Engagement Lab Offers a [Clean] Helping Hand

Roughly 12,000 children in Ghana die each year from diseases—cholera, pneumonia—that could be prevented by simple handwashing with soap and water.

The Emerson Engagement Lab has co-designed a game to teach children how, why, and when to wash their hands, which they hope will change behaviors and save lives in the West African nation.

“What’s interesting about it is it’s an individual action with public consequences,” said Eric Gordon, founding director of the Engagement Lab.

The project is a collaboration between the Engagement Lab, UNICEF Ghana, the Ghana Red Cross Society, and the Red Cross Red Crescent Climate Centre, as well as government partners in Ghana, including the Ghana Educational Service. The Lab, UNICEF Ghana, the Red Cross, and Right to Play, an organization that uses a lot of game-based learning, did research and came up with the idea to make a storybook game, Handwashing with Ananse, based on a traditional Ghanaian folk character.

Wade Kimbrough MFA '14, the project manager and game designer from the Engagement Lab, worked closely with partners to ensure Handwashing with Ananse fit into the lore of the traditional stories. Ananse is a spider-like man who, according to folklore, steals all the wisdom in the world and hides it in a pot at the top of a tree. The pot ends up falling and shattering, so all the wisdom is released back into the world, Kimbrough said.

“We tell the children the handwashing knowledge didn’t go back into the world, and that they need to play through this book to bring that back into the world,” Kimbrough said.

Barriers to Good Handwashing

Many schools in Ghana have access to clean water, Kimbrough said, but many don’t have the infrastructure, i.e., handwashing stations, that make it easy for children to wash their hands throughout the day. Even for those that do have the infrastructure, there are other barriers like attitudes about handwashing, he said.

“The other thing is creating attitudinal shifts and behavior change,” Kimbrough said. “There’s some misconception around the critical times that you need to wash your hands.”

Kimbrough said in doing their research, they heard of children saying things like, “Germs don’t make you sick, they make you stronger.” Also, because children in Ghana tend to eat with their hands, they don’t like to wash before eating because the soap makes their food taste off.

Playing the Game

The game consists of three segments, each with a narrative around Ananse and companion activities, and each with a specific goal: teaching children why they should wash their hands, the best way to do it, and when they should do it.

A crucial part of the storytelling aspect of the game is that the stories not only feel right in terms of tone and plot, but are also told using traditional, interactive methods. To get it right, Kimbrough said, the team met with performers from the National Theatre of Ghana who taught them traditional storytelling using song and dance, he said. They then developed a guide for facilitators who might need help with their narrative skills.

The active parts of the game also hew closely to what children find familiar. During the game that teaches children how to handwash, students pass stones to music. When the music stops, there’s a kind of relay race in which players run to wash their hands. To remind them of the correct steps, their team sings them a song. It is very similar to the traditional Ghanaian game and song “Sansankroma.”

“That actually seems to be the most popular game, because it’s a traditional game of stone-passing,” Kimbrough said.

Determining if It Works

So far, about 600 students have helped the team with the development of the game. The most recent step has been a “quasi-experimental study” involving ten “treatment” schools that will use Handwashing with Ananse and ten “control” schools that will not, Kimbrough said.

In the schools where the game is being tested, the school partners will build “tippy-tap stations”—simple contraptions using jerry cans that pour water when a log is stepped on—which can ensure children have a place to wash their hands, he said. Sensors will be placed on the tippy-tap stations to measure how often, and how well, children are washing their hands.

The team will start collecting data in June and should know by early next year whether the game is successful. If it is, the program could be scaled up across Ghana, reaching 1.5 million to 3 million children. The game also could be adapted to other countries in the developing world, since many cultures have a “trickster” kind of character like Ananse, he said.

Kimbrough, whose master’s thesis was done through the Engagement Lab and involved creating a game around helping subsistence farmers understand the principles of flood prediction in Zambia, said he’s really excited about the measurement and evaluation of the project.

There has been a lot of research on games and whether or not they help players retain knowledge, he said, but there hasn’t been much study done on whether they can change people’s behaviors.

“In terms of actually creating behavior change and getting somebody to wash their hands, to me, is really exciting,” Kimbrough said, “and to see if this game actually does that is going to be amazing.”