SuperAmma

1. SuperAmma Promoting Handwashing with Soap in Rural India. Adam Biran, Val Curtis, Bob Aunger LSHTM

2. Val Curtis • Wolf Schmidt • Bob Aunger • Katie Greenland • Adam Biran • KirubaVaradharajan • DivyaRajaraman • Raja Kumar • BalajiGopalan Funded by Wellcome Trust and SHARE

3. Background Germs cause disease Lack of evidence for effectiveness Increasing recognition of ‘non-rational’ influences

5. Formative research in 12+ countries • Experimental work – UK • When do people wash hands? • Why do they wash hands? • What could motivate handwashing?

6. The Challenge • Promote handwashing with soap at key times • No health messages • No mass media • Potential for scaling up • Small intervention team • Limited contact time

7. The intervention

8. Active Ingredients • Behaviour drivers • Nurture • Disgust • Norms • Local role models • Cues and reminders • SuperAmma • Central character

9. Disgust : what you don’t wash off you eat!

10. A Day in the Life of a Hand Animation of daily hand contamination

11. Social Norms Everyone is doing it... • Pledging ceremony • Stickers on pledged houses

12. Wall of All

13. Stickers in bathrooms • Children’s report card (2 weeks) Reminders – for Habit Formation

14. Local Relevance • Posters local people • Important people are doing it • Video testimonials of local people • People like me are doing it

15. Nurture • SuperAmma film • A heart-warming tale of maternal love... and handwashing

17. School Activities Moral Stories Mid-Day Meal

18. Poo tag game Children’s rally

19. Rewards: Gifts, Certificates, Ceremonies

20. Jingle She washes her hands with soap, Before idli or before soup, She combs my hair, She cuts my nails, She can get me ready Before I can say My mom is a supermom! My mom is a supermom! She wakes up before the sun, She cleans up everyone, She brushes my teeth, Washes my face, She can cook up a meal before I can say My mom is a supermom! My mom is a supermom! She tells me many good stuff, Some easy and some tough, wash my hands with soap after toilet, Wash my hands with soap before I eat, but she can do all this and more Before I can say My mom is a supermom! My mom is a supermom!

21. Delivery • Two mobilisers, 1 technician, 1 driver • 4 days – 2 consecutive and 2 a week apart • School and community events days 1 and 4

22. The study

23. Study Site • Southern Andrhra Pradesh • Village size 300-1500 • Water from pumps and standpipes • Soap present in all households • Open defecation

24. Study Design • Cluster randomised, controlled trial • 7 village pairs matched on size • 1 village from each pair randomised to receive intervention • Controls receive nothing • 25 households per village • Random selection from school register

25. Outcome Measures Behaviour change • Primary outcome • % of key events when hands are washed with soap • Secondary outcome • % of all handwashes using soap Data collected by structured observation 05:30 – 08:30 At baseline and 3 weeks post-intervention

26. Soap use at key events 35% Figure 2.Handwashingre and post-intervention by study arm. 30% 25% 19% 20% 15% intervention Difference 16% 0.005 p= 10% control 5% 2% 4% 1% 0% Pre-intervention Post-intervention handwashingwithsoap

27. Soap-use for all handwashes 45% 40% 36% 35% intervention 30% Difference 18% 0.001 p= 25% Handwashing with soap 19% 20% 18% control 18% 15% 10% 5% 0% Pre-intervention Post-intervention

28. Normative Beliefs about HWWS

29. Conclusions • Suggests behaviour change can be achieved • Not about health • Creative inputs are important • Still a lot of unwashed hands For more information visit www.choosesoap.org