Framing Flu Prevention-An Experimental Field Test of Signs Promoting Hand Hygiene During the 2009-2010 H1N1 Pandemic

Objective: During the 2009-2010 H1N1 flu pandemic, many institutions installed alcohol-based hand sanitizer dispensers in public settings in an effort to prevent the spread of the virus. Yet, usage of these dispensers remained low. Method: Point-of-use reminder signs were designed to emphasize four theoretically grounded health beliefs: perceived susceptibility, social norms, consequences of the behavior framed as gains, and consequences of the behavior framed as losses. From October 2009 to March 2010, 58 sanitizer dispensers in public buildings were randomly assigned to have one of the four signs placed next to it, and dispenser usage was continually monitored. Results: All signs were associated with greater sanitizer usage compared to no sign. The gain-framed sign was associated with greatest usage (66% over no sign). Signs emphasizing susceptibility to H1N1 were associated with the lowest usage (41% over no sign). Although usage declined over time and closely mirrored trends in public interest about H1N1, the influence of the signs was not dependent on degree of public interest. Conclusion: This experimental field study shows how simple, theoretically grounded signs can serve as cues to action in promoting the adoption of preventive behaviors. Gain-framed signage is particularly effective in promoting hand hygiene in a flu pandemic.