Shock and shame: Graphic messages increase hand washing compliance

March 15, 2011

Graphic messages and reminders that use a shock-and-shame approach may get more people to wash their hands, according to a Kansas State University professor and his colleagues.

"Those 'Employees Must Wash Hands' signs in bathrooms may not be the most effective reminder," said Doug Powell, professor of food safety at K-State. "We wanted a comprehensive review of what others had done, and combined this with our own work on messages that lead to behavior change. We weren't interested in self-reported surveys where everyone says they always wash their hands, but studies based on observed increases in compliance."

Powell worked with Casey Jacob, a former K-State research assistant in the department of diagnostic medicine and pathobiology, and Sarah Wilson, formerly of the University of Guelph. Their review of techniques to improve hand washing behavior was just published in the journal Critical Public Health.

The review was conducted as background for several ongoing experiments involving Powell and colleagues to increase hand washing rates in cafeterias, restaurants, hospitals, veterinary clinics and petting zoos. The team has previously designed hand washing campaigns at K-State involving both shock and shame.

"Social pressure, or shame, has been successfully used, especially within an entire organization," Powell said. "If you were in the bathroom at a restaurant and saw an employee not washing his or her hands, would you say, 'Dude, wash your hands?' The shock approach is designed to get people to 'be the bug' -- just for a moment -- and think about where their hands have been and where they are going to be, especially when around hospitals, or animals. Dangerous move around a lot."

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