Developing sustainable interventions.

Behavior change takes time. Not only do people need to be motivated initially to take up a healthy behavior, but this motivation must be sustained for the maintenance of this behavior. Whether due to fatigue or the rise of other immediate needs, without reinforcement, healthy habits drop down on the priority list. Several studies in the 2022 Hand hygiene summary report highlight the need for sustainable interventions for lasting behavior change.


In a domestic setting, Sedekia et al. (2022) conducted a study and held 20 household sessions on soil-transmitted helminth (STH) among children after which 18 households installed handwashing stations. However, after 8 months, only 8 households had maintained the handwashing stations. These findings show that, although the sessions were initially effective, sustained interventions were necessary to motivate households to maintain and utilize the handwashing stations. Similar effects were seen in a study by Nalule et al. (2022) assessing the effectiveness of hand hygiene interventions including building facilities, providing training, and establishing cues on improving hand hygiene practices among midwives and caregivers. The study found significant improvements among midwives and caregivers in healthcare facilities but only limited improvements in the postnatal home environment.

Both examples highlight the need for sustained interventions to maintain behavior change long-term. Once behavioral determinants are identified, program managers must select, refine and implement a set of activities or interventions that best address those determinants to not only change but sustain hand hygiene behavior.