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B.3 Motivators and Barriers: Knowledge

To adopt and practise hygiene behaviours, such as handwashing with soap, an individual usually needs three types of knowledge: (1) health knowledge (also called system knowledge or factual knowledge) is knowledge of how diseases spread from one person to another and their consequences (2) action knowledge refers to knowledge of actions that can block the spread of diseases, e.g. handwashing with soap and (3) procedural knowledge is knowledge of exactly how to execute these actions, such as when and how to wash hands. 

All three types of knowledge (but in particular action and procedural knowledge) are typically important pre-conditions for individuals to adopt a behaviour. However, research has shown that knowledge is rarely enough to motivate and enable people to practise hygiene behaviours. Therefore, hygiene promotion (HP) that imparts knowledge to the target audiences should always be combined with other interventions. Knowledge-focused HP may have previously been implemented in the community, so the population’s knowledge level should be assessed before implementation. A Knowledge, Attitude and Practice T.24 or RANAS F.20 survey may reveal if targeting knowledge or other motivators and barriers is the most promising way to promote hygiene behaviours, or indicate that other interventions should be given higher priority. 

Process & Good Practice

  • Assess people’s knowledge levels in the three knowledge areas. Design different interventions to address any low-level areas of knowledge that are likely to be a barrier to improving hygiene practices. 

  • Consider using diagrams to increase health and action knowledge. For water-borne diseases, an F-diagram T.53 graphically shows the faecal-oral transmission pathways and how to interrupt them. It can be explained to participants directly or distributed as a puzzle - participants put the pieces in the correct order - or serve as a starting point for group discussions. Similar diagrams can be produced for vector-borne diseases or airborne infections.

  • Use depictions of potential events or scenarios to target health and action knowledge. Give scenarios to participants that show how situations in their everyday life lead to disease and which protective behaviours can prevent them. Storylines can be brought to life by, for example, showing the participants (anonymised) pictures of their peers’ risky behaviour and subsequent contracting of the disease. Participants can then discuss the situations in which they may experience similar risks. 

  • Use visual aids: procedural knowledge can be supported effectively using visual aids showing, for example, when to wash hands, recommended handwashing steps or the correct use of a latrine. 

  • Use the hygiene facilities themselves as prompts (if they are installed in a convenient location). A basin and soap, for example, may serve to remind the participants of the relevant procedural knowledge. 

  • Combine an intervention that targets procedural knowledge with one that targets practice, e.g. if possible, practise the recommended handwashing steps with participants and install a visual aid to depict the procedure.

  • Combine knowledge-sharing interventions with approaches that address motivators and barriers. Avoid the common pitfall of designing and implementing knowledge interventions that rely exclusively on knowledge to trigger behaviour change. Knowledge is an important pre-condition for behaviour change but rarely works on its own. 



To understand the role that knowledge plays in social and behaviour change and how this can be applied to programming. 


  • Knowledge of the causes and effects of disease, protective behaviours and how to practise them are often important pre-conditions for hygiene behaviours. 

  • Behaviour change interventions cannot rely exclusively on increasing people’s hygiene knowledge and imparting knowledge about what to do and not to do. Hygiene behaviours are influenced by multiple motivators and barriers which need assessing prior to implementation.  

  • Having knowledge is not a prerequisite for behaviour change to occur – in many cases, social norms and the influence of others may be more significant. 


Activities to use the F-diagram to impart health and action knowledge

IFRC (undated): Disease Transmission (Chain of Contamination) Instruction (Available in different languages)

RANAS catalogue proposing several BCTs to target health and action knowledge

WHO, UNICEF, WSSCC (2008): Celebrating World Water Day 2008. Theme: Sanitation Matters! – An Advocacy Guide