Designing and Testing Nudges to Improve School Handwashing in the Philippines
School children in the Philippines suffer from a high burden of preventable diseases, with hygiene deficiencies identified as a common cause. Handwashing with soap is considered to be one of the most effective measures to reduce respiratory tract infections and diarrhea and prevent the transmission of infectious diseases. IDinsight’s previous research in Philippines public schools has found that independent handwashing with soap (iHWWS) rates are below 10%, even when adequate facilities are available. The research also has found that targeted behavior change campaigns conducted by teachers have not effectively led to meaningful changes in handwashing behavior, despite strong implementation. Therefore, there is an ongoing need for effective programming which instills the habit of regular handwashing by pupils in schools.
UNICEF and DepEd want to understand whether behavioral “nudges” built into the handwashing environment can improve pupils’ handwashing behavior. The nudge intervention is designed to address the primary barriers to handwashing among children in the Philippines, which our previous studies have found to be forgetfulness and more broadly, a lack of habit formation.
The nudges will be:
Rotating posters in the bathroom that motivate and remind students to wash their hands.
Footprints painted on the floor, designed to lead students from the toilet to the handwashing station.
Mirrors above the handwashing station, designed to draw pupils to the handwashing station.
As in previous handwashing studies with IDinsight, DepEd and UNICEF want to know whether to incorporate this intervention in the national WASH in Schools policy.
IDinsight is supporting this project in three ways:
Designing the intervention: While we are drawing on previous studies that used similar nudges, we are adapting the nudges to the Philippine context. In particular, this means considering how these nudges will function in Philippine public schools, where toilets are attached to classrooms and handwashing stations are in the classrooms (rather than in school-wide toilet and handwashing facilities).
Overseeing implementation: To ensure that the nudges are installed according to our design specifications, we will manage implementation by a local team.
Conducting a decision-focused evaluation: To assess whether these nudges improve handwashing rates, we are conducting an impact evaluation using a clustered randomized controlled trial. Half of the 100 schools will be randomly selected to receive the nudges intervention and the remaining half will serve as controls. Data will be collected on grades 1-3 and 4-6, as well as on boys and girls, in order to evaluate the effects on different age and gender groups. The primary objective of the evaluation is to estimate the effect of the intervention on independent handwashing with soap after toilet use by pupils.
The project is ongoing.
The project is ongoing.