Health Education Research Advance Access originally published online on March 13, 2009
Health Education Research 2009 24(4):655-673; doi:10.1093/her/cyp002
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Planned, motivated and habitual hygiene behaviour: an eleven country review
1 Hygiene Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2 Division of Social Statistics, School of Social Sciences, University of Southampton, Southampton SO17 1BJ, UK
* Correspondence to: V. A. Curtis. E-mail: val.curtis{at}lshtm.ac.uk
Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child caretakers HWWS after the toilet. Handwash ‘habits’ were generally not inculcated at an early age. Key ‘motivations’ for handwashing were disgust, nurture, comfort and affiliation. Fear of disease generally did not motivate handwashing, except transiently in the case of epidemics such as cholera. ‘Plans’ involving handwashing included to improve family health and to teach children good manners. Environmental barriers were few as soap was available in almost every household, as was water. Because much handwashing is habitual, self-report of the factors determining it is unreliable. Candidate strategies for promoting HWWS include creating social norms, highlighting disgust of dirty hands and teaching children HWWS as good manners. Dividing the factors that determine health-related behaviour into planned, motivated and habitual categories provides a simple, but comprehensive conceptual model. The habitual aspects of many health-relevant behaviours require further study.
Received on June 13, 2008; accepted on January 27, 2009
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