma Promoting Handwashing with Soap in Rural India. Adam Biran, Val Curtis, Bob Aunger LSHTM.
SuperAmma
Promoting Handwashing with Soap in Rural India.
Adam Biran, Val Curtis, Bob Aunger LSHTM
• Val Curtis• Wolf Schmidt• Bob Aunger• Katie Greenland• Adam Biran
• Kiruba Varadharajan• Divya Rajaraman• Raja Kumar
• Balaji Gopalan
Funded by Wellcome Trustand SHARE
Germs cause disease
Background
Lack of evidence for effectiveness
Increasing recognition of ‘non-rational’ influences
• Formative research in 12+ countries
• Experimental work – UK
–When do people wash hands?–Why do they wash
hands?–What could motivate
handwashing?
The Challenge• Promote handwashing with soap at key times
• No health messages• No mass media
• Potential for scaling up– Small intervention team– Limited contact time
THE INTERVENTION
Active Ingredients• Behaviour drivers–Nurture–Disgust –Norms
• Local role models• Cues and reminders• SuperAmma– Central character
Disgust : what you don’t wash off you eat!
A Day in the Life of a Hand
Animation of daily hand contamination
Social NormsEveryone is doing it...• Pledging ceremony• Stickers on pledged houses
Wall of All
Reminders – for Habit Formation
•Stickers in bathrooms•Children’s report card (2 weeks)
Local Relevance• Posters local people– Important people are doing it
• Video testimonials of local people– People like me are doing it
Nurture• SuperAmma film– A heart-warming taleof maternal love...
and handwashing
Mid-Day MealMoral Stories
School Activities
Poo tag game
Children’s rally
Rewards: Gifts, Certificates, Ceremonies
She wakes up before the sun,
She cleans up everyone,
She brushes my teeth,
Washes my face,
She can cook up a meal
before I can say
My mom is a supermom!
My mom is a supermom!
She washes her hands with soap,
Before idli or before soup,
She combs my hair,
She cuts my nails,
She can get me ready
Before I can say
My mom is a supermom!
My mom is a supermom!
She tells me many good stuff,
Some easy and some tough,
wash my hands with soap after toilet,
Wash my hands with soap before I eat,
but she can do all this and more
Before I can say
My mom is a supermom!
My mom is a supermom!
Jingle
Delivery
• Two mobilisers, 1 technician, 1 driver
• 4 days – 2 consecutive and 2 a week apart
• School and community
events days 1 and 4
THE STUDY
Study Site• Southern Andrhra Pradesh• Village size 300-1500• Water from pumps and standpipes• Soap present in all households• Open defecation
Study Design
• Cluster randomised, controlled trial• 7 village pairs matched on size• 1 village from each pair randomised to receive
intervention• Controls receive nothing• 25 households per village – Random selection from school register
Outcome MeasuresBehaviour change
• Primary outcome– % of key events when hands are washed with soap
• Secondary outcome– % of all handwashes using soap
Data collected by structured observation 05:30 – 08:30At baseline and 3 weeks post-intervention
2% 4%1%
19%
0%
5%
10%
15%
20%
25%
30%
35%
Pre-intervention Post-intervention
Soap use at key events
intervention
control
Difference 16%p= 0.005
hand
was
hing
with
soap
18% 18%19%
36%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Pre-intervention Post-intervention
Han
dwas
hing
with
soa
p
Soap-use for all handwashes
intervention
control
Difference 18%p= 0.001
Normative Beliefs about HWWSIn this village... Intervention Control
almost everyone HWWS before eating
35% 8%
almost everyone HWWS after defecation
36% 10%
People HWWS more than in other villages
98% 42%
Conclusions• Suggests behaviour change can be achieved• Not about health• Creative inputs are important• Still a lot of unwashed hands
For more information visit www.choosesoap.org