Testing disgust-and shame-based safe water and handwashing promotion in urban Dhaka , Bangladesh

Testing disgust-and shame-based safe water and handwashing promotion in urban Dhaka , Bangladesh

Diarrheal disease is one of the two leading killer diseases in the world. An estimated 2.2 million children under the age of 5 years die from diarrheal disease each year. Most of these deaths are from middle- and low-income countries. Improvements in sanitation, water quality, and hygiene could reduce the burden of diarrheal diseases by about one-fourth. Specifically, both water treatment with dilute chlorine solution and handwashing with soap reduce self-reported diarrhea.

Research into the determinants of handwashing and sanitation behaviors has identified disgust and social affiliation as key motivators for behaviour change. In developed countries, studies using disgust and shame messages have shown that both are more effective than traditional health messages.

This report describesthe development of the disgust and shame intervention that started with community assessment of practice, beliefs and attitudes of the people. It includes the summary report of the qualitative assessment done during the implementation phase of the intervention to assess its effectiveness. The authors measured the differences in change in behaviour between the two intervention groups, one that received the traditional health messages and the other that received the disgust and shame messages.

There is no consistent evidence that disgust and shame improved demand for or usage of a chlorine dispenser or soapy bottle relative to a traditional behavior change message focused on germs and health.

The chlorine dispenser is not popular in Dhaka, though a niche market may exist for a small share of compounds. The soapy bottle, in contrast, has very low cost and holds promise for increasing handwashing in other settings where households share water sources or latrines.

Messages designed to elicit disgust and fear of shame did not reach most of the compound members (especially men) and also did not lead to measurable changes in self-reported attitudes or observed social interactions. Thus, it is unsurprising these messages also did not lead to larger changes in behavior than traditional messages emphasising germs and health. It remains unclear if a more sustained set of messages would lead to the hypothesised changes in attitudes and behaviour.

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