HAND WASHING BEHAVIOR OF WOMEN IN PUBLIC RESTROOMS The act of washing one’s hands, especially after using the restroom, is a necessary procedure to ensure sanitation and good hygiene. It is also a social norm to wash one’s hands. However, with the exception of small children and food handlers, this norm is not monitored. Health specialists agree that hand washing is one of the most effective defenses against the spread of infections and diseases. The Association of Rehabilitative Nursing Journal states that hand washing is the most effective means of preventing infection. However, for many people, it is not a part of the routine restroom behavior. Hand washing has become something that is forgotten or taken for granted. In addition, it has become an act done out of social expectation instead of sanitary reasons. Past research shows that people wash their hands because they feel it is the socially excepted thing to do. When a person is not around to monitor the hand washing behavior, it no longer becomes necessary. Conversely, when another person is present in a public restroom, it may cause a degree of self-awareness and allow the person to feel that they should do the socially desired thing. Studies have shown that as many as 50 percent of Americans do not wash their hands (Renner, 2000). There are other of factors that play into whether or not a person will wash their hands in a public restroom. The social norms of society often guide the actions and routines of people. People are taught at birth how and when to properly wash their hands. Others take on certain responsibilities that require even more detailed instruction regarding simple sanitary actions. Riolo ran an observational learning study in which first-year nursing students viewed videotapes of how to properly wash and sterilize their hands (Riolo, 1997). Hand washing should be a routine that does not need instruction and guidance past the childhood years with the exception of certain professions. However, the notion of self-awareness is one of the biggest roles in the deciding factor to whether or not a person will wash her or his hands. Self-awareness occurs when conditions are created in the environment that allows a person to remind herself of her status as an object in the world. Examples of this are looking into a mirror, hearing one’s voice, seeing a photograph of oneself, or any other situation in which the reflection of oneself is visible. This however is subjective self-awareness. Objective self-awareness is proposed when other human beings become present in the environment (Duval, 1972). This is where hand-washing behavior ties into self-awareness as well as social expectations. The Hawthorne effect, a subjects awareness that he or she is being observed, affects a person’s social behavior (Earl, Jackson, & Rickman 2001). In other words, if another person is present in the restroom it may increase the level of self- awareness. In addition, social expectation plays a very large role in hand washing behavior. If another person is present in the restroom, it will cause the person to be more aware of themselves and feel more inclined to conform to social norms. In a study mentioned in The New York Times on the prevalence of hand washing behavior in this country, it was found that Americans characteristically ignore the act of washing their hands. The researchers either concealed themselves in restroom stalls or combed their hair while observing 6,333 men and women. This was done in a variety of cities including New York City, Chicago, and New Orleans. In New York City about 60 percent of those using the restroom in Penn Station washed their hands after actually using the restroom. This was the lowest rate of hand washing prevalence. In Chicago 78 percent of the restroom users washed their hands and in New Orleans about results varied from 64 to 71 percent (Dewan, 1996). However, in a telephone survey done later people were asked whether or not they wash their hands after using public restrooms. Of those survey, 95 percent said that they did wash (Dewan, 1996). This study was completely observational since the researchers did not attempt to manipulate the environment of the restroom in any way. Other studies, however, have used manipulation of the environment to observe how people will behave in the restroom. In a study done by Munger and Harris tested the theory of self-awareness on restroom hand washing behavior. In the first situation the researcher quietly observed the subjects who entered the restroom alone. No data was taken from subjects when another user entered the restroom. The researcher was visible half of the time and not visible half of the time. In a second situation, the “observer-visible” condition, the researcher made certain that she was visible by saying “HI” to every woman that came into the restroom. When the observer was visible, 24 out of 31 subjects washed their hands. In the situation in which the observer was not visible, only 11 out of 28 of the subjects stopped to wash their hands. The results they found were consistent with the Wicklund’s theory of objective self-awareness as well as other theories of social influence. This theory states that paying more attention to oneself instead of the external environment allows people to become more self-aware and conform to social norms. This study accurately illustrates why people choose to wash their hands or not wash their hands. In the current study the researchers observed the hand washing behavior of women in a bar setting. A recent survey done by the Association of Rehabilitative Nursing Journal showed that female staff members washed their hands more often than male staff members (AORN, 2002). Since only women were observed in the current study, it is possible that the data for men would be more extreme. Running the study in a bar allowed other factors to influence the act of hand washing such as what time of night it was. The researchers manipulated the situation by either washing their hands or talking on a cellular phone. The independent variable was the act that the researcher decided to participate in: either washing their hands or talking on the phone. When the researcher washed her hands she also engaged in a short dialogue with the subject. This was done to increase the level of self-awareness of the subject. This influenced the dependent variable, whether or not the subject washed her hands. This is different from previous studies since the observers were visible at all times. In addition, the researchers actively manipulated the environment by washing or not washing her hands. Therefore, this experiment studied the notion of self-awareness as the other did, but it pertains even more closely to social norms. When the subject witnessed another person not washing her hands, she may have felt that the social norm did not apply and therefore she did not feel obligated to partake in the necessary ritual. If the subject was in the presence of someone else washing her hands, she may have felt more obligated to follow social norm.
METHOD-None-PARTICIPANTS
Participants for this study included those women who entered the women’s restroom of a bar called “Friar Tucks” in New Orleans. It is assumed that these women were over the age of 18 and no younger since the bar checks identification at the door for people of this age. The type of sampling used was convenience sampling. Ethnicity and age of the participants will not be recorded. The researchers plan observed a total of 80 women. Informed consent was unnecessary and therefore exempt on the basis that this study is observational and there are no apparent risks to the subjects. In addition, debriefing was not necessary since knowledge of the study could have potentially affected the data. MATERIALS
The study took place in the restroom of a bar. This was done so that all the women observed were assumingly of the age of 18 or older. The researchers actively manipulated the environment by either washing or not washing their hands. The materials needed were a pen and pad to record the data, a sanitary sink, soap, paper towels, and a cellular phone. If the soap or paper towels ran out the researchers asked management to refill them. The researchers also came prepared with soap and paper towels in case the bar ran out. There was also a recording sheet that the researchers used to record whether or not the subject washed her hands, how long she washed her hands for (duration), whether or not she used soap, and the time of night. DESIGN AND PROCEDURE
The design of this study is an experiment since the researchers were actively manipulating the environment. There were two levels of the independent variable. In the noticing observer situation the researcher made some comment to the subject such as “hello” or “hi, how are you” and then proceeded to wash her hands. Since there is an expectation of privacy in public restrooms, the researcher was visible at all times. In the non-noticing observer situation the researcher appeared to be talking on a cell phone. The researcher was sure to appear uninvolved and nonchalant when talking on her cell phone at all times in order to make the subject believe that she was not being observed. The dependent variable was whether or not the subject washed her hands. Since all research obtained had to be anonymous, women that the researchers knew were excluded from the data. In addition, other data that was excluded included incidences in which large crowds of women enter the restroom. In this case, an accurate analysis of motives for hand washing cannot be made. Only those who entered the restroom alone were observed. The environment of the restroom, a clean sick, available soap, paper towels and water, were the control in the experiment. Informed consent was not necessary since there were no potential risks to the subjects and since the study was mainly observational. Also, it is believed that informed consent would have affected the results of the study since knowledge of the study may be made public. The subjects were not given any information regarding the study since it is not necessary for them to know about it and since there is no expectation of risks involved. No debriefing was necessary. Upon witnessing a woman enter the restroom alone, the researcher proceeded to enter the restroom. In the noticing observer situation the researcher made some very brief dialogue with the subject and then proceeded to wash her hands. In the non-noticing observer situation the researcher appeared to be speaking on her cell phone. She did not say anything to the subject nor did she make eye contact. Among the subjects who washed their hands, the duration of the wash, whether or not the subject used soap, and the time of night was recorded.
RESULTSRegarding the main hypothesis, a significant positive correlation was found between the researchers action of washing or not washing her hands and the subjects response of washing or not washing (r =.287 , p <.01). Overall, only 40 percent of the women in the study washed their hands. This supports the hypothesis that a woman is more likely to wash her hands when someone else is present washing her hands, and less likely to wash her hands when there is a non-observant by-stander present. In the hand washing condition, the subjects were more likely to wash their hands (M =.56, SD =.50). In the cell phone condition, subjects were less likely to wash their hands (M =.27, SD =.45). Another strong negative correlation was found between the time of night and whether or not the subject washed her hands with (r = -.436 , p. <01). A t-test was done to compare the means of those who washed their hands in the cell phone groups and in the washing group. The mean of the cell phone group (M = .27, SD =.45) was comparable to the mean of the washing group (M =.56, SD =.50) which shows a significant difference between the two. There was no significant effect of the behavior of the researcher on time or duration of the subject’s wash.
DISCUSSIONThe present research explored the hand washing behavior of women in public restrooms. Results suggest that a subject’s decision to wash her hands greatly depended on whether or not the researcher washed her hands. When a subject observed the researcher washing her hands, she was more prone to washing her own hands. This was probably due to an increase or decrease in self-awareness. In the hand washing condition, the subject’s self-awareness was increased since the researcher was standing closer to the subject, and in addition made some sort of short dialogue with her. This may also be attributed to a subject’s desire to abide by social norms, since hand washing is socially expected. In the non-washing, non-observing condition, the subject’s self-awareness was not as high since the observer stood further away, did not make dialogue with the subject, and did not make eye contact. In this situation the subject did not feel observed and therefore did not feel the need to abide by social norms. The results indicate that of the women in the cell phone condition, 27 percent washed their hands. However, of the women in the washing condition, 56 percent washed their hands. These results allow the researchers to reject the null hypothesis. These findings have statistical meaning since it is apparent that women were more likely to wash their hands when there was someone else present washing their hands. This study supports the previous research done by Munger and Harris (1989). They predicted that hand washing is the result of an increase in self-awareness and social expectation. In this particular study, Munger and Harris found that 24 of 31 female subjects washed their hands after using toilet facilities when they knew they were being observed, while 11 of 28 washed their hands when they were alone. The current study found similar results, however, the method was somewhat different. In the Munger and Harris study, the researchers were either present or not present. In this study, the researchers were present at all times and either washed or did not wash their hands. Therefore, the results found in this study were not entirely due to objective self-awareness, but also to the fact that the subjects might have been modeling after the researcher. In both conditions, cell phone and washing, the percentage of women who washed their hands was very low. In the study done by The New York Times (Dewan, 2000) on prevalence of hand washing in various cities, the percentages of those who washed were actually higher. For example, in New York, the city with the lowest rate of hands washing, of those observed 60 percent washed their hands. The New York Times study was done in random restrooms and was completely observational. Many people were present in the restroom as opposed to the current study in which only two people were present, the subject and the researcher. Therefore, the fact that other people were present may have increased the self-awareness of people in these restrooms. However, an average of 40 percent of all the people observed in the various cities did not wash their hands. There is also a strong relationship between the time of night that the data was recorded and whether or not a subject washed her hands. It appears that as the night progressed, subjects were less likely to wash their hands. This may be due to the fact that subjects became increasingly tired by the end of the night. Since the study was conducted at a bar, it may have been due to higher levels of intoxication. Other less significant relationships were found between soap use and the duration of the wash. Of those who washed their hands, there is a positive correlation between women who used soap and how long they washed their hands. In other words, if a woman used soap, she was more likely to wash her hands for a longer period of time. In addition, women who washed their hands were more likely to use soap then to wash their hands without the use of soap. Of those who washed, there was a negative correlation between the duration of the wash and the time of night. In other words, as the night progressed the length of time the subject washed her hands lessened. Although the results support the hypothesis, both researchers feel that there may have been outside factors affecting the subjects’ willingness to wash their hands. For example, both researchers belong to a sorority. When sorority paraphernalia was worn by either of the researchers, it may have increased a subject’s willingness to wash her hands. In addition, although paraphernalia was not worn most of the time, many of the subjects may have been aware that the researchers belong to a sorority since the study was run in an establishment frequented by students who attend the college that the researchers attend. Since a large majority of those observed were freshman women who may be going through recruitment, hoping to join a sorority, it may have affected their decision to wash their hands. Because some of the women observed were aware that the researcher present in the restroom was in a sorority, it may have increased the likelihood of them washing their hands. The researchers feel that this may have affected the results.Another outside variable that cannot be controlled for is the fact that the researchers were upperclassman and many of the subjects observed were underclassman. This also may have increased the likelihood of a subject to wash her hands since freshman women sometimes look up to the upperclassman. In the future, the results may be more accurate if the study is run in an establishment with which the researchers are not affiliated with or known. If this study is repeated in the future it would be beneficial to use a larger sample size in order to get clearer, more meaningful results. The researchers agree that a person’s decision to wash their hands is greatly dependent on self-awareness. Despite the fact that abstaining from this necessary ritual involves a threat to a person’s health, people are still not washing their hands after using the restroom. Hand washing is the most effective means of preventing infection. If people could learn make this simple practice a habit, it would decrease many of the day-to-day health problems that exist.
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