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Poor household hygiene contributes to the spread of diseases and the preventable deaths of millions of people in low-income settings around the world – especially among the elderly and children under 5 years of age. In 2010, Canyon Ranch Institute partnered with The Clorox Company to develop the Arts for Behavior Change (ABC) Program in Lima, Peru. The ABC Program aims to advance health literacy and improve household hygiene through the arts.


In the densely populated settlements that sprawl across the barren desert outskirts of Lima, Perú, homes are often built from materials scavenged from nearby garbage dumps and landfills. The water may not be clean and may arrive by pipe, by truck, or by hand in some cases. In all cases, this is the water people use for drinking, cooking, bathing, washing clothes, and cleaning.

Canyon Ranch Institute (CRI), in partnership with The Clorox Company, collaborated with the Boston University College of Fine Arts to develop the Arts for Behavior Change (ABC) Program. The ABC Program is a unique merger of health literacy, the arts, and public health. In addition, experts from the Mel and Enid Zuckerman College of Public Health at the University of Arizona conducted microbiological work to identify changes in levels of disease-causing germs in households. Local Peruvian groups also collaborated to produce the artistic components of the program and to evaluate its effectiveness. Read about the collaborators.

How We're Making a Difference

The ABC Program's innovative approach used storytelling arts, such as theater, music, and dance, to advance health literacy about healthy Two_actors_web_250Actors from Asociación Kallpa, an ABC Program collaborator, presented "telenovela" plays and engaged audience members in addressing community health challenges. hygiene practices and improve the health of people living in low-income communities. What we learned from the ABC Program in Perú has strengthened our ability to help prevent disease and death in the United States and around the world.

The ABC Program was based on a large body of work often called Theatre of the Oppressed, which uses a range of theatrical forms to develop collective solutions to concrete problems. In this effort, CRI developed a brand-new type of theater called “Theater for Health.” In this type of theater, the community participates in the development of a play. During the performances, actors and participating community members interact and learn to collaboratively develop solutions to health challenges.

Content of the artistic performances was informed by an initial formative assessment that identified existing hygiene practices, barriers to healthier behaviors, and culturally grounded and widely shared narratives that could be adapted for this project.


Evaluation is a key and robust part of the ABC Program and uses qualitative and quantitative methods. The ABC Program was evaluated through:

  • Microbiological testing for levels of a suite of bacteria, viruses, and parasites in a sample of households;
  • Assessment of the implementation and impact of the program on participants' hygiene-related behaviors;
  • Changes in knowledge and attitudes related to household and personal hygiene; and
  • Process evaluation to monitor and document the implementation process for future replication by learning about participants’ reactions and take-aways after attending performances, and to improve the intervention by providing feedback to the artists.

Setting the Stage for Better Health


Actors from Asociacion Kallpa, an ABC Program collaborator, present "telenovela" plays and engage audience members in commenting and providing potential solutions to community health challenges.

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