Measuring Handwashing Behavior: A Critical Step in Improving Health

According to the World Health Organization, each year nearly two million people (mostly young children) in the developing world die from diarrheal diseases. The simple act of handwashing with soap is one of the most cost-effective ways to prevent diarrhea. In fact, WHO statistics show that hygiene education and the promotion of handwashing can lead to a 45 percent reduction of diarrheal cases. Because handwashing offers such significant health benefits, efforts are ramping up across the globe to promote this behavior.

Accurately measuring handwashing behavior is a critically important step in understanding and improving overall health. However, the lack of a universally applicable method for measuring handwashing behavior makes gathering reliable data a challenge. 

A new working paper published by the Water and Sanitation Program seeks to address this gap. In Practical Guidance for Measuring Handwashing Behavior, Pavani Ram, MD, assistant professor in the Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, discusses the validity, reliability, efficiency, and best use of handwashing behavior measures, including:

  • self-reports
  • rapid household observations
  • microbiological measures
  • structured observations
  • bars of soap with motion sensors
  • combined use of structured observations and motion sensors

“My goal with this paper was to help enable practitioners to feasibly evaluate their programs and show their true impact on behavior and/or health, to enable more and more programs of any size to incorporate the measurement of handwashing into their health, as well as water and sanitation, initiatives,” explains Ram.

Practical Guidance for Measuring Handwashing Behavior offers suggestions to assist researchers and program managers in measuring handwashing behaviors in a variety of settings. It is based on research conducted in Bangladesh, along with a review of the broader literature. “There is no one ‘perfect’ measure of handwashing behavior,” Ram notes. “However, the key to achieving reliable results is to continue using the most effective measures consistently in order to demonstrate that hygiene programs are changing handwashing behavior over time.”
The ability to understand and change handwashing behavior lies at the core of successful hygiene interventions, and Ram acknowledges the potential in, and need for, further study. “This remains such a vibrant field, and I sincerely hope my contributions will be useful and have real value and application in the field, especially for public health and water and sanitation practitioners trying to
reduce the substantial burden of morbidity and mortality related to diarrhea and respiratory illness.”

Ram conducted her research and report on behalf of the Water and Sanitation Program’s
Global Scaling Up Handwashing Project, currently being tested in Peru, Senegal, Tanzania, and Vietnam.
For more information, please contact Eduardo Perez,
wsp@worldbank.org or visit www.wsp.org/scalinguphandwashing.