Assessing the impact of handwashing nudges in urban public markets in the Philippines during the COVID-19 pandemic

ABSTRACT Handwashing with soap is a key preventive health measure against the COVID-19 pandemic. Behavioral nudges are effective in increasing handwashing rates in important settings. The Wash O'Clock campaign aimed to promote handwashing with soap practice in public markets through behavioral nudges. This cross-sectional study aimed to evaluate the effectiveness of nudges installed in six public markets during the pandemic. The study employed intercept surveys, observations, and key informant interviews before and after the campaign. Two scenarios were tested – a poster nudge to an existing handwashing facility and a colorful handwashing facility built where none previously existed. No significant change in handwashing behavior was observed in settings with existing facilities. The introduction of the Wash O'Clock facility, however, increased handwashing with soap behavior over time by 17%. Factors that deterred intended handwashing behavior were inconsistent with water and soap supply, the availability of hand sanitizers as alternatives, and difficulties in attracting attention in crowded, transient spaces. Recommendations include combining different types of nudges to attract attention, ensuring buy-in from stakeholders for program sustainability, establishing partnerships with private sector and community organizations, regular maintenance of facilities, and further community research regarding hand hygiene interventions.