Effectiveness of behaviour change techniques used in hand hygiene interventions targeting older children – A systematic review

Watson, Julie; Cumming, Oliver; MacDougall, Amy; Czerniewska, Alexandra; Dreibelbis, Robert

doi:10.1016/j.socscimed.2021.114090

Cited by 21 publications

(28 citation statements)

References 65 publications

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“…Our study also demonstrates that observational methods can be readily used to evaluate the impact of simple interventions to improve adherence, providing a better indication of where problems lie and what interventions work to resolve them. This is consistent with other evidence on the efficacy of the use of notices and other environmental prompts for activating behaviour changes, including hand hygiene 6 .…”

Section: Observed and Self-reported Covid-19 Health Protection Behaviours On A University Campus And The Impact Of A Single Simple Intervsupporting

confidence: 91%

Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention

Davies

Weinman

Rubin

2021

Preprint

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Objectives Hygiene behaviours had been an essential component of attempts to slow the spread of SARS-CoV-2. Most data on adherence to these behaviours is collected via self-reporting, which can differ from observed behaviours. We quantified this discrepancy among a university sample and tested the impact of simple intervention on observed behaviour. Study design Cross-sectional questionnaire of behaviour on campus compared to direct observation on one day without, and one day with, additional signage. Methods We circulated an email inviting all staff and students at our university to complete a questionnaire asking how often they wear a mark or practice hand hygiene when entering campus buildings, and how often they practiced social distancing within campus buildings. We observed all entrants to the main building on one campus on a baseline day and on a day after installing a large sign reminding people that these behaviours were mandatory. Results In our survey, 172 out of 252 respondents (68%) reported always cleaning their hands, 225 out of 251 (90%) reported always wearing a face covering, and 124 out of 252 (49%) reported always maintaining social distancing. On the baseline day of observation, 50 out of 311 people (16.1%) cleaned their hands and 256 (82.3%) wore a face covering correctly. Out of 119 people whom we could assess, 9 (7%) maintained social distance from others. The signage was associated with significant improvements for cleaning hands (104 / 375 people: 27.7%), wearing a face covering (374 / 375; 99.8%) and maintaining social distance (79 / 144; 54.8%). Conclusions Greater use of observational methods will provide a more accurate measure of behaviour than the current reliance on self-report and allow interventions to be robustly tested.

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Section: Observed and Self-reported Covid-19 Health Protection Behaviours On A University Campus And The Impact Of A Single Simple Intervsupporting

confidence: 91%

Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention

Davies

Weinman

Rubin

2021

Preprint

View full text Add to dashboard Cite

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“…By giving real-time feedback (handwashing instructions and rewards) during the handwashing activity, the self-efficacy and motivation of the children are enhanced, attitude and confidence are boosted which leads to improvement of hand hygiene behaviour. A promising hand hygiene behaviour change intervention should include “demonstration of behaviour”, “instruction on how to perform the behaviour”, and “adding objects to the environment” such as installing handwashing stations and providing soap [ 10 ]. It is important for the children to understand how to perform handwashing in a correct way and provide the right tools to be able to do so [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hand hygiene interventions that could enhance psychosocial variables such as behavioural capacity, attitudes, and subjective norms are widely used in educational settings [ 3 , 9 ]. Also, incorporating behaviour change techniques and play in hand hygiene interventions for children provide effective results in promoting hand hygiene behaviour [ 10 , 11 ] and building self-efficacy in handwashing [ 12 , 13 ]. Many of these studies that used hand hygiene interventions among children in educational settings evaluated effectiveness in reducing infectious related-absenteeism [ 5 , 11 , 14 ], decreasing infections [ 5 , 7 ], hand hygiene compliance [ 4 , 15 , 16 ] and microbiological effect [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Hand hygiene of kindergarten children—Understanding the effect of live feedback on handwashing behaviour, self-efficacy, and motivation of young children: Protocol for a multi-arm cluster randomized controlled trial

et al. 2023

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Early implementation of interventions at a young age fosters behaviour changes and helps to adopt behaviours that promote health. Digital technologies may help to promote the hand hygiene behaviour of children. However, there is a lack of digital feedback interventions focusing on the hand hygiene behaviour of preschool children in childhood education and care settings. This study protocol aims to describe a study that evaluates the effectiveness of a gamified live feedback intervention and explores underlying behavioural theories in achieving better hand hygiene behaviour of preschool children in early childhood education and care settings. This study will be a four-arm cluster randomized controlled trial with three phases and a twelve-month follow-up by country stratification. The sample size is 106 children of which one cluster will have a minimum number of 40 children. During the baseline phase, all groups will have automated monitoring systems installed. In the intervention phase, the control group will have no screen activity. The intervention groups will have feedback displays during the handwashing activity. Intervention A will receive instructions, and intervention B and C groups will receive instructions and a reward. In the post-intervention phase, all the groups will have no screen activity except intervention C which will receive instructions from the screen but no reward. The outcome measures will be hand hygiene behaviour, self-efficacy, and intrinsic motivation. Outcome measures will be collected at baseline, intervention, and post-intervention phases and a 12-month follow-up. The data will be analysed with quantitative and qualitative methods. The findings of the planned study will provide whether this gamified live feedback intervention can be recommended to be used in educational settings to improve the hand hygiene behaviour of preschool children to promote health. The trial is registered with ClinicalTrials.gov (registration number NCT05395988 https://clinicaltrials.gov/ct2/show/NCT05395988?term=NCT05395988&draw=2&rank=1).

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“…However, designing effective hygiene programmes in crises or public health emergencies is a complex task. Literature reviews have identified major gaps in our understanding of what works to change and sustain hygiene behaviour in stable, non-emergency settings [8][9][10][11][12]. The majority of these reviews conclude that health information alone is unlikely to be sufficient to change behaviour.…”

Section: Introductionmentioning

confidence: 99%

How are hygiene programmes designed in crises? Qualitative interviews with humanitarians in the Democratic Republic of the Congo and Iraq

et al. 2022

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Background Hygiene behaviour change programmes are complex to design. These challenges are heightened during crises when humanitarian responders are under pressure to implement programmes rapidly despite having limited information about the local situation, behaviours and opinions—all of which may also be rapidly evolving. Methods We conducted in-depth interviews with 36 humanitarian staff involved in hygiene programme design in two crisis-affected settings—one a conflict affected setting (Iraq) and the other amid a cholera outbreak (Democratic Republic of the Congo). Interviews explored decision-making in each phase of the humanitarian project cycle and were thematically analysed. Results Participants considered the design and implementation of hygiene programmes in crises to be sub-optimal. Humanitarians faced sector-specific challenges as well as more general constraints associated with operating within the humanitarian system. Programme-design decisions were made naturalistically and relied heavily on the intuitions and assumptions of senior staff. National organisations were often side-lined from programme design processes despite being in a better position to gather situational data. Consequently, programme design and decision-making processes adopted by humanitarians were similar across the two settings studied and led to similar types of hygiene promotion activities being delivered. Conclusion Hygiene programming in crises-affected settings could be strengthened by initiatives targeted at supporting humanitarian staff during the pre-implementation programme design phase. This may include rapid assessment tools to better understand behavioural determinants in crisis-affected contexts; the use of a theory of change to inform the selection of programme activities; and funding mechanisms which encourage equitable partnerships, phased programming, regular adaptation and have programmatic components targeted at sustainability and sector capacity building. Initiatives aimed at sector reform should be cognisant of inter and intra-organisational dynamics, the ways that expertise is created and valued by the sector, and humanitarian habits and norms that arise in response to system constraints and pressures. These micro-organisational processes affect macro-level outcomes related to programme quality and acceptability and determine or limit the roles of national actors in programme design processes.

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Effectiveness of behaviour change techniques used in hand hygiene interventions targeting older children – A systematic review

Cited by 21 publications

References 65 publications

Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention

Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention

Hand hygiene of kindergarten children—Understanding the effect of live feedback on handwashing behaviour, self-efficacy, and motivation of young children: Protocol for a multi-arm cluster randomized controlled trial

How are hygiene programmes designed in crises? Qualitative interviews with humanitarians in the Democratic Republic of the Congo and Iraq

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