Team  

Alex Surasky-Ysasi  |  Hongqiao Lu  |  Melanie Swartz  |  Stefanie Owens

Objective

To understand the underlying motivations and behaviors as to why people don't practice proper hand washing in public restrooms. 

My Role

Research Plan Design  |  All Stages of Research

Timeframe

2 months


Project Objective

During a user research methods course at Carnegie Mellon, a team and I were tasked with identifying and then studying an interesting problem area around the realm of personal hygiene.  My initial thought was, "well, this could get awkward fast..." but through secondary research and a group brainstorm, our group settled on studying people's hand washing habits in a public bathroom setting.  

 
95% of people don’t wash their hands properly, despite well-publicized criteria for ‘correct hand washing’ published by the FDA.
— Study from Michigan State University
 

Most of us are at least aware that it is important to wash our hands, whether that's advice from the FDA or simply from our mothers, yet hardly anyone does it well!  Why?  We collaborated over the course of two months to understand the motivational behaviors behind people’s hand washing habits in a public bathroom setting.  We constructed our research plan in order to cover as much breadth and depth as we could into this dirty topic.  It was a particularly interesting research challenge due to the big gap between what people say they do and what they actually do.   We conducted secondary research, surveys, interviews, observations, cultural probes, product audits, usability testing and co-design activities. 

 

Process

After over 45 surveys and a number of one-on-one interviews, most participants identified that they always notice when other people do not wash their hands, and admitted that they themselves were aware that there is a "correct" method, but do not always follow it due to time constraints, environmental conditions, and simply not feeling like their hands are dirty. 

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The survey we distributed gave us a place to start with understanding the general issues with habitual hand washing. We followed this up with a series of in-depth interviews with a variety of students, university staff and healthcare professionals to dig a bit deeper.  Our focus was to get their perceptions of other people's internal motivations of hand washing; we were careful to construct this part of the study as third-person referential questions rather than asking the user themselves what they do.  We feared that people may not be as honest if it was a reflection on themselves and their (likely) poor habits of hand washing versus asking them to perform a reflection on the general public.

 A product audit of other hand washing solutions most commonly used in the public bathroom setting

A product audit of other hand washing solutions most commonly used in the public bathroom setting

 
Studies have shown that a prompt in the moment proves to be the most effective method to get people to wash their hands.
— Interview with a Director of Health Promotion Programs

By this point in our research, we were able to understand the current experience of hand washing in a public restroom pretty thoroughly, but needed to push forward into exploring how we might design a future experience that incentivizes consistently good behavior of hand washing.  One of the research methods we employed was a co-design activity to gauge how the preference of environmental aspects in the bathroom setting can influence a person's desire to wash their hands properly.  Through this activity we were able to learn that there was a general preference for familiar public bathroom fixtures, and that creating a habit for proper hand washing can be easily challenge by the hugely varying inconsistencies in technology and cleanliness of facilities. 

 Our co-design Activity involved participants choosing their preferred bathroom fixtures and then placing Sensors (if they desired Automation) where they would expect them to be located.

Our co-design Activity involved participants choosing their preferred bathroom fixtures and then placing Sensors (if they desired Automation) where they would expect them to be located.

 Team synthesis and affinity diagramming of our research thus far 

Team synthesis and affinity diagramming of our research thus far 

Research Insights to Guide Future Design: 

The focus of the course was on using various research methodologies to find guiding insights for the design of a following solution.  While we did not design a finished solution itself, we discovered a couple of key factors regarding people's hand washing habits that would greatly influence their success or failure of following correct hand washing procedures.

1.  Our results concluded that time is the most important factor for people when deciding whether or not to wash their hands correctly (for a full 20 seconds). 

2.  Automation in public bathroom fixtures is widely preferred however unclear functionality or a failure to function is a huge deterrent for people washing properly. 

3.  Making people aware of the importance of hand washing in the moment is very effective in producing successful hand washing results. 

Many research participants indicated that they would need some sort of distraction in order to make them want to stand and wash their hands for a full twenty seconds.  While many popular public health signs suggest singing "Happy Birthday" twice as you wash, can you ever think of a time that you have actually done that?  

How might we gamify the hand washing process to engage people to wash their hands correctly?

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We brainstormed a variety of gamification tactics and then prototyped out a rough idea for a hand washing challenge in our own design studio at Carnegie Mellon.  We created a game-like timer interface that users could start and stop to see how long they washed their hands for.  We then asked participants to record their times on a poster we hung on the bathroom mirror.  We were surprised with how many people actually participated, but then also surprised to see how much longer the washing times were in comparison to our contextual inquiry studies in the field. (Yes, by "contextual inquiry" I mean observing random people wash their hands in public bathroom facilities and counting how long they washed).  

 

The usability test may not have been perfect, but it did lead us to realize that while awareness in the moment of hand washing is important to encourage proper hand washing technique, we also realized that measurement informs awareness.  

Why not create a solution similar to the familiar water bottle refill stations where a user is encouraged to watch a gamified bar fill up or deplete as they scrub their hands?  This would be a relatively easy solution to implement, especially on the nearly ubiquitous automated fixtures in public bathroom facilities across the United States, not to mention leave a huge impact on public health if more than 5% of the population actually washed their hands correctly.