ArticlePloS one2018
How a smiley protects health: A pilot intervention to improve hand hygiene in hospitals by activating injunctive norms through emoticons.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology.Journal of medical Internet research · 2021Pooled it
- A Systematic Review of Emoji: Current Research and Future Perspectives.Frontiers in psychology · 2019Pooled it
- Nudge-based patient education by pharmacists to promote self-care behaviors for preventing and mitigating chemotherapy-induced skin toxicity: rationale, design, and study protocol of the PHARM-NUDGE trial.Journal of pharmaceutical health care and sciences · 2026Article
- Article
- A systematic review of nudges on hand hygiene against the spread of COVID-19.Journal of behavioral and experimental economics · 2023Article
- Not in their hands only: hospital hygiene, evidence and collective moral responsibility.Medicine, health care, and philosophy · 2023Article
- Health persuasion through emoji: How emoji interacted with information source to predict health behaviors in COVID-19 situation.SSM - population health · 2023Article
- Using the health action process approach to predict facemask use and hand washing in the early stages of the COVID-19 pandemic in China.Current psychology (New Brunswick, N.J.) · 2023Article
- Are emojis ready to promote the WHO 5 moments for hand hygiene in healthcare?Antimicrobial resistance and infection control · 2022Article
- Studying Factors Affecting Success of Antimicrobial Resistance Interventions through the Lens of Experience: A Thematic Analysis.Antibiotics (Basel, Switzerland) · 2022Article
- Hand Hygiene during the Early Neonatal Period: A Mixed-Methods Observational Study in Healthcare Facilities and Households in Rural Cambodia.International journal of environmental research and public health · 2021Observational
- Hand(y) hygiene insights: Applying three theoretical models to investigate hospital patients' and visitors' hand hygiene behavior.PloS one · 2021Article
- Emojis in public health and how they might be used for hand hygiene and infection prevention and control.Antimicrobial resistance and infection control · 2020Review
- Emojis and Emoticons in Health Care and Dermatology Communication: Narrative Review.JMIR dermatologyArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Hand hygiene practice in hospitals is unfortunately still widely insufficient, even though it is known that transmitting pathogens via hands is the leading cause of healthcare-associated infections. Previous research has shown that improving knowledge, providing feedback on past behaviour and targeting social norms are promising approaches to improve hand hygiene practices. The present field experiment was designed to direct people on when to perform hand hygiene and prevent forgetfulness. This intervention is the first to examine the effect of inducing injunctive social norms via an emoticon-based feedback system on hand hygiene behaviour. Electronic monitoring and feedback devices were installed in hospital patient rooms on top of hand-rub dispensers, next to the doorway, for a period of 17 weeks. In the emoticon condition, screens at the devices activated whenever a person entered or exited the room. Before using the alcohol-based hand-rub dispenser, a frowny face was displayed, indicating that hand hygiene should be performed. If the dispenser was subsequently used, this picture changed to a smiley face to positively reinforce the correct behaviour. Hand hygiene behaviour in the emoticon rooms significantly outperformed the behaviour in three other tested conditions. The strong effect in this field experiment indicates that activating injunctive norms may be a promising approach to improve hand hygiene behaviour. Theoretical and practical implications of these findings 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.