Effect of a behaviour-change intervention on hand washing with soap in India (SuperAmma): A Cluster-Randomised Trial

In this cluster-randomized trial [1], the authors tested whether a scalable village-level intervention based on emotional drivers of behavior, rather than knowledge, could improve handwashing behaviour in rural India. Fourteen villages were randomly assigned (1:1) to intervention (community and school-based events incorporating an animated film, skits, and public pledging ceremonies) or control (no intervention). Outcomes were measured by direct observation in 20-25 households per village at baseline and at three follow-up visits (6 weeks, 6 months, and 12 months after the intervention). At 6 weeks, hand washing with soap at key events was more common in the intervention group than in the control group (19% vs 4%; P=0.005). At the 6-month follow-up visit, the proportion washing hands with soap was 37% in the intervention group versus 6% in the control group. At the 12-month follow-up visit, after the control villages had received the shortened intervention, the proportion washing hands with soap was 29% each in the intervention and control group. The authors concluded that substantial increase in hand washing with soap can be achieved using a scalable intervention based on emotional drivers.