Gross Messaging Increases Handwashing

DENVER – Research conducted by University of Denver (DU) associate professor Renée Botta suggests that it takes "gross" messaging to get undergraduate students to wash their hands more frequently after going to the bathroom.

In the fall quarter of 2007, researchers posted messages in the bathrooms of two DU undergraduate residence halls. The messages said things like, "Poo on you, wash your hands" or "You just peed, wash your hands," and contained vivid graphics and photos. The messages resulted in increased handwashing among females by 26 percent and among males by 8 percent.

"Fear of spreading germs or getting sick by not washing didn't mean much to students," says Botta, the lead author of the study and an associate professor in the Department of Mass Communications and Journalism Studies. "What got their attention was the knowledge that they might be walking around with 'gross things' on their hands if they didn't wash."

Observations in two control dorms over the same four-week period showed handwashing decreased 2 percentage points among females and 21.5 percentage points among males.

"We tried gross messages, germ messages and you'll-get-sick messages. And the only ones that stuck was gross," says assistant director of health promotions Katie Dunker, one of a team of five who conducted the pilot study. "We found that the 'gross factor' is what works, and we were able to increase hand washing behavior by a lot."

The findings are generating interest. Universities including UC Santa Barbara, Wyoming, ColoradoState and CU–Colorado Springs want to borrow DU's techniques in hopes of improving student handwashing behavior on their campuses.

"The relevance of the message is really, really important," she says. "You can threaten that they'll get the flu or promise a flu-free winter, but if they don't really care about that, your message is going to fall flat," Botta says.

What was clear, she adds, was that the grossness campaign brought positive results not only in the study but also in a campus emergency that broke out last April. A week before the study was to be expanded to the entire University, a norovirus outbreak made 63 students ill over a four-day period. Handwashing was identified as an important way to prevent the disease from spreading.

The study appears in the October edition of the Journal of Communication in Healthcare.