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.

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Background: Multiple Sclerosis Adult Day Programs (MSADPs) offer life-enhancing services for individuals and informal caregivers affected by MS. Specific services offered may include medical care, rehabilitation therapies, nutrition therapy, cognitive training, tailored education, exercise programs, and social interaction. The purpose of this study was to examine the effects of MSADPs on health-related quality of life (HRQOL) and health care utilization of persons with MS and HRQOL and well-being of informal caregivers. Methods: The study used a quasi-experimental design that compared the outcomes between a baseline and follow-up 1 year later of two groups: persons with MS and informal caregivers who used MSADP services and a comparison group of similar persons with MS and caregivers who did not use MSADP services. For persons with MS, outcomes included standardized measures of physical and mental HRQOL and health care utilization. For caregivers, outcomes included physical and mental HRQOL and well-being. Changes in outcomes between baseline and follow-up for the groups were examined using propensity score weighted difference-in-difference (DiD) regression analysis. Results: For persons with MS, MSADP use had a significant positive effect on SF-12 physical component scores, although the difference was not clinically meaningful. MSADP use did not have effects on any other outcomes for persons with MS or caregivers. Conclusions: MSADP use did not show a clinically meaningful impact on HRQOL for persons with MS or informal caregivers. MSADPs do not appear to offer sustained benefits to persons with MS or caregivers but the possibility of initial short-term benefits cannot be ruled out.