Social Influence on Handwashing with Soap: Results from a Cluster Randomized Controlled Trial in Bangladesh (original) (raw)
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Tropical medicine & international health : TM & IH, 2017
To determine the impact of environmental nudges on handwashing behaviours among primary school children as compared to a high-intensity hygiene education intervention. In a cluster-randomised trial (CRT), we compared the rates of handwashing with soap (HWWS) after a toileting event among primary school students in rural Bangladesh. Eligible schools (government run, on-site sanitation and water, no hygiene interventions in last year, fewer than 450 students) were identified, and 20 schools were randomly selected and allocated without blinding to one of four interventions, five schools per group: simultaneous handwashing infrastructure and nudge construction, sequential infrastructure then nudge construction, simultaneous infrastructure and high-intensity hygiene education (HE) and sequential handwashing infrastructure and HE. The primary outcome, incidence of HWWS after a toileting event, was compared between the intervention groups at different data collection points with robust-Poi...
Tropical Medicine & International Health, 2019
Objective: The behavioral effect of large-scale handwashing promotion programs has been infrequently evaluated, and variation in the effect over time has not been described. We assess the effect of a largescale handwashing promotion program on handwashing outcomes in a community setting in Dhaka, Bangladesh. Methods: We analyzed data from a cluster-randomized trial that included 3 arms: vaccine-and-behaviorchange intervention (VBC), vaccine-only (V), and no intervention (Control). Data collectors randomly selected different subsets of households each month during the study period and assessed: 1) temporal variation in availability of soap and water at handwashing place; 2) the use of water and soap by participants when asked to demonstrate handwashing, and; 3) handwashing behavior according to structured observation. We used log-binomial regression analyses to calculate prevalence ratios (PR) and 95% confidence intervals and compare outcomes by study arms. Results: Data collectors surveyed 9325 households over 28 months. In VBC, there was a significant positive trend on availability of water and soap from baseline to 9 months after the start of the intervention (p-fortrends < 0.001), and no significant trend during months 10-28 (p-for-trend = 0.297). In the entire study period, availability of water and soap was higher in VBC (43%) than in V (23%) (PR = 1.92; CI = 1.72, 2.15) and Control (28%) (PR = 1.53; CI = 1.38, 1.69) households. There were no differences between study arms with regard to use of soap during handwashing demonstrations. Observed handwashing with soap after toilet use was higher in VBC (17%) than in V (8%) (PR = 1.47, CI = 0.58, 3.75) and Control (2%) (PR = 3.47, CI = 0.48, 23.33) groups. At other possible pathogen-transmission events, the prevalence of handwashing with soap was ≤ 3%.
Journal of Water, Sanitation and Hygiene for Development
Social and behavior change (SBC) has long been recognized as a necessary step in the promotion of handwashing with soap (HHWS), and identifying the barriers and enablers of this behavior are key to increasing its adoption. Based on the health belief model (HBM), the theory of reasoned action (TRA) and other behavioral models, this barrier analysis study was conducted to identify the barriers and enablers of HWWS after defecation in an urban setting in Bangladesh. We conducted interviews with 45 adults who washed their hands with soap after defecation (doers) and compared them to 45 adults who did not (non-doers). The analysis showed that the main barriers of HWWS after defecation were related to perceived self-efficacy, difficulty to remember to buy soap, access to low-cost soap, low perceived severity of diarrhea, and not believing that HWWS would reduce diarrhea. Believing that it is Allah's will when one gets diarrhea was mentioned more frequently by the non-doers, while feel...
Americn Journal of Tropical Medicine, 2020
This study reports the impact of the HiFive program, a 6-week handwashing campaign that targets social and emotional motivators to improve student handwashing in primary schools in the Philippines. We designed a clustered randomized trial to evaluate the impact of HiFive on student handwashing behavior, motivation, and access. Of the sample of 196 primary schools located in two districts, half were randomly assigned to receive the program in the 2017-2018 school year. Survey and observation data were collected 3 months after the conclusion of the campaign. In control schools, only 2.5% of students were observed washing their hands with soap and water, our primary outcome and 14.8% were observed washing their hands with at least water. HiFive led to a 3.7 percentage point (p.p.) increase (P < 0.01) in the rate of handwashing with soap and water and a 5.6 p.p. increase (P = 0.03) in handwashing with at least water after toilet use. HiFive also led to a 10.8 p.p. (P < 0.01) increase in the number of handwashing facilities stocked with soap. The program had limited impact on the motivators targeted by the program, suggesting that the small improvements in handwashing may have been driven by increases in the availability of soap. More research is needed to understand how interventions can effectively trigger social motivators to improve handwashing behavior among schoolchildren, and whether the effectiveness of these programs can be augmented with "nudge"-based interventions from the behavioral sciences.
Perception and Practice of Hand-washing among Children in Rural Area of Rajshahi
TAJ: Journal of Teachers Association, 2018
This cross-sectional type of descriptive study was undertaken to assess the awareness and practice of hand-washing among children in three villages of Puthia Upazila, Rajshahi District, Bangladesh. A total of 1152 children aged 5-18 years old were purposively selected from the study area. Majority (96%) of them was students of primary or secondary grade. A few were involved in business, farming, service and others. Face to face interview was conducted with the help of a semi structured questionnaire on the variables of interest. Nearly half (49.5%) of the respondents was 11-15 years and the rest >15 years old. Male-female distribution was almost equal. Fathers of the children were service-holder (18.7%), businessman (28.6%), farmer (26.1%) and day-laborer/rickshaw puller (26.5%). Nearly 60% of respondents belonged to poor family having monthly income Taka < 10000. Majority (97.1%) of the respondents was aware of the importance of hand washing and 75% perceived that diseases could be prevented through hand washing. More than 90% of the respondents were used to using soap and water for washing hands and over 80% washed hands regularly. Over three-quarters (77.8%) were accustomed to washing hands in school before tiffin. Most (81.8%) of the respondents used sanitary latrine for defecation. The use of soap-water for washing hands after defecation was significantly higher in older children (> 12 years) than that in younger children (≤ 12 years) (p = 0.020). The use of soap water for washing hands after defecation tends to be associated with children's grade of education with higher tendency being observed in children of secondary and higher secondary school (p < 0.001). Children belonging to higher family income were more cautious in using soap/antiseptics (p < 0.001). The study concluded that perception and practice of handwashing is appreciably high among rural children. However, older children, children studying in secondary grade and belonged to families with higher monthly income were more cautious about hand-washing.
Family & Community Health, 2013
A cross-sectional study was conducted in 5 randomly selected villages to assess prevalence of good hand-washing practice (GHP) among adolescents, and describe the social determinants. The prevalence of adolescent GHP was 32.1% (95% CI = 27.1, 37.1). Logistic regression established 5 significant positive predictors-maternal GHP, presence of sanitary latrine, availability of soap at hand-washing locations, in-house water supply, and higher per capita income. Our research provides a scope for better understanding of the socioeconomic determinants of GHP in a rural Indian setting, and may find implications in the Total Sanitation Campaign launched by Government of India.
International Journal of Environmental Research and Public Health, 2016
Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing traditional handwashing infrastructure, and at multiple time periods following targeted handwashing nudges (1 day, 2 weeks, and 6 weeks). No additional handwashing education or motivational messages were completed. Handwashing with soap among school children was low at baseline (4%), increasing to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. Results indicate that nudge-based interventions have the potential to improve handwashing with soap among school-aged children in Bangladesh and specific areas of further inquiry are discussed.