The Wash’Em process enables humanitarians to rapidly design evidence-based and context-specific handwashing behaviour change programmes. It uses five rapid assessment tools to understand behavioural determinants better. The findings from the tools are entered into the Wash’Em software that provides tailored programme recommendations.
The Wash’Em process consists of five rapid assessment tools that explore different determinants of handwashing behaviour. The assessment tools are specifically designed for emergency contexts and to aid programme design. The assessment data is entered into the Wash’Em programme design software along with data about the context and programme constraints (e.g. time, budget and security). The software generates between five and nine recommended hygiene promotion activities. The Wash’Em software contains 80 handwashing promotion activities each with step-by-step instructions, tips and guidance on budgeting, procurement and implementation. Typically, the full Wash’Em process can be completed in less than a week. Despite being a rapid process, Wash’Em places a strong focus on holistically understanding behaviour and ensuring that crisis-affected communities are at the heart of programme design. The Wash’Em tools have been developed over several years as part of a consortium of researchers, humanitarian practitioners and experts in learning and software development. The Wash’Em process and activities draw on multiple behavioural theories and are the output of literature reviews, interviews with humanitarians and in-depth qualitative research in several humanitarian settings. Wash’Em has been used to prevent and respond to outbreaks (including COVID-19, cholera and Ebola) and in droughts, flooding and typhoon response. Wash’Em has also been used in a range of conflict-affected settings with internally displaced people and refugees who are living in either camps or informal settlements.
Assessment: Wash’Em uses five rapid assessment tools with interactive activities to learn about the enabling environment, disease perceptions, motives, potential delivery channels and people’s broader experiences of the crisis. It includes tools and methods such as Demonstration T.10, Focus Group Discussion T.14 and individual Interviews T.23.
Implementation: covers infrastructural improvements to handwashing facilities P.2, community engagement (chapter E ), household-level activities and motivational stories. The activities are designed to go beyond hygiene education and use behaviour change techniques (chapter B ) to make people think differently about handwashing, motivate people to take action, make handwashing convenient and desirable, reward good behaviour and make handwashing normative.
The Wash’Em process was designed primarily for use in emergencies but it can also be applied in longer-term stabilisation and recovery contexts. It is rapid, requires few staff and targets the determinants that are most important in a crisis. Wash’Em has been used in more than 80 crises and has been iteratively improved to strengthen its validity and reliability. All the tools are qualitative and aim to capture as much diversity in the sampling as possible. Wash’Em can only be used for handwashing promotion. Users may be able to adapt the tools and recommendations to incorporate other behaviours. It works best when it is incorporated into proposals during the onset of a crisis and used to guide programme design. It can also be used to adapt longer-term programmes. Wash’Em is designed to explore handwashing practices at the community level and may not be the best approach for schools or health centres as there are often different determinants driving behaviour within institutions.
The Wash’Em process was developed to be quick and easy to complete requiring, on average, a week to implement when used for the first time. This includes one day to familiarise with the training resources, one-to-two days to train and practise with the team, two-to-three days to collect the data and one day to summarise the data and generate recommendations. A minimum of six people (three groups of two) is recommended for data collection. The process requires access to a computer and access to devices that can record video. No prior knowledge of behaviour theory is needed.
Existing evidence and Behavioural Theory B.2 have been used to inform all stages of the development of Wash’Em. The approach welcomes consultations with humanitarians and continuous feedback to iteratively improve the process. Wash’Em is a new approach (launched in 2020) but has already been tested by more than 50 organisations in 80 crises. Case studies of its use can be found on the Wash’Em website. An evaluation to better understand its effectiveness is ongoing and recommendations for monitoring and evaluating Wash’Em-designed programmes are available.
Focus on the goal of people washing their hands with soap more frequently rather than more thoroughly
Work with other organisations during Wash’Em training, data collection and sharing results
Ask for support or give feedback: firstname.lastname@example.org
Allocate appropriate funding to allow the implementation of Wash’Em activities
Do not assume that knowledge will make people more likely to wash their hands with soap
Do not undermine the importance of handwashing infrastructure and products in your handwashing promotion programme
Several case studies from organisations that have used Wash’Em are available. In the Philippines, Wash’Em was used by the WASH Cluster (including ACF, Oxfam, Samaritan’s Purse and UNICEF) for a Super Typhoon Ompong recovery. Ten WASH programme managers and members of the government were trained. The data collection took 2.5 days. Since then, Cluster partners have repeated the process in the conflict-affected region of Mindanao and as part of the COVID-19 response. A video and case study about their experience is available.
To rapidly design evidence-based and context-adapted handwashing behaviour change programmes in emergencies
Wash’Em (undated): Wash’Em Website
White, S., Heath, T. et al. (2018): Designing Evidence-Based and Context-Specific Hygiene Programs in Emergencies: Could There be an App for That?, WEDC, Loughborough University
White, S. (2019): Wash’Em Webinar: Doing Hygiene Programming Better, CAWST
Mills, O., White, S. et al. (2019): Wash’Em Launch Webinar, CAWST
White, S., Dreibelbis, R. et al. (2020): The Determinants of Handwashing Behaviour in Domestic Settings: An Integrative Systematic Review, International Journal of Hygiene and Environmental Health. Vol. 227
Wash’Em (2021): Wash’Em and the COVID-19 Response, LSHTM, ACF, CAWST
White, S. (2021): How Can Implementers Use Evidence to Inform Their Handwashing Programme Design?, LSHTM, ACF, CAWST