Slow Ideas in Health
“In our era of electronic communications, we’ve come to expect that important innovations will spread quickly.” An article published last year in the New Yorker, Slow Ideas, argues that this is not always the case. Unlike trends on social media that spread and die just as quickly, social change that sticks moves slowly. Changing the norm takes time.
Some innovations spread quicker than others; this can be because of resistance and skepticism, it takes time to change behaviours to form habits, and a vested interest and tangible benefits in the innovation by all parties is needed.
Vomiting, diarrhea, and worms are common in children of informal settlements in Nairobi. One cause for these problems is poor hygiene practices. Hygiene is an ‘invisible’ problem with physical manifestations. A solution to poor hygiene is hand washing.
Access Afya is running a Healthy Schools program, which combines primary care with hygiene and nutrition interventions in private schools in the informal settlements near Access Afya clinics. One of the tools the program is introducing to improve hygiene in the schools is hand washing.
Handwashing has been shown to be the single most effective intervention to reduce diarrhoea in children. The process of implementing hand washing was a lesson in this concept of ‘slow’ ideas, changing behaviours and creating new norms. Introducing hand washing, what was originally thought to be a quick solution to hygiene, became a month long process. Signs, a song, and the hand washing station sitting near the bathroom became reminders for the children and the teachers. However it was only through having staff at the school full-time reminding children to wash their hands before each meal, after playing and after the toilet that saw the habit form.
Diffusion of behaviours like hand washing ‘is essentially a social process.’ Incentives and rewards can only go so far. What is needed is the human element. For people to model the behaviour, persuade others why this change is necessary, and become actors of the change itself. We found this to be true through having key community members and the children buy into the behaviour and convince others of its necessity.
At the beginning there was some resistance from both teachers and children. It was more work; it took more time out of other activities. The benefit to the teachers was not immediate. However, after one month the children are remembering to wash their hands on their own.
One of the hopes of introducing hand washing into the Healthy Schools program is so the habit will transfer from school to the children’s home. This habit diffusion has already begun with children asking parents for more soap at home as they want to wash their hands. This is how it starts. Big ideas calling for habit change often take time. This is slow change so that it sticks.