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Exploring Trends in Hand Washing Posters

What are emergent patterns in medical signage on hand hygiene? How can they inform how we communicate proper health behavior in literate and illiterate populations? 


How are literacy, signs, and compliance related?

Anchor 1
  • Barriers in LMICs: overworked, under-resourced staff and systemic educational barriers among patients.

  • Largely illiterate populations; literacy doesn't necessarily mean English-speaking.

  • Care continuum: Family and friends may act as primary caregivers in and outside the hospital.

  • Education delivered at two main access points: initial contact with nurse upon admission and through print media placed throughout wards.

  • Excessive use of inaccessible informational tools negatively impacts care: compliance, health behavior, self management, engagement, retention, etc.

The Trends

Anchor 2


A Spectrum of Styles



Audience-Directed, Personification, Call to Action


Modes of Imagery





Anchor 3

Cultural Relevance

"When" & Image Based

Things to Avoid:


    Dependency on language to communicate

  • Personifications of germs or visible dirt


    Sequences of steps or "how-to" guides

  • Dull or sterile colors

  • Simple images of hands paired with text

References & Database

Anchor 4

Posters that embody major trends are listed here with descriptive detail with related images. Primary databases for hand hygiene signage and leaflets are:

Minnesota Department of Health

Center for Disease Control and Prevention

US Department of Veterans Affairs

Becker's Clinical Leadership & Infection Control

  1. Cabieses, B., & Bird, P. (2014). Glossary of access to health care and related concepts for low-and middle-income countries (LMICs): a critical review of international literature. International Journal of Health Services, 44(4), 845-861.

  2. McNicol, S. (2014). Humanising illness: presenting health information in educational comics. Medical humanities, 40(1), 49-55.

  3. Byram, M. L., & Garforth, C. (1980). Research and testing non-formal education materials: a multi-media extension project in Botswana. Educational Broadcasting International, 13(4), 190-194.

  4. Fussell, D., & Haaland, A. (1978). Communicating with Pictures in Nepal: Results of Practical Study Used in Visual Education. Educational Broadcasting International, 11(1), 25-31.

  5. Tatalovic, M. (2009). Science comics as tools for science education and communication: a brief, exploratory study. Jcom, 8(4).

  6. Mumford, M. E. (1997). A descriptive study of the readability of patient information leaflets designed by nurses. Journal of Advanced Nursing, 26(5), 985-991.

  7. Ryan, L., Logsdon, M. C., McGill, S., Stikes, R., Senior, B., Helinger, B., ... & Davis, D. W. (2014). Evaluation of printed health education materials for use by Low‐Education families. Journal of Nursing Scholarship, 46(4), 218-228.

  8. Roter, D. L., Rudd, R. E., Frantz, S. C., & Comings, J. P. (1981). Community-produced materials for health education. Public Health Reports, 96(2), 169.

  9. Anderson, M. E. C., & Weese, J. S. (2012). Video observation of hand hygiene practices at a petting zoo and the impact of hand hygiene interventions. Epidemiology & Infection, 140(1), 182-190.

  10. Curtis, V. A., Danquah, L. O., & Aunger, R. V. (2009). Planned, motivated and habitual hygiene behaviour: an eleven country review. Health education research, 24(4), 655-673.

  11. Vivas, A., Gelaye, B., Aboset, N., Kumie, A., Berhane, Y., & Williams, M. A. (2010). Knowledge, attitudes, and practices (KAP) of hygiene among school children in Angolela, Ethiopia. Journal of preventive medicine and hygiene, 51(2), 73.

  12. Söderbäck, M., & Christensson, K. (2008). Family involvement in the care of a hospitalised child: A questionnaire survey of Mozambican family caregivers. International Journal of Nursing Studies, 45(12), 1778-1788.

  13. Hoffman, M., Mofolo, I., Salima, C., Hoffman, I., Zadrozny, S., Martinson, F., & Van Der Horst, C. (2012). Utilization of family members to provide hospital care in Malawi: the role of hospital guardians. Malawi Medical Journal, 24(4), 74-78.

  14. Coignard, B., Grandbastien, B., Berrouane, Y., Krembel, C., Queverue, M., Salomez, J.L. and Martin, G. (1998). Handwashing quality: impact of a special program. Infection Control & Hospital Epidemiology, 19(7), pp.510-513.

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