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Through skits, animation flms and posters, researchers experimented with ouremotions like nurturing (the desire or a happy, thriving child) and disgust(the desire to avoid and remove contamination), to encourage people to washtheir hands with soap beore eating and cooking and ater using the toilet orcleaning a child

The team created a fctitious character called !"uper#mma$, a orward thinkingrural mother to help communicate their message in schools and to thecommunity

%and &ashing with soap was higher among children than in adults at the end othe study period' it was much the same in men and women, and did not diersignifcantly by socioeconomic status, the evaluation ound #nd interestingly,the rates were almost identical in households with and without water accesswithin their compound

ey events (ater deecation, ater cleaning a child*s bottom, beore ood

preparation, and beore eating)+y contrast, research done by our group into the motivations underlying handwashing practice across several countries, suggested that emotional drivers,notably nurture (the desire or a happy, thriving child), disgust (the desire toavoid and remove contamination), aliation (the desire to ft in with what othersin a reerence group are perceived to be doing), status (the desire to havegreater access to resources than others in the group), and habit, had a moreimportant role than rational health belies

-bservations took place rom ./0. h to .10. h when most householders werepresent and when the behaviours o interest were likely to be seen23 -bservers

recorded the hand washing behaviour o all household members #ll occurrenceso the our key event types (ater deecation, ater cleaning a child*s bottom,beore ood preparation and beore eating) were recorded as well as the age andgender category o the actor involved (man, woman, school4aged child,preschool child)

We considered the physical and social environments, existing behavioural routines, and

fundamental human motivations15,30associated with hand washing practice.

5or each village, outcomes were assessed in a random sample o 6/ householdsthat had at least one child aged between 1 and 20 years who attended the state4

run primary school in the village

STATISTICAL ANALYSIS

&e used a cluster4level analysis to account or the village4level allocation o theintervention #nalysis o cluster4level proportions, as opposed to analyses doneat the level o participants or individual hand washing occasions, is a suitablemethod to account or clustering o hand washing prevalence in villages i thetotal number o clusters is small02 7n a cluster4randomised trial, this approachcommonly also accounts or lower4level clustering, which is expected to increasebetween4village variability02 &e calculated prevalence o cluster4level handwashing and soap use at baseline and ollow4up or each village "ince the

distribution o the village4level proportions deviated rom normal in theintervention group, we used a permutation test on the standard t test (the

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permute command in "T#T#) or the estimation o statistical signifcance,stratifed by randomisation blocks o dierent population si8e02

9lanned subgroup analyses were stratifcation by sex, socioeconomic status,caste, and level o education &e used principal component analysis o proxies osocioeconomic status (ownership o land, animals, household assets, wateraccess, and house characteristics) to classiy households by socioeconomicstatus "tatistical support or eect modifcation was assessed by computing thedierences in hand washing prevalence between subgroups within each villageand then comparing the mean dierences between intervention and controlvillages using the permutation test &e calculated intraclass correlationcoecients using "T#T#*s loneway command

EVO-ECO Model.4 The model draws on evolutionary theory, psychology,

and neuroscience to propose a systematic means o classiying the in:uencesand drivers o human behaviour

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;ata analysis explored dierences between mothers who wash their hands withsoap and those who do not, similar to the segmentation approach used in thedoer