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Analysis of the "SuperMum" () handwashing campaign reveals for the first time that using emotional motivators, such as feelings of disgust and nurture, rather than health messages, can result in significant improvements in handwashing behaviour, and could help to reduce the risk of infectious diseases.

An evaluation of the behaviour-change intervention, published in journal, shows that six months after the campaign was rolled out in 14 villages in rural India, rates of handwashing with soap increased by 31% compared with communities without the programme.

Study author Dr Val Curtis, Reader in Hygiene at the °®ÍþÄÌapp of Hygiene & Tropical Medicine, said: "Every year, diarrhoea kills around 800,000 children under five years old. Handwashing with soap could prevent perhaps a third of these death.

"This research demonstrates that emotions are important levers of behaviour change and that handwashing practices can be changed sustainably.

"We look forward to scaling this approach up to improve health in the countries that need it most."

In this cluster-randomised community trial across 14 villages, researchers from the °®ÍþÄÌapp of Hygiene & Tropical Medicine and St John's Research Institute, with communications consultants Centre of Gravity in Bangalore, India, tested whether a village intervention designed to increase handwashing with soap in southern Andhra Pradesh, India, was successful in bringing about behavioural change.

The team adapted an and targeted emotional drivers found to be the most effective levers for behaviour change: disgust (the desire to avoid and remove contamination), nurture (the desire for a happy, thriving child), status (the desire to have greater access to resources than others), and affiliation (the desire to fit in).

As part of the SuperAmma intervention, promoters put on community and school-based events involving animated films, comic skits, and public pledging ceremonies during which women promised to wash their hands at key occasions and to help ensure their children did the same.

At the start of the study, handwashing with soap was rare in both the intervention and control groups (1% vs 2%). After six weeks, handwashing was more common in the intervention group (19% vs 4%), and after six months, compliance in the intervention group had increased to 37% compared with 6% in the control group. One year after the campaign, and after the control villages had received a shortened version of the intervention, rates of handwashing with soap were the same in both groups (29%).

Co-author , Research Fellow at the °®ÍþÄÌapp of Hygiene & Tropical Medicine, said: "The SuperAmma campaign appears to be successful because it engages people at a strong emotional level, not just an intellectual level, and that's why the behavioural change was long-lasting. Whether the observed increase in handwashing with soap is sufficient to reduce infection remains unclear, but in view of our promising results, public health practitioners should consider behaviour change campaigns designed along the lines of our approach."

In a linked Comment, Elli Leontsini and Peter J Winch from Johns Hopkins Bloomberg School of Public Health, caution: "The level of handwashing uptake achieved for key occasions post-intervention was comparable to that of other studies…and might not be high enough to have an effect on public health. Creation of a more enabling environment by means of multiple conveniently placed and replenished handwashing stations in and around the home might be needed to achieve a higher, more effective, increase in handwashing with soap at key occasions."

The study was funded by the and UK aid from the as part of the research programme.

Publication

• Adam Biran, Wolf-Peter Schmidt, Kiruba Sankar Varadharajan, Divya Rajaraman, Raja Kumar, Katie Greenland, Balaji Gopalan, Robert Aunger, Val Curtis. Lancet Global Health. DOI: 10.1016/S2214-109X(13)70160-8