Habit Formation and Rational Addiction: A Field Experiment in Handwashing

Abstract

Regular handwashing with soap is believed to have substantial impacts on child health in the developing world. Most handwashing campaigns have failed, however, to establish and maintain a regular practice of handwashing. Motivated by scholarship that suggests handwashing is habitual, we design, implement and analyze a randomized field experiment aimed to test the main predictions of the rational addiction model. To reliably measure handwashing, we develop and produce a novel soap dispenser, within which a timestamped sensor is embedded. We randomize distribution of these soap dispensers as well as provision of monitoring (feedback reports) or monitoring and incentives for daily handwashing. Relative to a control arm in which households receive no dispenser, we find that all treatments generate substantial improvements in child health as measured by child weight and height. Our key test of rational addiction is implemented by informing a subset of households about a future boost in monitoring or incentives. We find that (1) both monitoring and incentives increase handwashing relative to receiving only a dispenser; (2) these effects persist after monitoring or incentives are removed; and (3) the anticipation of monitoring increases handwashing rates significantly, implying that individuals internalize the habitual nature of handwashing and accumulate habit stock accordingly. Our results are consistent with the key predictions of the rational addiction model, expanding its relevance to settings beyond what are usually considered 'addictive' behaviors. * We are indebted to research assistant Sami Safiullah for his excellent field work and continual insights. We thank the Birbhum Population Project (BIRPOP) of the Society for Health and Demographic Surveillance (SHDS), a Health and Demographic Surveillance Site in West Bengal, India: in particular, the team of surveyors, survey managers, field monitors, data entry operators, data managers, and the research team. We are extremely grateful to Nan-Wei Gong, who designed the sensors, as well as AQS, who manufactured them. We received guidance from

Influencing Hand-washing Behaviour With a Social Robot: HRI Study With School Children in Rural India

“…Hussam et al [17] investigated the use of nudges and rational habit theory applied to handwashing behaviour at the critical moment just before preparing food or eating. They measured handwashing by a soap dispenser embedded with time-stamped sensor.…”

“…We also did not study the influence of novelty effect as the children might have to drawn to the robot and follow what instructions the robot was giving due to its novelty. Previous research indicates that handwashing behaviour change takes time, and a oneoff intervention may not be sufficient to achieve a sustainable habit formation [17].…”

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“…A few exceptions include two small studies, one in which soap bars with embedded toys where distributed to households with children (Watson et al 2018) and another one where villagers were able to sell their household's urine to be used as fertilizer (Tilley 2015), both of which reported positive results. Perhaps one of the best examples is a randomised controlled trial that involved nearly 3000 households in India, which used novel soap dispensers fitted with sensors that monitored use (Hussam et al 2017). Households were randomly assigned to either control group (no soap dispenser) or to one of three interventions: a) soap dispenser; b) same as a plus monitoring with biweekly performance reports during home visits; and c) same as b plus incentives (tickets were earned according to dispenser use, which were later exchangeable for catalogue items focused on child health, schooling, or on the household).…”

Menstrual Health, Worker Productivity and Well-being among Female Bangladeshi Garment Workers

“…Beyond menstrual health, this paper also contributes to a larger literature on adoption of health promoting behaviour in developing countries. For example, Luby et al (2004), Hussam et al (2017 and Bennett et al (2018) all test for the effectiveness of interventions promoting more frequent hand washing in Bangladesh and Pakistan. Lack of information and lack of habit formation are shown to slow down the adoption of this crucial health behaviour.…”