Malaysian Journal of Public Health Medicine 2013, Vol.

13(1): 48-58

REVIEW INTERPERSONAL TOUCH: THE LOST ART OF MANKIND - A REVIEW

Choy HH, Khalib AL Faculty of Medicine, Department of Community Health, University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.

ABSTRACT
Surprisingly little was known about the importance of touch in life which was placed at a lower emphasis than the rest-namely visual, auditory, olfactory sense and etc. This writing aimed to decipher the significances of interpersonal touch, its culture, practices, barriers and challenges, which were then conveyed to the public as a form of health promotion. Methodology includes narrative review where the suitable literatures used were searched using ScienceDirect database under the keywords of Interpersonal Touch, Oxytocin and Touch . In this review, we have highlighted some of the most critical points which should have been promoted to the public. For example, touch satisfies individual psychosomatic and psychosocial needs. It forms a non-verbal communication culture which interacts about emotions, trust, compliance and more. Furthermore, it has been linked to the secretion of multifunctional bioactive chemical-oxytocin which was well-known in its therapeutic advantages for a wide range of commonest chronic diseases and social ills. Although some dysfunctional consequences may be resulted, incorporating genuine interpersonal touch into todays efforts is undeniably viewed as a good option in solving many social problems. Key words: Interpersonal touch, touch hunger, oxytocin, therapeutic potential, health promotion, challenges.

INTRODUCTION
All along in the history whether between mankind and animal kingdom, both have shared a similar trait of showing affection and delivering emotion to one another through. A touch or a hug is scientifically referred as a form of interpersonal touch. It is the universal form of physical intimacy used to convey feelings and love as well as to ease pain and burden suffered by another party. It is a required psychosocial need to give a true meaning in life. It helps to maintain health and to move forward and growth. If these needs are not met, human easily fall apart both mentally and even worse biologically. It may drives towards a serious toll to all forms of psychosomatic and psychosocial illnesses. Those who are socially isolated (rarely touch) is a major risk factor for morbidity and mortality from widely range of commonest chronic diseases1. Thus interpersonal touch may potentially works as a remedy to overcome problem that cannot be solved by the modern methods. Hugging could be adopted as a potential form of healing2. The issue is how to rebrand this lost art of mankind as a therapeutic intervention to minimize and curbing the issue pertaining to socially deprive life loneliness.

Interpersonal touch may not be a cure, but it offers us something that a cure cannot. Thus, this paper was constructed based on intense reviews on the current available scientific writings to support and serve as a form of an encouragement to instill the need and importance of interpersonal touch in daily life. It is a hope that this writing is possible to serve as a trigger to revive such practice in people whom had once been habitually incorporate interpersonal touch in daily life and as well as to those who have doubts or never exposed to it, in order to be convince and give birth to this new form of culture that assist in the betterment in mankind and health. If the culture integrating interpersonal touch in life brings only about benefits, it is believe that promoting such therapeutic technique as a form of health promotion shall gain recognition of many individuals, sooner or later. This review was constructed using the results from narrative review method where the key words Interpersonal Touch, Oxytocin and Touch were searched under the ScienceDirect database. Related literatures were also referred using Google search and the link to the webpages were cited as accordingly. Lessons from the animal kingdom Over the last three decades, various studies on interpersonal touch in different interactions were

Malaysian Journal of Public Health Medicine 2013, Vol. 13(1): 48-58 done3. This unique trait is not shared among humans only. An American psychologist quotes it in his writing, The Nature of Love as, We believe that contact comfort has long served the animal kingdom as a motivating agent for affection responses4 His idea was further supported with the findings by scientists on chimpanzees. Chimps were observed to comfort each other after fighting with a reassuring peck on the cheek and a consoling hug5. Kisses, strokes and hugs helped to lower stress levels and in addition to the previous study, a paper was published in the Proceedings of the National Academy of Sciences concluded that chimps do kisses and hugs after argument and friends chimps who always shared foods or played together were the most likeliest to offer support5. The stress levels of the chimps were measured and recorded based on the frequency of self-scratching and self-grooming which then are compared to the normal levels of a happy chimp. Scientists were able to draw a conclusion for the very first time that cuddles and hugs possessed a calming and reassuring effect on the subject 5. Such consoling behavior has also been seen before in wild apes, dogs, rooks and even human. Interpersonal touch trait in mankind Touch is the very first sense experienced by mankind6,7. It is a physiologic phenomenon that is manifested since childhood. The fetus receives the first touching stimulation through contact with the mothers womb and in later stage via breastfeeding and cuddling from parents8,9,10. A seven year old child puts an arm around a friends shoulder if he has been bullied, or a child hugs a doll or his/her mother when he/she feels threatened by an unfamiliar person, this display a need for protection-a sense of trust, believing and the calming affection. When a child falls down, instinctively a parent may cuddle him/her or offer a kiss onto the bruise or injured area to make it feels better. Some children (and even adults) enjoy hugging their favorite pillow or bolster as a way to ease their discomfort. Interpersonal touch utilizes our largest sense organ, the skin11,12,13. It consists of a firm handshake, an inspiring pat on the back, a gentle brush of the shoulder, a warm hug or other forms of sincere physical contact, which is believed to be associated with the action to foster or to cherish14. The cross-culture practices The universal mutual benefits of touching, the feeling of relief and satisfaction, is an understanding fact. Although it is slightly varied according to their social class, setting, ethnic identity, gender, faith etc. its important social tool is keep maintained and to be enriched. The experiences from its practices should be a source of a good lesson if interpersonal touch is to be valued. Interpersonal touch is generally rooted and evolved within its social class. Its style differs from one to another, depending upon its specific purpose and its society. It is more obvious in the established society compared to more metropolitan nation. Couples in Puerto Rico touch more (approximately 100 times in one hour) compared to couples in England (which is averagely zero)15. Whereas, French adolescent prefers touching each other more than American adolescent who normally enjoys self touching i.e. rubbing their arms and putting fingers on their hair16. It is also conditioned by its setting, circumstances or contexts. Higher frequency of touch is observed in the recognized communal areas such as caf, restaurants, airports (particularly the departure hall or lounge) and others17. The finding revealed that touching in the caf was more obvious compared to other settings such as airports, shopping mall and other - approximately 60%. The reason being is caf is a more suitable atmosphere for intimate couples to meet and to enhance practice of touch between themselves than people who are sharing casual or formal bond. As to its ethnic identity, Latin culture for instance, values interpersonal touch as a form of a joyous greeting. Their males hug and pat on others back as their routine custom. As for the women, their social hug usually accompanied with a kiss on the receivers cheek. Some culture regards it as a way to groom the future generation into a pleasing mannerless aggressive, respect and caring18. With regards to parenting style, French parents display much frequent affection touch to their offspring compared to the American19. Such parental grooming has then reflected to the kids aggressiveness level, whereby the French kids showed less aggressive behaviors when compared to the American. Many studies have demonstrated that the duration, frequency and intensity of touch are correlated significantly with its age and gender. It is observed that among the school teenager,

Malaysian Journal of Public Health Medicine 2013, Vol. 13(1): 48-58 their touch appears much longer for the similar sex pairs than those of cross-sex pairs. Further more, the hugging is also more intense between females compared to male20-25. However, when maturation takes place, the touch practices tend to be differed26. Students are more incline towards the opposite sex. Whilst males are more dominant when introducing this practice among collages in the college. Nonetheless interpersonal touch is viewed differently according to peoples indigenous religion and their faith. As these teachings are being rooted for thousands of years, some are encouraged, whereas some are discouraged. Therefore, it may appear unfavorable and it could pose a great challenge towards promoting interpersonal touch as an option for healing. As it tends to be perceived differently, its practice must be cautiously used for fear of triggering conflict, social calamity or even lawsuit. Evidences have clearly shown that those with weak religious knowledge are easily engaged with the wrong doing such as kissing, groping, sexual assault - cornering, actual or attempted rape, illegal sex, other non physical harassment and its consequences, to the extreme27. Literatures have also found that unwanted touch can easily be labeled as a form of sexual harassment, embarrassment, interrupting personal right, demoralize people, insulting and towards an extent which is a form of sin27-29. In the era of borderless nation, where interpersonal touching is silently advocated worldwide, and now become the trend-the phenomena of today generation. Its development certainly undeniable and must be closely scrutinized and monitored so that it could help to satisfy its very core principleself-relief, harmonize self and life satisfaction. Global slogan and movement like Hi-Five and Hip-Hop to name a few, has become the favorite social expression and already a trend when teenagers gather30. They give breath to a new custom of touch by introducing they own greeting identity including verbal words such as Yo, how are you dude, Wazsup dude (how are you, my friend) and etc. It gives them satisfaction and closeness. In United States, these practices are examples of today culture especially among the teenagers. So long it brings a favorable outcome and helps to enhance ones feeling, it should be encouraged. For diversity nation with multiethnic countries and various cultures, this global trend certainly required an in-depth examination across culture if it is planned to be incorporated into various components of national agenda. The role of oxytocin the touch hunger hormone Interpersonal touch acts to trigger the secretion of miraculous and multifunctional love hormone named oxytocin, a hormone secreted by the pituitary gland. This hormone is traditionally known to have a dominant role for lactation, uterine contraction, maternal instinct and its well-known roles in sexual reproduction. But latest research reveals that oxytocin plays a significant role in human behaviors which comprises of sex behavior (orgasm), social recognition and communication, pair bonding (romantic attachment), compliance, positive social judgment and trustworthiness, social rewarding experiences, and anxiety (influences stress and blood pressure)11,31-35. It also helps to give greater longevity, successful aging, cardioprotective effect, stress reduction, sedation for drug and alcohol dependency issues, prevention of neurodevelopment delays, better protective effect on gastrointestional function, enhance immune response to endotoxins, aid in responses to infection and injury, accelerates wound healing processes, and more36-46. However, the release of oxytocin can be affected if the role of touch is being ignored. This is especially true among those who are socially isolated, lonely or having difficulties to communicate, express their feeling and problems, and unmotivated to ask question (i.e. in a classroom while the subject is a student). Mankind (regardless of age) is facing all kinds of distress phenomenon due to insufficient physical stimulation11. Among kids, it may impair the cognitive capability due to delay in neurological development, and in some cases, the problem can be irreversible and permanent47-50. Whereas for the youngsters, their academic performance shall be discouraging which may affects their intellectual ability and their progress in life51. Although synthetic oxytocin is available in the market to solve the problems, many researches nowadays still centre on the question whether endogenous oxytocin could possibly be used to enhance emotion and social functioning to a wide set of disorders which includes schizophrenia, autism, depression and anxiety52-54. This has invited an intense interest to advocate touch hunger and touch hugger as a way to secrete oxytocin to overcome various forms of distressrelated illnesses affecting human and its relationship.

Malaysian Journal of Public Health Medicine 2013, Vol. 13(1): 48-58 Interpersonal touch and its therapeutic potential Interpersonal touch is viable non-verbal practice to express love and friendship without much stigma. It is approximately ten times more effective than verbal communication55. Its bonding feeling between infant and spouse, emotional support, dispel anxiety, comforting depression and stress and consolation are well documented31,56. Literature search brings forth some significant evidences of incorporating the element of touch as a therapeutic remedy in daily life. Even the shortest duration of touches from other people can provoke a strong emotional relief experience55. For instance, the soothing sensation of being touched by the loved ones (such as the spouse) can be immediately given rise to a great satisfaction. The effect is further enhanced if it is compliment together with the pleasing oral support57,58. Touch or touching is known to improve the sexual relationship between couples. In one study using the synthetic oxytocin, it helps to increase calmness and decreased anxiety between conflicting couples, and indirectly promotes positive and better sexual interaction between them57,59,60. This indicates oxytocin activity during a distress relationship is capable to facilitate social reconciliation or pair-bonding and can serve as an active coping mechanism. Therefore, many scientists believe oxytocin can be used as a marker or as an index to predict poor marriage or its intimate relationship61,62. Interpersonal touch may also be used to improve consumption compliance. In study done to observe the consumer behaviour, higher compliance is observed to those who are personally being touched compared to those who are not63. In fact, the effect of brief touch has also triggered a positive outcome on the increment of relationship, friendliness, honesty, sincerity, agreeableness and kindness64. In the academic field particularly to the school students, touching has increased the rate of student volunteerism. The students who are briefly empowered with a physical touch by the teacher perform much better exercise compared to the others who are not touched. Furthermore, they are more willing to participate and to demonstrate their eagerness to the exercise given on the blackboard65,66,67. Congruent results are also reported among those who have a higher liking to comply with tasks63. In another experiment conducted, it is found that those who are caringly touched answer much more items and more likely to complete the whole survey, in contrast to those who were not touched69. Perhaps the most important therapeutic effect of interpersonal touch is on the trust development whether among people who we know or stranger. Physical touch is capable to advocate positive social judgments (facial trustworthiness and attractiveness) and enhancing the affection behavior towards unfamiliar peoples31. The mechanism is believed to be associated with the suppression of defensive behavior created by the end-product of oxytocin on amygdale (which is group of neurons positioned in the brains medial temporal lobes), thus promotes attachment and affection-related behavior (i.e. compliance, less objection, viewing others more attractive and trustworthy). The degree of trust is further improved if its environment is stimulating70 and if a brief physical contact is also applied71. This is reaffirmed by a separate research72, which indentifies human social perception, judgment and behaviors are in fact influenced by their external stimuli which include touch and warmth, outside of their awareness (unconsciously). Therapeutic potential of touch is also tested for patient with social problem especially among autistic and children with ADHD (Attention Deficit Hyperactivity Disorder). Many studies have found that gentle caring massage (a special form of physical touch) do give a rewarding benefits into certain extent such as improving sleeping problems, increase the attention in the classroom and more active and favorable behavior73-76. To prove this clinically, the effect of the synthetic oxytocin was applied on a group of autism children, where pleasing effect was demonstrated77. Despite of various benefits on interpersonal touch to our health and socio-emotion wellbeing, study on touch and the emotion aspects of it has been neglected by scientists over the time and most researchers appear to be committed in trying to uncover the mysteries on the emotion aspect of other human senses (i.e. audition, vision olfaction and taste) compared to the sense of touch78-81. The positive oxytocin-touch linkage to limit social-related disorders has given a new dimension in therapeutic care. Scientists from worldwide begin to acknowledge that this approach could be an ultimate suggestion to remedy various psychosomatic and psychosocial illnesses82,83. Insight towards health promotion It is quite unusual if certain healthy practices could easily be propagated without formal and intense planning. But, it is true for interpersonal

Malaysian Journal of Public Health Medicine 2013, Vol. 13(1): 48-58 touch. Its remarkable global progress, supported with phenomenon of todays living style, create a surprising shock for most of the health promotion planners. Mediated by variety of social networks, particularly YouTube, its associated activities non-formal social events and functions have continuously viewed and shared. The Free Hugs Campaign for instance, is the most establish global social movement to date. It is non-formally introduced by a lonely Australian guy, Juan Mann in 2004, with the goal to reach out and hug a stranger to brighten up their lives. This movement is spreading like wildfire across globe affecting everyone especially the young generation. It generates and unifies the global community on the phenomena of free huggers56. This story has certainly given a new insight in health promotion activity as not all practices are knowledge-driven. It is about society engagement and trust onto a new thing, new practices. If the practices are universally accepted and convincing, obviously it is a plus point because the journey towards it can be shorten and the efforts can be minimized. Its hugging phenomena also reflect universal social satisfaction. When people are together for common goal, undoubtedly it fulfils the most basic social need of mankind namely security, acceptance, love and care. In long term, it may also satisfy other collateral benefits particularly those related to psychosomatic matters sickness, wellbeing and mental comfort. Therefore, the effort should then be focused on positioning touch for one desire outcome- to ease soul for health betterment. There are at least four target areas that need to be positioned in order to guarantee success in promoting interpersonal touch. It includes the societys ability to trust, societys expectation, the acceptable therapeutic method and the strong therapeutic attachment84,85. Out of four, societys ability to trust is regarded the most crucial area to the success. It is a core value that can contribute to the success of the intended living style that can lead to a positive outcome. The society who has doubts or distrust and defensive to this practice can act as a barrier to the efforts in promoting it86 because trust opens the door to initiate new identity and new role while they are participating. Thus, give them the hope that change is possible for their own betterment in life. Societys expectations also need to be understood well prior to positioning the touch. It is human nature to desire and prefer aspects which brings benefits to them whether to their health or the overall well-being. The significances of interpersonal touch have been highlighted, which is more to gain than to loss. Thus, we the therapist must carefully and specifically tailor an approach to meet their expectation and needs. If the culture forbids touch between male and female who are not related by blood, then interpersonal touch should be suggested to be incorporated between spouses of family members, parents and children or infant or between similar sexes. If the society cannot accept the heavy dosage type of interpersonal touch (i.e. a hug), then encouraged them to inculcate the milder forms (i.e. a firmer or longer duration of handshake starting with just using a hand then progressively to handshake using both arms like AsianMuslim greeting manner, or a gentle pat of the shoulder while conversing, in their daily activities (increasing the frequency of touch) while having the rational on the appropriate situation to deliver a touch/touches. On the acceptability of the therapeutic technique, it is viewed as the details process on how interpersonal touch is buried and internalized. It is not a miraculous cure for chronic diseases, well, at least none of the literatures states 100% confidence on it but it does have healing capabilities and had been used unconsciously by majority living beings in this universe. With a deep understanding, supported with decent scientific based evidences supported by the therapist, it promotes trust and confidence in it which results in a higher compliance level to practice it. The process does not just stop over here, as they demonstrate the therapeutic technique, interpersonal touch shall make them experience a rewarding state (benefits) and further lead them to greater trust and success in their and others life. Finally, the strong therapeutic relationship or attachment must be build strongly (results from mutual understanding and trust) between the society and promoter (people who introduce such culture). The society need to perceive in a way that to them, building a strong bond with the other party is important and usually requires responsive and caring attitude as the fundamental framework. Such strong attachment can be manipulated to make sure that the messages (benefits of performing interpersonal touch) are being passed to the society effectively and genuinely with no exaggerated myth or urban-legend type of unproven facts. Would a person listens well and believe in words of a stranger, or an insincere, not caring and untrustworthy person? Obviously No and let

Malaysian Journal of Public Health Medicine 2013, Vol. 13(1): 48-58 along the compassion or drive to practice what was discussed. It is human nature to have an innate, motivating drive to seek and maintain contact with others who are viewed as important to them and positive attachment creates a secure environment for changes to take place87. The phenomena created through new media like YouTube, blogs and Facebook are not only fast, but very effective. The promoted practices however, require a close monitoring so that its negative elements can be minimized. With great care, all healthy intended outcomes can be expected if its processes are carefully managed. Barriers and challenges A limiting factor to propose interpersonal touch to be used confidently on everyday basis is the dysfunctional mindset of the society regarding touch. When a person hears about touch, one would instinctively relate the word with sex. Why does this happen? The connection between sex and touch is actually being embedded into mind since childhood where sexuality matters is controlled by parental caution of Dont simply touch people from opposite sex, Good girls dont let boys to touch them, Girls should play with girls and boys should hang along with boys, Big boys dont cry, Never receive anything from a stranger (i.e. a touch or hugs from a stranger, children are told that it is bad51. When such mindset was formed from a very early stage of life, this could be resulted later that touch can only be accepted within the legitimate or secure sexual bond such as marriage which proceeds with sexual activity. Thus, one could say this mindset in a way has imprison the genuine concept of touch by confining it to mere content of sex and when a person request for touch, he or she would imply that they want sex. A person may agree to have sex if they want a warmth touch or closeness they need. Surveys indicated that female actually do not seek for sex but rather due to the hunger for touch and such hunger is a real human need51. It can be rather difficult for men to admit they need touch due to their ego. They are up bring in a way was told to be strong, in control and not running to mommy to ask for help or comfort when they face troubles and they are the leader of a family and must show a good example to their spouses and children. So, they (male) find it pathetic when they have to express their need for touch and similarly, when their spouse (female) request for touch. This issue does not bring mutual benefits between spouses but only a weakness in the family where the woman finds her husband to be unresponsive and cold while the husband perceive his wife to be a pathetic sight. When this issue prolongs, the hunger for touch become much more severe and may lead to loss of touch and breakage of a marriage. Moving onto the next challenge on the perspective of religious teachings, certain religions is the world forbids the touching between sexes (female and male or vice-versa) except among parents and children (those sharing family relationship) and spouses but the condition does not apply between the same sex. Thus, the young ones were taught at the very early stage of development with such concept and affection usually is not shown in the public. The act of touching on the head is not encouraged especially a child in India. When observed and compared with other religions available in the globe, certain religious teachings in Asia are clearly more open to interpersonal touch (i.e. hugging) as there are no restriction on physical contact between sexes than the rest of the religion in the same nation but, the culture of giving and receiving touch is still far behind compared to Western communities. Arab peoples may be friendly when it comes to touching or may not prefer to touch at all except between spouses or family members. Interpersonal touch is non-verbal communication Human communicates for four main purposes which includes to share idea, feelings, idea, opinion and stories, to serves as a method to educate the public for the development of skills, knowledge, personality/character and inner-self qualities (spiritually). It is a process to persuade or influence the public in order to gain their compliance, needs and lastly, it acts as a form of entertainment for the sake of self-relaxation. What are the changes that can be done using communication? There are three possible changes which can take place in the public and they are cognitive changes (to educate the public on the significances of interpersonal touch or the awareness on the existence of the interpersonal touch concept), emotion changes (to instill the cultural and social values of the interpersonal touch to the society whether it centers around family unit-spouse vs. spouse, parents vs. children/infant, among relatives, between working unit-staff vs. staff, staff and superiors) and finally, behavioral or attitude changes (to encourage the public to practice interpersonal touch as part of healthy living). The public need to know about these findings, as soon as possible. All these three stages of change may take time to root in their self but are possible to be done by

Malaysian Journal of Public Health Medicine 2013, Vol. 13(1): 48-58 utilizing the powerful media exposure written or non written media. By having media in the picture, the power to advocate benefits of interpersonal touch, as well as to influence and to convince public shall be amplified. Who would resist something which is beneficial to their health, easy to be applied, applicable to old and young peoples, and yet, it is free of charge? I would love to coin a famous and well refined quote88 regarding a theory, Media or press may not be successful much of the time in telling people what to think, but it is stunningly successful in telling its readers what to think about. This quote from Cohen is actually the foundation for the world famous media AgendaSetting Theory89. Public tend to judge what is significant in the real world based on the media and what to focus is based on their own assumption of which is the most important issues. Media is inseparable for the modern peoples lifestyle and comprises of television, radio, internet, right up to any written materials which are publishable. In simple words, media have influences and capabilities to cause cognitive changes by structuring what is important to the public into their (public) mind. Thus, if the significances and the appropriate practice of interpersonal touch are being emphasis on the media, slowly but progressively, it is possible to influence the public to think that it is important in their daily living and transforming it into a practical culture. We have to re-structure the conventional-dysfunction thinking behavior of the public (i.e. touch is sex, touch is not something to be easily used, I am not eligible to touch nor to give touch, touch is a forbidden issue which cannot be discussed and etc) while suiting to the appropriateness of certain culture and religion or other factors. It is utmost important to let the public know that the intention of promoting or introducing interpersonal touch into their living lifestyle is for their own betterment, no hidden agenda or bad intention. This idea is further enhanced with the utilization of Cultivation Theory which states that repetition and pervasive (spread throughout) pattern of ideologies and images can change the publics thoughts and actions. If people spend hours a day, year after year, watching television, browsing internet, listening to radio, reading newspapers and etc, and if all of the materials are about the benefits of interpersonal touch and proper way to gain those benefits, people will come to believe that the world is filled with warmth, love and empowerment which are possible via touch. Instead of encouraging the mean world syndrome90,91,92 which is the effects of receiving high dose of crime and violence from television and causes the viewers to perceive this world as a dangerous and gloomy place to live, we can promote the reciprocate effects whereby touch can make this world into a better place. By using the approach of these two theories, media can acts as a facilitator and fertilizer to introduce, and to keep on promoting (encouraging) and to fertilizing the culture of touching into the society for all stages of age, religion, countries and etc. It is not impossible to make interpersonal touch as a good practice in life with a stage-by-stage and careful planning and most importantly is for the society to be aware of the miraculous effect of touch, to convince and to gain their consent.

CONCLUSION
Interpersonal touch is undeniably needed in life and its significances whether in social, emotional and medical aspects are proven and crucial. Human are social creatures and physical contact is unavoidable and necessarily needed as a fulfillment for psychosocial and psychosomatic needs. It should be well understand that interpersonal touch or touching consist of varying and diverse definition across culture, religion and countries. The question remains; Should or should not physical contact be included in our life especially in medical aspects while considering all the limiting factors? The bottom most approach of interpersonal touch should begin with a handshake. If the issue switches its prospect to centralized onto who should be the one carrying out the touch, then, let it begin with someone who the subject is comfortable with (i.e. between family members such as spouses, parents and their children and infants and etc) and soon be carried by the similar sex members (i.e. friends) and latter, progress to strangers (i.e. someone we just meet, either coincidently or bound by formal occasions) and across sexes (if it is not prohibited by religious factor). The role played by health promotion which encompassed health communication, education, various advocating -media usage and etc are utmost essential to have in order for interpersonal touch be rooted in this and the subsequent generations.

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