Designing evidence-based communications programs to promote hand washing with soap in Vietnam

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Since 2006, the Vietnam Ministry of Health and the Vietnam Women’s Union, with support from the World Bank’s Water and Sanitation Program, have been carrying out an evidence-based, comprehensive behaviour change communications program to promote hand washing with soap among women aged 15-49 and schoolchildren aged 6-10 throughout Vietnam.

The ultimate objective is to reduce the incidence of diarrheal diseases in children under five.

The program has reached over 1.8 million people in the first phase, with a target of 30 million to be reached in phase II. Vietnam is one of four countries (the others are Tanzania, Senegal and Peru) involved in a large global Scaling
Up HWWS Behaviour Change project by WSP that aims to test whether innovative behaviour change approaches can generate widespread and sustained changes in hand washing with soap habits in target populations. To date, the program has developed two communications campaigns, one aimed at caretakers of children under five and the other targeting rural and semi-urban schoolchildren in Vietnam.

In developing both communications campaigns, a framework was created to analyze formative research findings; campaign concepts were designed for pretesting and adjustment; and there was a monitoring system designed based on the communications campaign objectives. This process resulted in complimentary campaigns: one for caretakers that taps into the aspirations of mothers to ensure the health and development of their children; and a children’s program that promotes hand washing with soap through games, contests and a cartoon series shown on media channels targeting children. The campaigns integrate national mass media, community-based interpersonal communications activities, high-impact community marketing events and public relations and advocacy aimed at national policy makers.

After extensive research, the group published the following findings from the research with caretakers:
• 92% of caretakers reported washing hands at critical junctures - but only with water;
• 60% of caretakers who washed their hands did not feel that soap was important or necessary;
• Caretakers were most concerned with ensuring that their children meet developmental milestones so that they are able to keep up with their peers;
• Smell is the most salient product attribute to soap;
• Many caretakers reported that “soap was too expensive,” yet most households had at least one type of soap;
• Television is the best way to reach caretakers, but Women’s Union members and heath workers are the most trusted sources of information.

When the formative research study was completed in Vietnam, there was no pre-existing framework for HWWS. WSP developed a framework titled FOAM (see below) to help guide WSP program staff in the four focus countries in designing and monitoring their hand washing communications programs. This framework was applied in the context of Vietnam to analyse factors that can facilitate or hinder HWWS behaviour. These include:
• Focus: who is target audiences and what is the behaviour we want them to adopt?
• Opportunity: is the target audience able to carry out the behaviour?
• Ability: is the target audience capable of carrying out the behaviour?
• Motivation: does the target audience want to carry out the behaviour?

While an end line impact evaluation is planned for the end of 2010, there has already been significant demand from other donor and government programs for integration of hand washing with soap messages into their water and sanitation programs using the materials developed by the Hand washing Initiative.

*Note: This summary is taken from a paper presented by Nga Kim Nguyen at the January 2010 South Asia Hygiene Practitioners’ Workshop in Dhaka, Bangladesh. Ms. Nguyen’s presentation also includes practical recommendations for program managers of behaviour change programs and includes examples of the communications materials developed for the Vietnam Hand washing Initiative. The presentation and others from the Workshop are being compiled in a joint publication from WSSCC, WaterAid, BRAC and IRC, the co-convenors. For more information, contact