Social Influence on Handwashing with Soap: Results from a Cluster Randomized Controlled Trial in Bangladesh

Grover, Elise; Hossain, Mohammed Kamal; Uddin, Saker; Venkatesh, Mohini; Ram, Pavani K.; Dreibelbis, Robert

doi:10.4269/ajtmh.17-0903

Cited by 18 publications

(13 citation statements)

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“…The salience of the nurture motive in our study population is consistent with other studies of students handwashing. For example, a study in Bangladesh that used covert video cameras to record handwashing behaviour found numerous instances of older children helping younger children washing hands and modelling positive behaviours for one another 29. Students in our study responded positively to the nurture messages, suggesting that positive peer pressures are a potential avenue for improving HWWS in schools.…”

Section: Discussionmentioning

confidence: 60%

Factors perceived to facilitate or hinder handwashing among primary students: a qualitative assessment of the Mikono Safi intervention schools in NW Tanzania

et al. 2019

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ObjectiveTo qualitatively assess the effects of a multi-modal school-based water, sanitation and hygiene (WASH) intervention on handwashing behaviour among primary students in North Western (NW) Tanzania.DesignThe study was a qualitative assessment of barriers and facilitators to handwashing among students attending primary schools participating in the Mikono Safi Trial (Kiswahili for ‘Clean Hands), a cluster-randomised trial assessing the impact of a school-based WASH intervention on selected soil transmitted helminth infections. Data collection methods included in-depth interviews with teachers, focus group discussions and friendship pair interviews with students collected between April and October 2018. The Capability-Opportunity-Motivation and Behaviour model was used to inform data collection and analysis.SettingThe study was conducted in four purposively selected intervention schools in three districts of Kagera region, NW Tanzania (Bukoba urban, Bukoba rural and Muleba districts).ParticipantsParticipants comprised 16 purposively selected teachers aged between 23 and 52 years and 100 students aged 7–15 yearsResultsThe Mikono Safi intervention increased students’ reported capability and motivation to wash their hands with soap at key times, particularly after visiting the toilet. Improvements in students’ handwashing knowledge and skills were reported by both teachers and students, and motivation for handwashing was enhanced by emotional drivers such as disgust, fear and nurture. Newly established handwashing stations improved the physical opportunity to wash hands, although the availability of water and the provision of soap was not always consistent (eg, due to internal organisational shortcomings or during the dry season). Students and teachers were actively engaged in intervention implementation which created a school community that valued and supported improved hand hygiene.ConclusionThe intervention was successful in improving capability and motivation for handwashing. Handwashing opportunity was also greatly improved, although the supply with water and soap was sometimes interrupted, calling for much stronger multi-sectoral collaboration to improve access to water at schools.Trial registration number ISRCTN45013173; Pre-results.

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Section: Discussionmentioning

confidence: 60%

Factors perceived to facilitate or hinder handwashing among primary students: a qualitative assessment of the Mikono Safi intervention schools in NW Tanzania

et al. 2019

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“…Can social influence or peer effects improve hand‐washing engagement? Recent works have identified that social influence plays an important role in many behaviors like exercise or diet (Aral & Nicolaides, ; Lim & Meer, ), and there is some initial evidence that it can play a role in individual hygiene (Grover et al., ). There is certainly a need for rigorous and carefully designed field experiments on a large population scale, to identify and measure the causal effect of digital nudges, incentives, and peer influence on public hand‐washing engagement of air travelers as well as the mechanisms of health‐enhancing human behavior change.…”

Section: Discussionmentioning

confidence: 99%

Hand‐Hygiene Mitigation Strategies Against Global Disease Spreading through the Air Transportation Network

et al. 2019

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The risk for a global transmission of flu-type viruses is strengthened by the physical contact between humans and accelerated through individual mobility patterns. The Air Transportation System plays a critical role in such transmissions because it is responsible for fast and long-range human travel, while its building components-the airports-are crowded, confined areas with usually poor hygiene. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) consider hand hygiene as the most efficient and cost-effective way to limit disease propagation. Results from clinical studies reveal the effect of hand washing on individual transmissibility of infectious diseases. However, its potential as a mitigation strategy against the global risk for a pandemic has not been fully explored. Here, we use epidemiological modeling and data-driven simulations to elucidate the role of individual engagement with hand hygiene inside airports in conjunction with human travel on the global spread of epidemics. We find that, by increasing travelers engagement with hand hygiene at all airports, a potential pandemic can be inhibited by 24% to 69%. In addition, we identify 10 airports at the core of a cost-optimal deployment of the hand-washing mitigation strategy. Increasing hand-washing rate at only those 10 influential locations, the risk of a pandemic could potentially drop by up to 37%. Our results provide evidence for the effectiveness of hand hygiene in airports on the global spread of infections that could shape the way public-health policy is implemented with respect to the overall objective of mitigating potential population health crises.

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“…Can social influence or peer effects improve smart hand-washing engagement? Recent works have identified that social influence plays an important role in many behaviors like exercise or diet 51,52 , and there is some initial evidence that it can play a role on individual hygiene 53 . There is certainly a need for rigorous and carefully designed field experiments on large population scale to identify and measure the causal effect of digital nudges, incentives and peer influence on public hand washing engagement of air travelers as well as the mechanisms of health-enhancing human behavior change.…”

Section: Discussionmentioning

confidence: 99%

Hand-hygiene mitigation strategies against global disease spreading through the air transportation network

Nicolaides

Avraam

Cueto‐Felgueroso

et al. 2019

Preprint

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Hand hygiene is considered as an efficient and cost-effective way to limit the spread of diseases and, as such, it is recommended by both the World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC). While the effect of hand washing on individual transmissibility of a disease has been studied through medical and public-health research, its potential as a mitigation strategy against a global pandemic has not been fully explored yet. In this study, we investigate contagion dynamics through the world air transportation network and analyze the impact of hand-hygiene behavioural changes of airport population against the spread of infectious diseases worldwide. Using a granular dataset of the world air transportation traffic, we build a detailed individual mobility model that controls for the correlated and recurrent nature of human travel and the waiting-time distributions of individuals at different locations. We perform a Monte-Carlo simulation study to assess the impact of different hand-washing mitigation strategies at the early stages of a global epidemic. From the simulation results we find that increasing the hand cleanliness homogeneously at all airports in the world can inhibit the impact of a potential pandemic by 24 to 69%. By quantifying and ranking the contribution of the different airports to the mitigation of an epidemic outbreak, we identify ten key airports at the core of a cost-optimal deployment of the hand-washing strategy: increasing the engagement rate at those locations alone could potentially reduce a world pandemic by 8 to 37%. This research provides evidence of the effectiveness of hand hygiene in airports on the global spread of infectious diseases, and has important implications for the way public-health policymakers may design new effective strategies to enhance hand hygiene in airports through behavioral changes.All rights reserved. No reuse allowed without permission.The copyright holder for this preprint (which was not peer-reviewed) is the author/funder. . https://doi.org/10.1101/530618 doi: bioRxiv preprint continents 5, 6 . The H1N1 flu, which caused around 300,000 deaths worldwide 7 , had a similar timeline. The first confirmed case of H1N1 was reported in Veracruz, Mexico on April 2009, while within few days the infection migrated to the US and Europe, and two months later the World Health Organisation (WHO) and the Centers for Disease Control and Prevention (CDC) declared the disease as a global pandemic.Bacteria, pathogens and viruses are also transmitted easily at airports or during flights, causing infections and bacterial diseases that can expand to global epidemics. The pathogens are transmitted through the air 8 , resulting in the contagion of airborne diseases, or through physical contact between individuals. The transmission is accelerated when a dense population of people is concentrated in a confined area 9 like an airport, with lack of good hygiene and efficient air ventilation. After an outbreak, infections diffuse while infected individ...

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Social Influence on Handwashing with Soap: Results from a Cluster Randomized Controlled Trial in Bangladesh

Cited by 18 publications

References 20 publications

Factors perceived to facilitate or hinder handwashing among primary students: a qualitative assessment of the Mikono Safi intervention schools in NW Tanzania

Factors perceived to facilitate or hinder handwashing among primary students: a qualitative assessment of the Mikono Safi intervention schools in NW Tanzania

Hand‐Hygiene Mitigation Strategies Against Global Disease Spreading through the Air Transportation Network

Hand-hygiene mitigation strategies against global disease spreading through the air transportation network

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