Table 1 Details of the three-part handwashing behavior change intervention, the Povu Poa Handwashing Stations School Pilot Study

Part 1: The “Toilet and Shake” Skit

To induce and use disgust as an emotional driver for handwashing

• The resource person pretended to go to the toilet and came back to the assembly without washing hands - simply wiping hands with toilet papers

• The resource person attempted to shake hands with the students

• The resource person asked questions about having dirty hands

Part 2: The Handwashing Song

To remind the students to wash their hands every time after using the latrine and before eating

• The resource person taught the students a song about handwashing with soap after using the latrine and before eating

Part 3: The Pledge

To promote a social norm of handwashing

• The resource person asked students to raise hands and say an oral pledge to always wash their hands every time after using the toilet

• The purpose of the pledging process was to create a social norm (specifically, injunctive norm) for handwashing - to make the students expect others to wash their hands and be aware that others also expect them to wash their hands, creating mutual expectation for handwashing after toilet use

• The pledge was meant to change the students’ social norms which could then drive their handwashing behaviors