Why aren’t we washing our hands?

In the absence of a vaccine, social distancing and hand hygiene offer the only defence against coronavirus infection. Yet despite the pandemic – and intense public health messaging – a study from Ulster University study found that more than 80% of us still do not wash our hands effectively.

“We know that most communicable diseases are spread by a lack of handwashing, but when it comes to compliance most of the research has taken place in healthcare settings. We really don’t know much about the habits of the general public,” said Aaron Lawson, research associate and lecturer in environmental health at Ulster University. “Coronavirus has made that very pertinent.”

Lawson set up a study in Belfast using thermal imaging cameras in public toilets as the COVID-19 pandemic unfolded in March, capturing a real-time behavioural snapshot. Examination of the film footage showed that almost two-thirds of people attempted to follow best handwashing practice (washing hands for 20 seconds using soap and water, and drying for 15 seconds using a hand dryer) but failing. Thirteen per cent made poor efforts, and just over 7% left the toilets without washing at all. Of the non-washers, there were twice as many men as women. Children scored highest, with 83% ranking as adequate or basic when it came to hand hygiene.

At Birmingham University’s department of economics, the advent of COVID-19 prompted Professor Ganna Pogrebna and her team to chart global attitudes to handwashing following a visit to the toilet. Literature searches provided the information to rank 63 countries: the best, Saudia Arabia, shows 97% compliance and the worst, China, just 23%. The UK ranks towards the middle of the table, with 75% of people reckoned to be washing their hands to some extent after visiting the toilet. The data was then plotted against the real-time advance of the coronavirus around the globe.

“We concluded that the initial pandemic spread was extremely correlated with handwashing culture,” said Pogrebna. “The hardest hit countries were those that also registered the lowest rates of handwashing."

A specialist in data science and behavioural design, Pogrebna argues we need to know more about cultural factors and population groupings to understand how to communicate the hand hygiene message better. “Some cultures protect their personal space and avoid touching, while others such as Italy, France and Spain are kissing cultures,” she said. “I have a hunch that different perceptions of proximity to other people have a bearing. If you’re used to being crowded together perhaps you are less cautious. Or more fatalistic.”

Pogrebna believes much more work is required to understand behaviours before public health policies are developed and messages disseminated. “This type of marketing research takes money, and handwashing hasn’t traditionally been seen as all that exciting by funders. Who’d have thought it would be one of the most significant areas of research you could be involved in right now?”

This is an extract from a feature that appears in the June 2020 issue of EHN magazine (login needed).