Effects of complexity of handwashing instructions on handwashing procedure replication in low-income urban slums in Bangladesh: a randomized non-inferiority field trial

Abstract

Handwashing instructions vary in complexity, with some recommending multiple steps. To assess whether complex handwashing instructions changed handwashing procedure replication, we conducted a randomized non-inferiority trial in a low-income area, Dhaka. We randomly assigned mothers and children aged 5–10 years to one of three handwashing instruction sets: simple (N = 85 mothers/134 children), moderate (N = 75 mothers/148 children), or complex (84 mothers/147 children). Simple instructions had three steps: wet, lather, and rinse hands, and moderate included the simple instructions plus steps to scrub palms, backs of hands, and dry hands in the air. Complex instructions included moderate instructions plus steps to scrub between fingers, under nails, and lather for 20 s. After baseline, cue cards were used to promote handwashing instructions, and adherence after 2 weeks of interventions was evaluated. Compliance with handwashing procedure replication to all instructions in simple, moderate, and complex increased after the intervention among mothers and children. Compliance to all instructions in the simple group was higher in the simple group (100%) compared to all instructions in moderate (47%) and complex instruction groups (38%). Simple handwashing steps are easier to remember for long time periods compared to complex steps.

Population-Level Preparedness About Preventive Practices Against Coronavirus Disease 2019: A Cross-Sectional Study Among Adults in Bangladesh

“…The findings show that 12–24% of respondents reported their inconvenience regarding proper handwashing practices and disinfecting items of personal use after each time they return home. This inconvenience related to personal hygiene could be attributed to factors like the availability of handwashing commodities, price, facilities, and knowledge and attitudes toward handwashing ( 27 – 30 ).…”

Nudge strategies for behavior-based prevention and control of neglected tropical diseases: a scoping review and ethical assessment

“…As detailed previously, 33 papers were retained following full-text analysis [38-70]. This section will present the eligible records and the extracted data relating to the study characteristics.…”

“…During that first modest increase (2010 – 2017), 12 studies were published [39, 41, 46, 49, 56, 59-61, 63-65, 67]. The exponential increase is most noticeable in 2018 resulting in 7 eligible studies [42, 43, 48, 50, 55, 57, 58], while in 2019, there were 9 included studies [38, 44, 45, 52, 54, 62, 66, 69, 70], and finally up until 6 th September 2020 we identified 5 additional studies [40, 47, 51, 53, 68].…”

“…Finally, decision information was the least used category with 5 nudges using "translate information" through simplification and message reframing [38,52,58,60], 3 nudges using "provide social reference point" referring to role-models [39,43,48,49], and 2 nudges implementing "make information visible" through visualization of the future and providing visual feedback [44,52]. The results of each of the eight ethical criteria described in Table 3 are presented below one by one, and the findings are visualized in Figure 4 targeted behaviors during specified moments such as water disinfection, or involving a certain group (e.g.…”

Data_Sheet_1.PDF

“…The findings show that 12-24% of respondents reported their inconvenience regarding proper handwashing practices and disinfecting items of personal use after each time they return home. This inconvenience related to personal hygiene could be attributed to factors like the availability of handwashing commodities, price, facilities, and knowledge and attitudes toward handwashing (27)(28)(29)(30).…”