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BEHAVIOUR CHANGE / HAND HYGIENE

A habit within reach

I explored hand hygiene during radiographers’ movement between wards. Research and co-creation led to a concept with reminders, sanitiser and feedback on the X-ray cart.

Role: Behaviour research, co-creation and physical prototyping.
Collaboration: Radiographers in India and the UK; concept feedback from clinicians.
Period: COVID-19 context.
Exact dates not recorded.
Scope: Ward entry, mobile X-ray carts and an Arduino proof of concept.

A clay model of a radiographer approaching a patient beside the physical Arduino, breadboard and illuminated sanitiser prototype. — A clay scenario and working electronics made the concept tangible.

TL;DR / Overview

Problem: Radiographers could miss hand hygiene at ward entry despite understanding its importance and having facilities available.
Role: I researched behaviour and hospital settings, facilitated co-creation and developed the cart concept and physical prototype.
Surfaces: Interview and behavioural-analysis tools, workshop sketches, a six-step storyboard, clay scenario and Arduino light-and-audio prototype.
Reach: 8 radiographer interviews in India and the UK; 7 radiographers in co-creation, with overlap undocumented.
Result: The prototype demonstrated local cues and dispenser-input feedback; remote feedback suggested noticeability, not measured behaviour change.
Status: Research concept and Arduino prototype; not deployed or validated in a hospital.

01 / THE MOMENT BETWEEN WARDS

The equipment moves.
So does the opportunity.

During COVID-19, radiographers moved between departments and patients with mobile imaging equipment. I focused on a specific moment in that journey: entering a new ward.

Illustration of the hospital's connected wards and a radiographer moving a mobile X-ray cart between them. — The movement map made the transition between departments a useful focus for the study.

The movement illustration for more than 80 imaging staff at The Royal London Hospital helped show how connected the hospital was through everyday work.

Why was hygiene missed at these transitions despite its known importance? I looked at the conditions around behaviour, not simply telling people to try harder.

The 80+ figure describes staff movement, not my interview sample or a concept outcome.

02 / LOOKING AT THE SETTING

The information was there.
The habit was not.

I compared hand-hygiene arrangements in India and the UK, then interviewed radiographers about the moments when the behaviour did and did not happen.

The hospital examples were Christian Medical College Hospital in Vellore and The Royal London Hospital. Both displayed hand-hygiene protocols, including the WHO’s five moments.

Station placement, drying materials and signage differed. The UK setting also used posters for COVID-19 zone protocols; wall reminders were only part of the environment.

I also reviewed examples of hand-hygiene stations beyond hospitals to understand different ways of attracting attention and encouraging use.

I interviewed 8 radiographers: 1 in India and 7 in the UK. Five reported incomplete awareness of, or inconsistent adherence to, the five moments.

Cleaning after patient contact or when soiled was more familiar than sanitising on entry to a department.

These self-reports were not observed adherence rates for either hospital or country.

Photographs of hand-rub dispensers, a sink and drying arrangements at Christian Medical College Hospital in Vellore. — Station placement and the surrounding environment in Vellore.

Photographs of sinks, soap and sanitiser dispensers, posters and paper towels at The Royal London Hospital. — The corresponding facilities at The Royal London Hospital.

Blue, amber and green COVID-19 zone posters documenting the different entry protocols in the hospital setting. — Historical COVID-19 zone signage from the study, not current clinical guidance.

Make the target behaviour specific.

I used AACTT: Action, Actor, Context, Target and Time to replace a broad “improve handwashing” brief with a specific transition, person and response window.

Action: Use hand sanitiser after entering a ward.
Actor: A radiographer moving with a mobile X-ray unit.
Context: Crossing into a ward before approaching patients.
Target: The radiographer and the patients and colleagues they encounter.
Time: The first 20 seconds after entry, as the concept’s response window.
Intent: Reduce opportunities for cross-contamination between wards.

The 20-second window was a concept response target, not clinical guidance on hand-hygiene duration or method.

Understand what helps the behaviour happen.

I organised interview findings with COM-B: Capability, Opportunity and Motivation. Not every missed action was a knowledge problem.

CAPABILITY

Knowing why was not enough.

People understood the importance of hygiene, but recall still needed support. Free hands and skin irritation also affected the physical act.

OPPORTUNITY

Work and peers set the pace.

Facilities existed, but workload and interruptions competed for attention. Seeing a colleague act could help; verbally reminding one could feel awkward.

MOTIVATION

After was more automatic than before.

Cleaning after contact was an established habit. Cleaning on entry was not. Safety mattered, but did not always translate into the action at that moment.

The barriers were practical and social.

Busyness, distraction, inconvenient station placement and an “after the task” habit mattered, with little routine accountability at ward entry.

The facilitators were already there.

Hygiene was recognised as safe practice. Peer behaviour, humour, friendly competition and small rewards could work with the team’s culture.

03 / DESIGNING WITH THE TEAM

Make room for
the people doing the work.

A workshop with 7 radiographers brought end users into idea-making, rather than only evaluating a finished proposal.

Their expectations and ideas drew on backstage rituals: games, competition, humour and buying coffee.

I combined workshop ideas with interviews. Playful cues and rewards needed to fit that culture, not impose another instruction.

I also studied analogous examples of behaviour change, then used whiteboarding and dot voting to narrow the concepts.

Ideas included door prompts, interactive washing-station feedback and rewards. I prioritised less cognitive load, familiar routines and fewer obstacles.

Radiographers seated together during the co-creation workshop, discussing and sketching ideas. — The 7-person workshop brought clinical routines into the design conversation.

Hand-drawn workshop concepts showing possible reminders, dispensers, feedback and incentives. — Participant sketches offered different ways to prompt and acknowledge the behaviour.

Research board grouping analogous interventions by cultural references, play, education, peer influence and technology. — Analogous studies helped compare different ways of attracting attention and changing behaviour.

Ideation board combining reference images, written concepts, behavioural prompts and dot-voting marks. — Whiteboarding and dot voting narrowed a broad set of possibilities.

Strategy framework linking familiar routines, convenience, salience, stimulation, competition and incentives to behaviour-change approaches. — Behavioural research informed the design strategies. Reward variants were exploratory; the final story uses weekly coffee.

EASY & FAMILIAR

Keep it close to the work.

Use an object and routine already present. Do not make someone leave the cart to complete an extra task.

SALIENT & TIMELY

Notice the moment.

Use visual and audio cues at the ward transition, with enough presence to be noticed without overwhelming the setting.

SOCIAL & REWARDING

Borrow the team’s energy.

Friendly competition and a modest reward could make the behaviour feel more like a shared activity than a reprimand.

04 / THE CART-BASED CONCEPT

Move the prompt.
Keep the routine.

Doorway stations would ask radiographers to leave and return to the cart; entrance cues would add infrastructure. I centred the concept on the cart instead.

The proposed cart carries the sanitiser, visual stimulus and audio cue. A ward transition starts a short response window; using the dispenser stops the cue and gives positive feedback.

Cues needed to reach radiographers without disturbing patients. Varying light patterns aimed to counter familiarity and disengagement.

A backstage score creates an element of friendly competition, with a cup of coffee or a coffee coupon at the end of the week.

Under the proposal, points would require a new ward transition, not stationary or repeated dispensing. That anti-gaming safeguard remained untested.

THE CONCEPT STORYBOARD

Storyboard showing hospital movement, a radiographer swiping an ID card and a backstage location board.

01 / IDENTIFY

Connect the person
to the journey.

The storyboard begins with the radiographer’s ID and location, connecting movement through the hospital to a backstage board.

Here, the board remains a concept sketch.

Drawings of a mobile X-ray cart approaching a ward doorway and entering after a proximity-triggered opening.

02 / ENTER

Use the transition
as the trigger.

Proximity-based door opening aimed to reduce surface contact, with a reminder triggered after entry to the new ward.

Sketch of the cart emitting a sound beside a blue illuminated ring used as the visual cue.

03 / NOTICE

Bring attention
to the sanitiser.

A light around the holder and an audio cue make the next action visible. The cue belongs beside the dispenser, not elsewhere in the room.

Hand-drawn countdown display and progress indicator on the mobile X-ray cart.

04 / RESPOND

Make the window
easy to recognise.

The sketch’s visual countdown marks the concept’s 20-second response window.

Storyboard of sanitiser being dispensed and a point appearing on the backstage scoreboard.

05 / RECORD

Acknowledge
the action.

Dispenser use stops the cue, plays positive feedback and adds a point in the proposed system. Points depend on a new ward transition, rather than repeated dispensing in one place.

Hand-drawn coffee cup and coupon representing the proposed weekly reward.

06 / REWARD

Keep the reward
small and familiar.

A coffee or coffee coupon draws on an existing team ritual. The proposal keeps the reward modest rather than turning a care behaviour into a high-stakes competition.

Original storyboard for the proposed system, not a hospital deployment.

05 / MAKING IT TANGIBLE

A cue you could see.
A response you could hear.

Two flowcharts translating ward entry, sanitiser use and feedback into proximity sensing, LEDs, buzzer, button input and an idle state. — The front-end experience and its corresponding electronics flow.

An Arduino prototype and clay scenario made the idea tangible. The electronics demonstrated a trigger, light sequence, dispenser input and audio feedback.

Ward entry, action and acknowledgement became a proximity sensor, LEDs, a buzzer and a button representing dispenser input.

If there is input, the light stops and positive feedback plays. Without input, the cue runs through the response window before returning to an idle state.

I also broke down the wider infrastructure: identity and location, entry detection, timing and animation, dispensing feedback and the scoreboard.

The physical prototype invited discussion; hospital network, door and central scoreboard integration remained unproven.

Handwritten system sketch linking ID and location to proximity sensing, visual and audio cues, and possible positive and negative score branches. — The early logic sketch, including branches that remained exploratory.

Break the system into decisions.

The early back-end sketch connects ID, location and score to the trigger and feedback logic. It also explores what happens when the sanitiser is not used.

It includes positive and negative scores as exploratory branches, not a tested incentive policy.

The front-end and back-end flowchart focuses on positive acknowledgement and a return to idle. The artefacts do not establish which scoring policy was finally tested.

Original Arduino programming screenshots for the hand-hygiene electronics prototype. — The Arduino sketches expressing the prototype interaction.

06 / WHAT WAS AND WAS NOT LEARNED

Attention was promising.
Adherence was unproven.

I shared the concept and videos remotely with radiographers and doctors in India and the UK. The response was positive, but the physical setup was not present during that feedback.

SWOT board identifying potential ease of adoption alongside distraction, habituation, competition, maintenance and electronic-waste risks. — Testing the idea against its own weaknesses, not just its intended benefits.

“Draws attention.”
Junior radiographer in the UK, responding remotely to the concept.

That suggested noticeability, not more frequent hand cleaning, protocol adherence or reduced cross-contamination.

A SWOT review helped me look beyond the appeal of the prototype to the ways it could fail in everyday use.

ATTENTION

A cue can lose its meaning.

People might get bored, find the cues annoying or learn to wait for a prompt. Patients could also find the system distracting.

SOCIAL EFFECTS

Competition can backfire.

Friendly scoring could create friction, avoidance or unexpected ways of using the system. The intended culture is not a guaranteed outcome.

THE WHOLE SYSTEM

The hardware has a lifecycle.

Sanitiser containers can change. Scoreboard integration can be difficult. Electronics add maintenance and eventual waste to the design.

What would need to happen next.

The next step was thorough usability testing with the physical setup and actual users in the hospital context. The costs of equipping carts and providing rewards also needed evaluation.

Scaling would require understanding the hospital network and changes to daily routines, then adapting the approach for other staff and equipment rather than assuming one solution fits everyone.

What I would carry forward.

Working with a familiar object at a specific moment was the key decision. Research, co-creation and prototyping grounded it beyond a general reminder.

This remains a proof of concept; adherence and infection outcomes were not measured.