Identifying behavioral determinants of handwashing with soap after defecation in an urban setting in Bangladesh: Findings from a Barrier Analysis

Social and Behavioral Change (SBC) has long been considered as core component of hand washing with soap (HWWS) intervention, but identifying barriers and enablers of HWWS from a behavioral perspective is limited. By examining twelve potential behavioral determinants this Barrier Analysis study was conducted to identify the barriers and enablers of HWWS after defecation in urban setting in Bangladesh. We conducted 45 interviews with those who washed their hands with soap after defecation (“Doers”) and another 45 interviews with those who did not (“Non-doers”). Data analysis was performed to identify which beliefs were most highly-associated with hand washing with soap. The analysis showed that two of the main barriers of HWWS after defecation were related to perceived self-efficacy and access, especially availability of soap. Non-doers claimed that access to soap was difficult due to lack of money and unavailability at nearby shops. Other important determinants such as difficulty remembering to buy soap (cues for action)), believing that most people did not approve of HWWS (e.g. perceived social norms), low perceived severity of diarrhea, and not believing that HWWS would work to reduce diarrhea (perceived action efficacy) were significantly correlated with adoption of the behavior. Perceived divine will (believing that it is God’s will when one gets diarrhea) was also a factor among the Non-doers. Other benefits such as feeling clean and keeping free from illness were reported more often by Doers, while Non-doers were more likely to report increased costs as a barrier to HWWS. The results suggest that an integrated behavior change strategy promoting specific beliefs about HWWS using culturally-inclusive messaging and activities to address the different barriers and leverage the different enablers may lead to better adoption of HWWS.

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Exploring behavioral determinants of handwashing with soap after defecation in an urban setting in Bangladesh: findings from a barrier analysis

Journal of Water Sanitation and Hygiene for Development ◽

10.2166/washdev.2021.070 ◽

2021 ◽

Author(s):

Md. Abul Kalam ◽

Thomas P. Davis ◽

Md. Ariful Islam ◽

Shahidul Islam ◽

Bonnie L. Kittle ◽

...

Keyword(s):

Reasoned Action ◽

Low Cost ◽

Health Belief ◽

Urban Setting ◽

Behavioral Models ◽

Behavioral Determinants ◽

Barriers And Enablers ◽

Barrier Analysis ◽

Belief Model ◽

Handwashing With Soap

Abstract 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 feeling clean and keeping free from illness were reported as benefits of HWWS significantly by the doers. The results suggest that an SBC strategy that addresses these key barriers and enablers would be more effective in promoting the adoption of HWWS.

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Strategy of Making Hand Washing a Routine Habit: Principles of 5Es and 3Rs

Journal of Nepal Medical Association ◽

10.31729/jnma.2693 ◽

2016 ◽

Vol 55 (203) ◽

pp. 40-44 ◽

Cited By ~ 2

Author(s):

Nirmal Kandel ◽

Jaya Lamichhane

Keyword(s):

Behavioral Change ◽

Cost Effective ◽

Educational Interventions ◽

Hand Washing ◽

Optimum Level ◽

Policy Makers ◽

Call To Action ◽

Good Practices ◽

Water And Sanitation Infrastructure ◽

Sanitation Infrastructure

Regular hand washing habit has potential to reduce morbidity and mortality due to diseases and improves child development and reduces absenteeism of children, teachers and workforce. Improving hand washing behavior is more cost effective than improving clean water and sanitation infrastructure. There are numbers of initiatives and interventions in place, which have gained momentum with key messages of a call to action with increasing investment in schools, engaging policy makers and demonstration them with evidence. However, change in behavior as a routine habit has not reached to an optimum level and requires institutionalizing hand washing practices in schools, from schools and by schools and develop it as a curriculum. Therefore, we are purposing principles of 5Es and 3Rs – a strategy to make hand washing a routine habit. These 5E principles are: i) Embedding in a system, ii) Enabling Environment, iii) Eliminating Friction, iv) Encouraging all, and v) Establishing intervention and 3Rs are practicing them Religiously, Routinely and Repeatedly.Numbers of interventions have well demonstrated that hand hygiene educational interventionscan help maintaining good practices. Finally, if schools and community start doing today, we canobserve behavioral change practices for hand washing as a routine habit by at least 10 years after.Keywords: Hand washing, Routine Habit, Principles of 5Es and 3Rs, Educational Interventions, School. | PubMed

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Social determinants of health, the family, and children's personal hygiene: a comparative study

10.1101/477943 ◽

2018 ◽

Author(s):

Antonio Jesús Ramos-Morcillo ◽

Francisco José Moreno-Martínez ◽

Ana María Hernández-Susarte ◽

María Ruzafa-Martínez

Keyword(s):

Cross Sectional Study ◽

Social Rejection ◽

Hand Washing ◽

Urban Setting ◽

Normal Families ◽

Personal Hygiene ◽

Cross Sectional ◽

Validated Questionnaire ◽

Vulnerable Families ◽

The Family

AbstractAimsTo examine differences in personal hygiene and in the perception of social rejection between children in reception centers and children living in a family setting.BackgroundLittle attention has been paid to the influence of the family as a unit on the personal hygiene behaviors of children.DesignCross-sectional study.MethodsChildren aged between 7-12 years were recruited from 2015 through 2017 from two centers in the Network of State Care Centers and from three schools selected from a rural, suburban and urban setting in the same region. A validated questionnaire on child personal hygiene habits was completed by 51 children in reception centers and 454 in normal families.ResultsData shows worse results for the majority personal hygiene habits studied in children in reception centers than in children living in families. Multiple logistic regressions showed lower frequency of body washing, hand washing after defecating, use of soap in hand washing, tooth brushing, and dentist visits during the previous year. Also, a significantly higher proportion of children in reception centers had experienced social rejection for being dirty and smelling bad in comparison to the children living in families.ConclusionsDeficient hygiene habits were observed in the offspring of families affected by the main features of social inequality, who were more likely to perceive social rejection for this reason and less likely to consider their family as the greatest influence on their personal hygiene practices. Promoting family practices designed to improve personal hygiene habits are needed specially in vulnerable families.

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“FORMATIVE RESEARCH” FOR SYSTEMATIC BEHAVIOR CHANGE PROGRAM DESIGN

10.31234/osf.io/bpqfw ◽

2020 ◽

Author(s):

Laxman Kharal

Keyword(s):

Behavioral Economics ◽

Diffusion Of Innovation ◽

Social Marketing ◽

Stages Of Change ◽

Formative Research ◽

Hand Washing ◽

Qualitative Assessment ◽

Baseline Survey ◽

User Centered Design ◽

Behavioral Determinants

We carried out a formative research for developing a structured hand-washing promotion in three municipalities of Bardiya district of Nepal. The research comprised of baseline survey in randomly selected 600 households along with survey on behavioral factors of RANAS (risks, attitude, norm, ability, and self-efficacy) and qualitative assessment of behavioral determinants of barriers and benefits among the doers and non-doers of hand-washing. The survey, assessment and subsequent intervention design were guided by different aspects we found relevant from the following theories and framework: (i) stages of change; (ii) diffusion of innovation; (iii) user centered design; (iv) social marketing; and (v) behavioral economics. The following have been identified among others to be considered while developing the promotion program in close consultation with the target audience: (a) to work on Attitude and Norm (shown by RANAS survey); (b) emphasize hand washing after cleaning child’s bottom and before feeding a child (shown by baseline survey); (c) promote hand-washing stations (as 92% now wash their hands at the tube wells only); (d) target reducing perceived barriers and increasing perceived benefits (from social marketing), nudging (a concept from behavioral economics) where possible; and (e) work with innovators and early adopters first (from diffusion of innovation). A two pager guide with objectives, overall strategy (including for communication) and activities has also been prepared for piloting and further adjusting the strategy before scaling it in a larger area mobilizing a wider stakeholders (such as municipalities, health-posts and schools) and using mass communications and broader distribution channels.

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A study on sanitary and hygiene practices in Chungwang VDC of Dhankuta District, Eastern Nepal

Journal of Chitwan Medical College ◽

10.3126/jcmc.v4i2.10856 ◽

2014 ◽

Vol 4 (2) ◽

pp. 20-24 ◽

Cited By ~ 1

Author(s):

RB Rayamajhi ◽

SS Budhathoki ◽

A Ghimire ◽

SR Niraula ◽

VK Khanal ◽

...

Keyword(s):

Drinking Water ◽

Behavioral Change ◽

Hand Washing ◽

Safe Drinking Water ◽

Oral Transmission ◽

Medical College ◽

Hygiene Practices ◽

Household Members ◽

At Home

Lack of proper practices of sanitary habit leads to ill health of household members, community and the nation as a whole. Provision of sanitary latrines and safe drinking water are necessary to prevent fecal oral transmission of infections. To conduct a study on sanitary hygiene and practices among the residents of Chungwang VDC. 97.4% of the respondents wash their hands with soap or other detergents though 99.3% of them had soaps at their home on observation. Similarly, 81.2% of them had toilet at home but only 79.2% used on regular basis. Basic hand washing was practiced by everyone during/after defecation and before meal but the importance of it after cleaning the bottom and nose of children and before preparing the meal was known to few of the participants. A need of behavioral change regarding optimum hygiene practices is required among the participants. DOI: http://dx.doi.org/10.3126/jcmc.v4i2.10856 Journal of Chitwan Medical College 2014; 4(2): 20-24

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The effects of a behavioral change program in reducing the house index of mosquito larvae in households in Phetcabun province, Thailand

Bhutan Health Journal ◽

10.47811/bhj.04 ◽

2015 ◽

Vol 1 (1) ◽

pp. 15-22

Author(s):

Ugyen Tshering ◽

Kamonchanok Pooma ◽

Kiratikarn Meksaengsee ◽

Nongnooch Aiemsa-ard

Keyword(s):

Dengue Fever ◽

Behavioral Change ◽

Perceived Risk ◽

Health Personnel ◽

Control Group ◽

Post Intervention ◽

Perceived Severity ◽

Local Product ◽

Program Intervention ◽

Group Post

Introduction: The purpose of this quasi-experimental research was to study the effectiveness of a behavioral change program in reducing house index of mosquito in Village Baan-Wangpong, Lomsak district in Phetcabun province, Thailand. Methods: The sample size of experimental and control group was 42 representatives of household in each group. Representatives of each sampled household were tested for knowledge, perception and behavioral practice in prevention of dengue fever before and after the program intervention. The program included training on dengue fever prevention by health personnel, demonstration of making mosquito repellents from local product, organising an awareness contest, broadcasting health messages through media and surveying households for mosquitoes’ larvae. Results: The study found that most households in village Baan-Wangpong had low knowledge (60.4%), perceived risk (60.4%), perceived severity (64.6%) and behavioral practice (77.1%) in the prevention of dengue fever prior to the program, with comparability in intervention versus control. The results showed that after the program intervention, the experimental group had a significantly higher level of knowledge (p=0.001), perceived risk (p=0.042), perceived severity (p=0.002) and behavior (p=0.028) in preventing dengue fever than before the program intervention and higher than the control group post-intervention. The experimental group’s house index was also significantly (p=0.001) lower than before the program and lower than the control group post-intervention. Conclusions: This study suggests that a proactive program about knowledge, perceptions and behaviors on prevention of dengue fever with support from public health personnel and community participation, can positively change health behavior, resulting in reducing the house index of mosquito larva.

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