Author:Celia McMichael (La Trobe University)
Paper short abstract:
Based on an anthropological evaluation of a ‘WASH’ project in Nepal, this paper identifies the multiple (plural) drivers of hygiene behaviour change, from biomedical health messaging, to emotional drivers, community/volunteer engagement, and elevation of local civic pride.
Paper long abstract:
This paper investigates drivers of hygiene behaviour change in Nepal. Health and hygiene behaviour change are notoriously difficult to initiate and sustain. Evidence indicates that health messaging is a poor motivator of behaviour change, and hygiene behaviours often drop-away post-intervention when focus dissipates. In Nepal, water, sanitation and hygiene (WASH) present significant challenges to population health. Based on an anthropological evaluation of a WASH project in mid-Western Nepal (conducted in 2014 for Australian Red Cross and with Nepal Red Cross Society), the paper examines the drivers and barriers to sustained hygiene behaviour change such as hand-washing with soap and elimination of open defecation. Many community members reported that improved hygiene behaviour prevents poor health and disease transmission; this suggests that the biomedical model is compelling and widely accepted. 'Biomedical' health messaging, however, was only one of a broad suite of triggers for hygiene behaviour change. Effective strategies included messages with a focus on emotional drivers (disgust, nurture, and affiliation), creation of new social norms, engagement and contribution of local volunteers, and elevation of civic pride related to personal and environmental cleanliness. The paper argues that it is the engagement and activation of pluralistic drivers of hygiene behaviour change, and the engagement and contribution of local volunteers, that have been central to the successes of this WASH intervention in remote Nepal.
Managing medical uncertainty