Amid an outbreak such as the coronavirus Covid-19, the challenge to get people washing their hands properly takes on even greater importance. It’s harder than you might imagine, but we can all do it, especially if we start forming collective habits, writes Dr Sarb Johal, an expert in the psychology of disaster recovery and pandemics.

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If you’re considering how the Covid-19 virus could affect you and your loved ones personally and wondering how you can minimise your chances of being infected, then you probably already know that washing your hands clearly helps. Yes, hand sanitisers can also help too, but hand washing has broader benefits.

So if we know this works, why did a study find that 28% of commuters in five different cities had faecal bacteria on their hands? Why do people say they wash their hands much more often that they actually do? Why do people wash their hands less when they think no-one is looking? And why do campaigns to increase hand washing often show results that are, well, disappointing to say the least.

Why don’t people wash their hands effectively and consistently?

Is it lack of awareness that hand washing works?

Possibly, but the evidence seems to tell us something else. The problem is that educational campaigns around hand washing, why its important and how to do it properly are essentially preaching to the converted. Campaigns have the effect of making people who were already washing their hands wash them even more frequently. This is clearly a problem because those who aren’t washing their hands seem to carry on regardless.

Are alternative strategies pulling focus away from hand washing?

Have you tried to buy hand sanitiser or a face mask recently? I have. None around. Lots of soap available though. People tend to wash their hands in private, in bathrooms and washrooms. People wear face masks and use hand sanitiser in public. So it appears relatively novel, unlike the washing of hands, which we have been nagged to do since we were children. And we like novel things, and we tend to prioritise novelty over behaviours we have been asked to do for a long, long time. The other issue is evidence that people have a risk thermostat: people taking protective measures in one area feel like they have greater license to take risks in another. Obtaining a face mask or hand sanitiser may make people feel more protected, and could mean they make less of an effort to wash their hands properly.

Is availability a problem?

Even if you put soap, water, towels and hand sanitiser in people’s way, it doesn’t mean they will use them. People may be aware of what they need to do but they don’t follow through because they don’t perceive them as available, even if they are hiding in plain sight. We need to ask where people stop, pause and look around (e.g. where people are waiting for an elevator) and make the hygiene product very loud and in-your-face. Use decision points to influence behaviour.

Are we just too busy, tired, and feel like it’s just all too much?

We may have the intention to wash our hands, but in the moment, we don’t do it. However, if in that moment, we see a message that is tailored to us, then it’s more likely to work. In one study, messages by soap dispensers seems to increase soap use, but the effects varied by gender. For women, messages that focused on how soap kills germs worked best for women; but for men, they responded best to messages that focused on evoking disgust.

The best tactic seems to be making hand washing habitual, so you don’t have to think about it. That’s why people are being asked to wash their hands to the tune of “happy birthday” sung through twice over. It recognises that since the song is familiar to us, we are more likely to proceed automatically to completion once we get started. Yes, you might find yourself singing it quicker to get it over with, but its less likely that you’ll cut yourself off in the middle of singing.

Other messages explicitly link hand washing with three regular activities to try to automatise the behaviour, and make it less about conscious thought, for example, when getting home or into work, blowing your nose, and eating or handling food. This helps to create hand washing cues that become a habit; things you don’t need to think about. These are then far less likely to be interrupted, or not done at all.

Keeping to these hand-washing can be hard, but they are critically important. People can find it difficult to take action now when the potential benefits are in the future, especially if they feel that hand washing is irksome and a chore. This might also be amplified if they feel that the benefits of the inconvenience of all the public measures around containing the outbreak accrue to other people, rather than themselves. And this is going to be especially challenging in the future when trying to get people who have already been infected and have recovered to keep up their hand washing habits.

So, tweak the environment to make it easy as possible to stick to the best advice. Build new habits by linking hand washing to existing behaviours that we do every day. We can all do it, especially if we start forming collective habits. What about if your workplace encouraged people to wash their hands on arrival? What about a hand-wash ritual before morning tea? Chanting can be optional.

If we prompt and form habits collectively, I think we’d be far more likely to embed these habits into our daily habits, and then we don’t need to think about them. We’d just do them. For ourselves, and by extension, for each other.