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Helping people get into healthy hygiene habits

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Children washing hands

Simple everyday actions to improve hygiene saves lives

It’s not easy to change the habits of a lifetime. So we came up with our behaviour-change methodology, Five Levers for Change (PDF | 4MB), to make good hygiene habits part of people’s daily routine. We use them in all our behaviour-change programmes: handwashing, toothbrushing and using toilets.

Here’s how we do it for handwashing.

Five Levers for Change

These five principles are the rock of our approach to changing people’s behaviour – and maximise our ability to create a good hygiene habits that last a lifetime.

We wanted to find ways to encourage people to use soap at the five occasions that have the biggest health impact: washing hands after going to the toilet; before breakfast, lunch and dinner; and while having a bath.

Lever 1: Making it understood

People commonly wash their hands with water alone and not soap – believing that if their hands look clean they are clean.

However unfortunately that’s not true. Germs which are invisible to the naked eye are a major cause of illness.

To help people understand germs and their dangers, we make the invisible visible through a powerful demonstration. Using Glo germ powder, which is only visible under UV light, we show how washing hands with water alone is not enough to remove the speckles of powder. Hands may look clean but when you shine the UV light they’re still covered in speckles.

It is only when you wash with soap that hands are speckle and germ free.

Lever 2: Making it easy

For a new behaviour to become a habit, it needs to be seen as easy to do and to fit into daily routines.

So we make it easy for people to remember when they need to wash their hands through songs, stories, diaries, rewards and daily sticker charts for children. All these and other little reminders at home and at school help make handwashing part of kids’ – and adults’ – daily routines.

Lever 3: Making it desirable

At the end of the day, people don’t usually do something unless they want to. We want kids to want to wash their hands. So we make it fun with our School of 5 comic books and stickers.

In 2017, we launched our first electronic handwashing device: Lifebuoy’s new Mickey Mouse No-Touch Foaming Hand Wash offers children – and their parents – a completely new handwashing experience. Using Unilever patented technology, it’s been designed to inspire and teach previously reluctant children to wash their hands with soap voluntarily. A blinking light guides child to rub their hands together for ten seconds, helping them to develop good handwashing habits. The electronic device delivers a perfectly sized squirt of instant-foaming Lifebuoy soap every time a hand is waved beneath its inbuilt sensor. And, it uses 18% less water than ordinary soap.

Lifebuoy Mickey Mouse advert

Studies show that people who commit to a future action in public are more likely to stick to it. Our Lifebuoy school programme uses the Classroom Soap Pledge. By asking kids to stand up together in class and promise to wash their hands, we’re also making it a way to win approval from teachers and classmates.

Pledging is also an important part of our mothers’ programme as it brings the family together to pledge to take care of the health of their baby.

Lever 4: Making it rewarding

We want to make people feel good for improving their hygiene habits. So we reward good behaviour. For example, kids get a reward if they successfully complete their handwashing diary for a full three weeks.

Lever 5: Making it a habit

Habits are created over time through repetition. We’ve found that practising a relatively simple habit like handwashing consistently over 21 days helps to make it a habit.1

That’s why we give children and mothers 21 day diaries – with rewards on completion – and teachers 21 days of activities to repeat handwashing until it becomes a routine.

Spotlight Spotlight

Lifebuoy advert

Helping fight the cost of disease through breaking gender stereotypes

In 2017, we launched a campaign in India showing how the active ingredients in our Lifebuoy soap bar can help people with low incomes to reduce costly medical bills. The unique Activ Silver ingredient in our Lifebuoy soap bar kills germs, helping to prevent disease and infection, and reduces the need for expensive medical treatment. And Lifebuoy’s Rs10 soap bar – the equivalent of just €0.13 – contributes to approximately half of Lifebuoy’s sales.

Central to the campaign was breaking gender stereotypes, reversing the roles of mother and father to engage as many people as possible. We launched a TV advert, featuring a real-life celebrity couple, Ajay and Kajol Devgn. Ajay is the concerned father, whose son is suffering from a stomach ache. When his son voices his discomfort, Ajay wants to help his son but worries about the cost of seeing the doctor.

Continuing the role reversal, the mother - played by Kajol – appears as a doctor, reminding Ajay that a stomach ache is caused by germs and of the importance of washing hands with soap.

“It was important for us to embrace Unilever’s #unstereotype approach to advertising, by featuring a father in the parenting role and a woman doctor,” says Abhiroop C, Lifebuoy Global Brand Director. “In contrast to our earlier ads, where mothers sought help from male doctors, this time the woman is the hero of the story. She enlightens the family, giving them confidence and knowledge on the right solution to prevent infections.”

Consumers have told us they feel female doctors empathise with their plight more than male doctors. For us, this change to our advertising has also been good for our business. In India, our market share has increased since launching the campaign launched.

Tracking our impact

How do we measure and evaluate whether people are actually adopting better handwashing habits? We do this by finding inventive ways to track what they actually do – not just what they claim to do. Monitoring and evaluation are at the centre of our behaviour change programmes. However, measuring a socially desirable, healthy behaviour like handwashing is notoriously difficult. Most people know they should wash hands regularly, so there is a significant risk that people overclaim how much they are washing their hands if you simply ask them directly.

One of the ways we overcome this - and other challenges – is through our sticker diary methodology, specifically designed to evaluate handwashing behaviour. The diaries are tailored to local routines for parents and children. Respondents use the diary to track a whole range of daily activities in a pictorial format. For parents, typical activities range from preparing and eating meals to doing the washing up and shopping, as well as washing hands and bathing. For children, typical activities include going to school, doing homework, playing as well as washing hands and bathing.

What happened?

This approach means respondents don’t know which daily behaviour we are specifically interested in – making it less likely they will overclaim how often they handwash to show they are doing the right thing. Using this methodology we have seen a sustained increase in the frequency of handwashing with soap as a result of our interventions. In Indonesia, it went up from 53% to 75%.2

A third more mothers and children washed their hands with soap following our programme in an Indian village, and the incidence of diarrhoea dropped from 36% to 5%.3 In Bangladesh, six months after the programme, reports showed a 33% increase in knowledge of the importance of washing hands with soap at key occasions, and a 43% increase in people putting washing their hands with soap regularly.4

In Ghana, the kids we reached through our programmes washed their hands more often and more thoroughly – spending 40% longer washing their hands every day. And they made an impression on their parents too, who used 18% more soap as a result.5

A clinical study in India showed that there were 25% fewer incidences of diarrhoea, 15% less acute respiratory infections and 46% fewer eye infections.6 And by staying well, they didn’t miss as much school either. Additionally, our neonatal programmes deployed in Kenya and India - on the ground and mobile - have also shown significant improvement in handwashing with soap on key occasions, with overall handwashing with soap habit improving by at least one occasion.

The results of our pilot handwashing programme in Nepal – the first programme of this kind to be deployed in an emergency setting – showed significant increases in handwashing with soap before eating and preparing food (18% and 17% respectively). The programme also proved to significantly impact habits after using the toilet, with 45% more mothers washing their hands with soap.7

1 Based on a clinical trial involving 2,000 families in Mumbai, India during 2007 and 2008. Published in: Nicholson, Julie A., et al. An investigation into the effects of handwashing intervention on health outcomes and school absence using a randomised control trial in Indian urban communities - http://onlinelibrary.wiley.com/doi/10.1111/tmi.12254/pdf, Journal of Tropical Medicine and International Health, 2014 19 no.3: 284-292.

2 Based on results from a quantitative behaviour measurement study in Indonesia.

3 Based on an independent evaluation of 579 households in Thesgora with children aged below 12 years, conducted by Nielsen in September 2013.

4 DFID South Asia WASH Results Programme (SWARP) 2014-2016.

5 Based on children in Ghana participating in our School of 5 intervention, in contrast to a control group who did not take part. The findings of this study were published in 2013 in the Journal of Tropical Medicine & International Health.

6 Based on a clinical trial involving 2,000 families in Mumbai, India during 2007 and 2008. Published in: Nicholson, Julie A., et al. An investigation into the effects of handwashing intervention on health outcomes and school absence using a randomised control trial in Indian urban communities - http://onlinelibrary.wiley.com/doi/10.1111/tmi.12254/pdf, Journal of Tropical Medicine and International Health, 2014 19 no.3: 284-292.

7 Lifebuoy and Unilever’s Chief Sustainability Office partnership with Oxfam, collaborating on a handwashing with soap behaviour change programme for communities affected by flood, earthquake or other type of emergency. The programme was piloted in Nepal following the earthquake in 2015.

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