Promoting Handwashing Behavior: The Effect of Large-Scale Community and School-Level Interventions

Abstract

Washing one’s hands with soap at critical points in time is a simple practice that helps to prevent serious infectious diseases. However, less than a third of the population in the developing world does it on a routine basis. The main economic question that this observation poses is how this behavior can be promoted in a cost-effective way. This paper analyzes a randomized experiment that uses novel strategies to promote handwashing with soap at critical points in time in Peru. It evaluates a large-scale comprehensive initiative which involved both community and school activities in addition to communication campaigns. The analysis indicates that the initiative was successful in reaching the target audience and in increasing the treated population’s knowledge about appropriate handwashing behavior. These improvements translated into higher self-reported and observed handwashing with soap at critical junctures. However, no significant improvements in the health of children under the age of 5 were observed. The results go one step further than the assessments of other promotion campaigns that have been based solely on mass-media, but they also suggest that changing behavior in any substantive way that will improve people’s health status is a complex task that requires intensive and more personalized interventions. This conclusion is in line with earlier contributions to the literature on the topic.