Contextual and Psychosocial Determinants of Effective Handwashing Technique: Recommendations for Interventions from a Case Study in Harare, Zimbabwe

Abstract

Abstract. Handwashing has been shown to considerably reduce diarrhea morbidity and mortality. To decontaminate hands effectively, the use of running water, soap, and various scrubbing steps are recommended. This study aims to identify the behavioral determinants of effective handwashing. Everyday handwashing technique of 434 primary caregivers in high-density suburbs of Harare, Zimbabwe, was observed and measured as an 8-point sum score of effective handwashing technique. Multiple linear and logistic regression analyses were performed to predict observed handwashing technique from potential contextual and psychosocial determinants. Knowledge of how to wash hands effectively, availability of a handwashing station with functioning water tap, self-reported frequency of handwashing, perceived vulnerability, and action planning were the main determinants of effective handwashing technique. The models were able to explain 39% and 36% of the variance in overall handwashing technique and thoroughness of handscrubbing. Memory aids and guided practice are proposed to consolidate action knowledge, and personalized risk messages should increase the perceived vulnerability of contracting diarrhea. Planning where, when, and how to maintain a designated place for handwashing with sufficient soap and water is proposed to increase action planning. Since frequent self-reported handwashing was associated with performing more effective handwashing technique, behavior change interventions should target both handwashing frequency and technique concurrently.

Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi

“…Such commitment should be made in public by caregivers together with their husbands as they have been found to have a major role in the construction of handwashing facilities and dish racks. As reported in other behavior change studies, 36,37,49 public pledges would also help to reach out to more people and, thus, change descriptive norms. Having adequate water at the household increased the confidence of caregivers to wash utensils with soap.…”

“…However, it has been successfully used to evaluate water treatment, sanitation, and handwashing behavior. 36,37 The RANAS model is applied in two stages: 1) determine the behavior factors for the individuals under study and 2) select behavior change techniques (BCTs) that should be applied to the identified gaps. 38 Consequently, this can provide scientific guidance on which strategies to follow during an intervention.…”

Analysis of Gender-Dependent Personal Protective Behaviors in a National Sample: Polish Adolescents’ COVID-19 Experience (PLACE-19) Study

“…The steps asked were as follows: folding sleeves (while it was also possible to declare as not applicable), removing watches and bracelets (while it was also possible to declare as not applicable), removing rings before or during handwashing (while it was also possible to declare as not applicable), using soap, using warm water, soaking hands before using soap (while it was also possible to declare as not applicable if they do not use soap), spreading soap lather throughout the hands (while it was also possible to declare as not applicable if they do not use soap), turning the faucet off with hand, and drying hands with a towel. The question and the steps included are commonly used in a number of studies dealing with handwashing procedure [ 58 , 62 , 63 , 64 ]. For the majority of steps, including them in the applied procedure was interpreted as needed according to the handwashing guidelines [ 7 , 8 , 9 , 52 ], but for the step described as “turning the faucet off with hand”, including it was interpreted as incorrect due to the fact the faucet should not be touched barehanded after handwashing.…”

A cluster-randomised trial to evaluate an intervention to promote handwashing in rural Nigeria

“…Observational studies have reported a positive association between hardware and handwashing practice (Biran et al 2005(Biran et al , 2009Schmidt et al 2009;Friedrich et al 2017). A review by White et al (2020) postulates that providing access to water and soap through a convenient and desirable handwashing facility may be the most effective means to influence behaviour (White et al 2020).…”