Publications

Our project is producing a variety of academic journal papers. This page is updated as soon as a new paper becomes available.

Rutter, S.; Stones, C.; Wood, J.; Macduff, C.; Gomez-Escalada, M. (2020) Effectiveness and Efficiency of Persuasive Space Graphics (PSG) in Motivating UK Primary School Children’s Hand Hygiene. Int. J. Environ. Res. Public Health17, 2351.

Abstract – Click here to view the paper.
Good hand hygiene is necessary to control and prevent infections, but many children do not adequately wash their hands. While there are classroom communications targeted at children, the toilet space, the location of many hand hygiene activities, is neglected. This paper describes an initial evaluation of “123” persuasive space graphics (images and messages integrated within an architectural environment that encourage specific actions). The effectiveness (whether hand hygiene improves) and efficiency (the ease with which a setting can adopt and implement an intervention) is evaluated in three UK schools and one museum. Five evaluations (participant demographic, handwashing frequency, handwashing quality, design persuasiveness, stakeholder views) were conducted. In the school settings, persuasive space graphics increased the quality and frequency of handwashing. In the museum setting, frequency of handwashing slightly increased. In all settings children found the graphics persuasive, and stakeholders also believed them to be effective. Stakeholders considered persuasive space graphics a low-cost and time-efficient way to communicate. It can be concluded that persuasive space graphics are effective in increasing hand hygiene, particularly in school settings where children have a longer exposure to the graphics. Persuasive space graphics are also an efficient low-cost means of communicating hand hygiene

Stones, C. M., Stark, J., Rutter, S., & Macduff, C. (2020). The Visual Representation of Germs–a typology of popular germ depictions. Visual Communication.

Abstract – Click here to view the paper
Germs have been visually represented in popular texts for over 100 years, yet little is understood about the dominant practices/concepts resident in such images. This paper presents a new typology of popular germ representations from the UK consisting of three main types: Scientific, Carrier and Analogous. The first category pertains to the realm of the scientist, the second to domestic space and social norms, and the third, primarily, to the realm of imagination. The study identifies a further 13 sub-types and discusses each, in turn. We argue that a more varied range of germ images exist than the previous binary positioning of germ representations in the U.S. would suggest. We account for the continued adoption of the Analogous Germ in relation to four key cultural forces and problematize the use of the Monster Germ and its alignment of ugliness and obesity with disease.

Stark, J. F., & Stones, C. (2019). Constructing representations of germs in the twentieth century. Cultural and Social History, 1-28.

Abstract – Click here to view the paper
The development of germ theories of disease was reliant on the exchange of representations and descriptions of microorganisms. Visual properties were critical in establishing a shared understanding of agents of disease and their causal role. However, historians have yet to explore in detail the representation of microorganisms aimed at audiences beyond specialists. The public visual culture of germs offers a new window through which to understand health campaigns, their motivations, and intended audiences. We argue that still and moving images of germs made visible social anxieties surrounding health, race, class, and national security in ways not yet recognised.


Rutter, S., Stones, C., & Macduff, C. (2019). Communicating Handwashing to Children, as Told by Children. Health communication, 1-10.

Abstract – Click here to view the paper
Posters encouraging handwashing would seem to offer a low-cost solution addressing barriers to handwashing in schools. However, what barriers can be successfully addressed and, how effective posters targeted at children may be is not known. In this study, using a co-design methodology, seventy-nine children (aged 6 to 11) from three English schools evaluated and generated handwashing messages in two workshops.The results were then compared with an evaluation (by the authors) of handwashing posters targeted at children. Messages that children considered most effective addressed barriers relating to reminders and encouragement, and education and information (particularly germ transmission, consequence, location and avoidance).Messages that addressed time and social norms were not considered as effective.Posters targeted at children also used reminders and encouragement, and education and information messages. However, the focus of these education and information messages was on instruction (how and when to wash hands), not on germs. Unlike the posters targeted at children, the majority of children’s messages were persuasive in that they did more than simply instruct. This has implications for the design of posters and educational material in handwashing interventions.

Rutter, S. MacDuff C, Stones C, Gomez-Escalada, M. (2019). Evaluating children’s handwashing in schools: an integrative review of indicative measures and measurement tools. International Journal of Environmental Health Research.

Abstract – Click here to view the paper
Children are a key target of handwashing interventions as washing hands reduces the spread of disease and reliance on antibiotics. While there is guidance for evaluating handwashing with adults in other settings, this is lacking for children in schools. An integrative review of 65 studies where handwashing was measured in schools was conducted to establish which indicative measures (what is measured to evaluate the processes and/or impacts of, handwashing) and measurement tools (data collection instruments) have been applied to evaluate handwashing in schools, and under what circumstances. Further analysis highlighted different challenges when seeking to apply such measures and tools in schools, as opposed to other settings. It was concluded that indicative measures, and measurement tools need to be appropriate to the organizational setting, the study participants, and research objectives. A summative analysis of relevant considerations is presented.