Why does hygiene education alone not always work?
Updated - Monday 28 November 2005
Why does hygiene education alone not always work?
Many hygiene education programmes focus on increasing people's knowledge. Planners and implementers assume that when people know better how water and sanitation diseases are transmitted, they will drop unhygienic practices and adopt improved ones. However, this is often not the case. Increasing people's knowledge does not automatically lead them to change behaviours. Cigarette smoking is a typical example. Although people generally know that it is a danger to health, a large number of people all over the world are still smoking, even health practitioners - doctors and nurses themselves.
To be able to develop interventions to promote hygiene behavioural change, planners and implementers need to take account of why people act as they do and what people think and understand about hygiene. In other words, they need to know the insiders' view, also known as the emic perspective.
Etic: This is the outsider's view, the scientists' perception. An etic definition is that hygiene is the practice of keeping one's self and one's surroundings clean, especially to avoid illness and the spread of infection. It focuses on diseases which are spread by the faecal-oral route, particularly diarrhoeal diseases which kill two or three million children under five each year.
Emic: This is the insider's view, the perception of the actors themselves. For instance most parents throughout the world think that their children's faeces are relatively harmless, though they are in fact (i.e. from the etic view) more infectious than those of adults. Most people usually don't practice hygiene for health reasons, but have other motivations that may include simple disgust at dirt, an aesthetic preference for cleanliness, a desire to protect their children and themselves from dangerous external influences, or (most potent of all) considerations of self-respect and social standing.
Hygiene education seeks to correct the emic perspective; hygiene promotion seeks to build on it by helping people to meet their own aspirations in ways that also contribute to improved health.
