Evaluating the Impact of Behavioral Nudges on Student Hand-washing in Elementary Schools in the Philippines
Condition: Hand Disinfection
Study type: Interventional

Summary: 
      This study evaluates the impact of school-based behavioral "nudges" installed in toilets and
      handwashing facilities on handwashing behavior among students in the Philippines. Nudges
      include: visible signage crafted to trigger behavioral motivators for handwashing; colorful
      pathway overlaid with footprints leading from the toilet to the handwashing station; sticker
      of a pair of eyes placed above the handwashing station; soap dish with an arrow beside it on
      the sink or counter to remind children to wash their hands with soap. The study's main
      hypothesis is that behavioral nudges will increase the percentage of students who wash their
      hands with water and soap after toilet use by 7 percentage points or more among schools where
      nudges were installed compared to control schools without nudges. The study is taking place
      in public primary schools in Zamboanga Del Norte, Philippines between October 2019 and May
      2020.
    

Detailed description: 
      The impact of the behavioral nudge intervention will be evaluated using a cluster randomized
      controlled trial (RCT). The investigators will randomly select 132 Department of Education
      (DepEd) schools across Zamboanga Del Norte province to comprise the study sample. 66 schools
      will be assigned to the treatment group, and 66 schools to the control group. Treatment
      schools will receive the behavioral nudge intervention, while control group will not. Both
      treatment and control schools will receive DepEd's national WASH in Schools (WinS) policy.
      WinS promotes "correct hygiene and sanitation practices among school children and a clean
      environment in and around schools" and includes initiatives related to infrastructure,
      knowledge, and behavior change, but does not include other programs with an explicit focus on
      handwashing promotion.

      Four months after installing nudges, enumerators will conduct structured observations in
      study schools, observing whether pupils wash their hands with soap, wash without soap, or do
      not wash, after they have used classroom toilets. This will be used to estimate the causal
      impact of the nudges intervention on rates of independent handwashing with water and soap
      after toilet use.
    

Intervention name(s): Behavioral nudges; National WASH policy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Behavioral nudges include the following:
Colorful pathway overlaid with footprints leading from the toilet to the handwashing station
Rotating posters in toilet areas with messages targeting behavioral motivators for handwashing (disgust, social affiliation)
Sticker of a pair of eyes placed above the handwashing station
Soap dish with an arrow beside it on the sink or counter to remind children to wash their hands with soap; The Philippines' Department of Education National WASH in Schools (WinS) policy promotes "correct hygiene and sanitation practices among school children and a clean environment in and around schools" and includes initiatives related to infrastructure, knowledge, and behavior change, but does not include other programs with an explicit focus on handwashing promotion.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Handwashing; Behavioral nudge; Contextual cue; Philippines; Health behavior; Nudge; Environmental cue; Behavior change