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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
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