Created by the World Bank's Water and Sanitation Program (WSP), the Vietnam Handwashing Initiative aims to reduce disease and mortality through a behaviour change communication (BCC) programme to promote handwashing with soap among caretakers of children under 5 and among primary school children aged 6-10 years. The initiative includes both: (i) a national mass media campaign geared toward children, and (ii) a school-based interpersonal communication activities campaign. It aims to ensure that semi-urban and rural schoolchildren will:
Campaign development started with formative research conducted in July 2008 amongst children in 6 primary schools from 3 provinces to represent northern, central, and southern regions of Vietnam; in each province, one peri-urban and one rural area were chosen. Research methods included:
- Family structure diagrams were developed by each child to learn about the social relationships within the child's household and how those relationships might affect children's ability to wash hands with soap. This method used pictures where the child (shown at the centre of the paper) drew lines to the person in the home they were closest to, spent the most time with, feared most, and so on.
- Daily diaries were used to learn about what children do from morning to evening. Drawings of two clocks (one for morning, one for afternoon/evening hours) were used for children to fill in activities that they did for each hour(s) per day. This was done as a group exercise.
- A series of Motivation Pictures showing various handwashing scenes were presented to children and they were asked to tell a story based on how they interpreted the pictures. The objective was to understand the emotional driver for washing hands such as disgust, morality, shame, regret, and so on.
- Students were asked to name their favourite role models, the reasons for their admiration and to list the careers they wanted.
- Belief interviews were conducted with individual students to understand what children believe are the benefits to washing hands with soap, the causes of diarrhoea, and so on.
- In-depth interviews and focus group discussions with headmasters and teachers were carried out to understand the school's organisation.
- Direct observations were made of water, sanitation, and hygiene facilities in both schools and homes to understand access and availability of water and soap.
Amongst the findings: a leading motivator for handwashing with soap is the desire to prevent others from getting sick (especially younger brothers and sisters). This and other findings were incorporated into a behavior change communication (BCC) campaign for children, launched in August 2009, using the theme "pride of the family". Handwashing with soap was positioned as an easy, fun, and smart behaviour with a tagline of "Wash your hands with soap for your own health and the health of others around you". WSP supported its partners to work with an advertising agency to develop a programme using an entertainment/education approach that was designed to generate interest and enthusiasm while promoting the practice of handwashing with soap. As a result, a campaign with colourful, attractive, and positive characters was developed around a superhero that gets special powers by handwashing with soap in order to help his family and others.
Rather than a top-down education approach, the campaign combined mass media and interpersonal communications activities. A series of 10 cartoon strips was printed in the weekly national children's "Youth" magazine beginning in September 2009. These were made into animated cartoons shown on the nightly children's television show "Goodnight Baby" beginning in March 2010. In addition, children's games were modified for use in schools along with singing of the "Five Clean Fingers" song used in the programme for mothers and grandmothers. A set of guidelines and an instructional DVD were made for training teachers about how to play the games as an addition to existing lessons on handwashing with soap. Each school within the programme areas will carry out 5 extracurricular activities throughout the year, including participating in a national handwashing drawing contest through the "Youth" magazine.
Vietnam is one of 4 countries within the WSP's Global Scaling-Up Handwashing Project (funded by the Bill and Melinda Gates Foundation), which focuses on learning how to apply innovative promotional approaches to behaviour change to generate widespread and sustained improvements in handwashing with soap at scale among women of reproductive age (ages 15-49) and primary school-aged children (ages 5-9). Other countries include Peru, Senegal, and Tanzania.
Over 10,000 students have been reached thus far through the school programme, and an estimated 630,000 children have been reached via the mass media programme. Lessons learned so far include:
- The consumer research state is crucial in developing a BCC campaign, as findings are very important for identifying the factors that determine behaviour and are used to make the campaign objectives.
- Research tools need to be developed that can uncover the individual, family, and larger society factors that may help or stop people from washing hands with soap.
- The normal research tools used with adults such as focus group discussion and in-depth interviews may not give enough useful insight needed as many children easily get bored with questions and are easily influenced by the responses of their friends. Thus, research activities need to be varied, participatory, and fun. Children should be allowed to take the lead. Pictures are a useful and easy way to get information and start discussion.
- During brainstorming activities, it may be better to ask children to list only their top 3 choices rather than listing all of their ideas.
- During pretesting, it is crucial to test at least 2 different campaign ideas; this ensures that audiences are provided a chance to respond to alternative concepts rather than only making comments on variations of the same concept. In this case, the campaign was tested with 2 different characters: a cartoon rabbit character and a more realistic rural school boy, Bi, who becomes a superhero. The character of Bi was more acceptable to children, and was further refined and pretested again several times before the final production. Ideally, there should be at least 2 rounds of pretesting.
- Research and pretesting should be done by an experienced person who has worked with children before and who can turn the discussion into an activity or game to help keep the children's attention.
- Timing is crucial. Start early when children are attentive and alert. Limit each group activity to one hour including a short break.
- "The advertising agency was given the results of the children's research, as well as guidelines. However the agency did not use these fully. Although the creative ideas looked good, WSP and its partners often had to supervise closely so that the creative ideas reflected the research findings."
WSP website, February 7 2012; and "The Development of an Entertainment Education Program to Promote Handwashing with Soap among Primary School Children in Vietnam" [PDF], by Nga Kim Nguyen, 2010.