Formative Research for the Design of a Baby Water, Sanitation, and Hygiene Mobile Health Program in Bangladesh (CHoBI7 Mobile Health Program)

Abstract

Poor food hygiene practices, child feces not being disposed of in a latrine, child mouthing of contaminated fomites, and poor hand hygiene of caregivers have been associated with diarrheal diseases, environmental enteropathy, and impaired growth in young children. Mobile health (mHealth) programs present a low-cost approach to delivering water, sanitation, and hygiene (WASH) programs. We conducted a theory-driven and evidence-based approach to formative research and intervention development to design and pilot test a Baby WASH mHealth program targeting food hygiene, child mouthing, and child feces disposal behaviors in urban Dhaka, Bangladesh. Formative research activities included 31 semi-structured interviews, five group discussions, six mHealth workshops, and a threephase iterative pilot study among 102 households. Findings from semi-structured interviews and group discussions indicate that caregivers of young children have relatively high awareness of the need for safer food hygiene, child mouthing, and child feces disposal practices, but are limited by existing household responsibilities and restricted access to enabling technology that would facilitate practicing recommended behaviors. The piloted Baby WASH mHealth program was well-received by households. This study presents a theory-driven and evidence-based approach for intervention development that can be implemented for the development of future WASH mHealth programs in low-resource settings.

Contextual and psychosocial factors influencing caregiver safe disposal of child feces and child latrine training in rural Odisha, India

“…In urban Bangladesh, caregivers of children <3 years old explained that the common practice in their neighborhood (i.e. descriptive norm) was to throw child feces and diapers into open areas [33]. In western Kenya, caregivers of children <2 years old similarly emphasized it was a social norm to bury feces, dispose of wash water (from cleaning cloths/nappies) wherever was convenient, and there was no expectation for older siblings, who sometimes cared for their younger sibling, to practice safe disposal [28].…”

“…Self-regulation is about a person's ability to continue performing a behavior in spite of conflicting priorities, distractions, and other barriers [14]. As qualitative studies document, caregivers are busy with many tasks and find it difficult to incorporate new CFM practices [31,33]. As such, along with norm techniques, CFM interventions focused on safe disposal can incorporate self-regulation techniques like goal setting and prompting caregivers to cope with barriers [49].…”

“…When it comes to improving caregivers' self-efficacy, some behavior change techniques include organizing social support, particularly instrumental support as already discussed, modeling or demonstrating the behavior, and provision of hardware [49]. There are mixed reviews on hardware like potties-some caregivers find them helpful while others do not [30,33]. Novel hardware for latrine training may be needed, especially in contexts where children must learn to squat rather than sit when defecating.…”

“…Consequently, another common finding is the negative attitudes and social norms caregivers experience when their child defecates around the household environment. Many studies documented the disgust caregivers feel towards seeing their child's feces and also the social judgement they face, or anticipate, from having a dirty home [28,[31][32][33].…”

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

“…16 Additional publications document the CHoBI7 mHealth program effect on handwashing with soap while in the hospital, 45 diarrheal disease knowledge, 46 process evaluation for CHoBI7 mobile health program delivery, 47 and recent formative research to develop a CHoBI7 Baby WASH mHealth program targeting safe child feces disposal, improved food hygiene, and safe child mouthing practices. 48 This prospective cohort study, also nested within the recent CHoBI7 mHealth program RCT, adds to this body of literature by investigating the environmental and individual-level risk factors for diarrheal disease among children under 5 years of age residing in slum areas of Dhaka, Bangladesh. We hypothesized that fecal contamination on the household compound and unsafe household hygiene practices would be associated with pediatric diarrhea in this setting.…”