ArticleInternational journal of environmental research and public health2016
Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh.
Article in International journal of environmental research and public health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
54 citing papers in PubMed, 4 syntheses or guidelines pooled it, 153 citations in OpenAlex.
- Nudge strategies for behavior-based prevention and control of neglected tropical diseases: A scoping review and ethical assessment.PLoS neglected tropical diseases · 2021Pooled it
- Hand-washing promotion for preventing diarrhoea.The Cochrane database of systematic reviews · 2021Pooled it
- A systematic review of hand-hygiene and environmental-disinfection interventions in settings with children.BMC public health · 2020Pooled it
- Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact.International journal of environmental research and public health · 2019Pooled it
- Household determinants of observed handwashing among primary schoolchildren in Hebron, Palestine: a cross-sectional study.BMJ open · 2026Trial
- The effects of skill-based health education-A randomised-controlled intervention in primary schools in rural Bangladesh.PloS one · 2025Trial
- Trial
- Impact of a school-based water, sanitation and hygiene programme on children's independent handwashing and toothbrushing habits: a cluster-randomised trial.International journal of public health · 2020Trial
- Effectiveness of a Behavior Change Intervention with Hand Sanitizer Use and Respiratory Hygiene in Reducing Laboratory-Confirmed Influenza among Schoolchildren in Bangladesh: A Cluster Randomized Controlled Trial.The American journal of tropical medicine and hygiene · 2019Trial
- Effect of an equipment-behavior change intervention on handwashing behavior among primary school children in Kenya: the Povu Poa school pilot study.BMC public health · 2019Trial
- Trial
- The impact of a rural sanitation programme on safe disposal of child faeces: a cluster randomised trial in Odisha, India.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2016Trial
- User experiences with food storage in a meatsafe (mesh-covered food storage cabinet) in an informal settlement in Dhaka, Bangladesh.Tropical medicine and health · 2026Article
- Positive outcomes of disease awareness information conveyed by high school students to their guardians.Fukushima journal of medical science · 2026Article
- Evaluating the impact of a low-cost food storage intervention on complementary food contamination and diarrheal disease in low-income urban households: A randomized controlled trial in Dhaka, Bangladesh.PLOS global public health · 2026Article
- Article
- Motivational effectiveness of prosocial public health messaging to reduce respiratory infection risk: a systematic review and meta-analysis.Communications medicine · 2025Article
- Impact of a nudge-based intervention on hand soap usage in a Japanese Hospital: interrupted time series analysis.Infection prevention in practice · 2025Article
- Improving WASH facilities and practices in Bangladeshi schools: progress and challenges from 2014 to 2018.Global health action · 2025Article
- Hand Hygiene Knowledge, Attitudes, Practices, and Hand Dirtiness of Primary School Students Before and After a Behavioral Change Intervention During the COVID-19 Pandemic, Belize 2022-2023.The American journal of tropical medicine and hygiene · 2025Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing traditional handwashing infrastructure, and at multiple time periods following targeted handwashing nudges (1 day, 2 weeks, and 6 weeks). No additional handwashing education or motivational messages were completed. Handwashing with soap among school children was low at baseline (4%), increasing to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. Results indicate that nudge-based interventions have the potential to improve handwashing with soap among school-aged children in Bangladesh and specific areas of further inquiry are discussed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.