How is hygiene behaviour affected by conflict and displacement? A qualitative case study in Northern Iraq

White, Sian; Heath, Thomas; Ibrahim, Waleed Khalid; Ihsan, Dilveen; Blanchet, Karl; Curtis, Val; Dreibelbis, Robert

doi:10.1371/journal.pone.0264434

Cited by 7 publications

(10 citation statements)

References 60 publications

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“…All of the methods aimed to identify contextual associational relationships within these broader determinant categories. The methodology adopted in this research replicated a process used in Iraq to understand how behaviour was affected during post-conflict displacement [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo

et al. 2022

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Background Handwashing with soap has the potential to curb cholera transmission. This research explores how populations experienced and responded to the 2017 cholera outbreak in the Democratic Republic of the Congo and how this affected their handwashing behaviour. Methods Cholera cases were identified through local cholera treatment centre records. Comparison individuals were recruited from the same neighbourhoods by identifying households with no recent confirmed or suspected cholera cases. Multiple qualitative methods were employed to understand hand hygiene practices and their determinants, including unstructured observations, interviews and focus group discussions. The data collection tools and analysis were informed by the Behaviour Centred Design Framework. Comparisons were made between the experiences and practices of people from case households and participants from comparison households. Results Cholera was well understood by the population and viewed as a persistent and common health challenge. Handwashing with soap was generally observed to be rare during the outbreak despite self-reported increases in behaviour. Across case and comparison groups, individuals were unable to prioritise handwashing due to competing food-scarcity and livelihood challenges and there was little in the physical or social environments to cue handwashing or make it a convenient, rewarding or desirable to practice. The ability of people from case households to practice handwashing was further constrained by their exposure to cholera which in addition to illness, caused profound non-health impacts to household income, productivity, social status, and their sense of control. Conclusions Even though cholera outbreaks can cause disruptions to many determinants of behaviour, these shifts do not automatically facilitate an increase in preventative behaviours like handwashing with soap. Hygiene programmes targeting outbreaks within complex crises could be strengthened by acknowledging the emic experiences of the disease and adopting sustainable solutions which build upon local disease coping mechanisms.

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Section: Methodsmentioning

confidence: 99%

How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo

et al. 2022

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“…Lastly, two studies were included despite not including any mental health parameters as a pre-specified outcome. In both studies [ 60 , 61 ], mental health challenges were identified in interviews as a barrier to practicing handwashing behaviour in camps for displaced persons in Iraq, therefore meeting inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…The influence of mental health on handwashing behaviour was significantly mediated by feelings and difficulty in getting enough soap for handwashing [20]. Four studies combined mental health disorders into a single mental health measure [50,51,53,61]. All four studies reported inverse relationships between mental health and handwashing behaviour.…”

Section: Combination Of Disorders and Handwashingmentioning

confidence: 99%

Mapping the association between mental health and people’s perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review

Ghassemi,

Thorseth,

Le Roch

et al. 2023

PLoS ONE

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Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people’s perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

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“…Understanding the quality, acceptability and effectiveness of hygiene programmes in emergencies should also foreground the views of crisis-affected populations. While not reported here, we conducted complementary in-depth qualitative research with affected populations in both settings [54,55]. Finally, 75% of our participants were male across the two countries and while this reflected the demographics of the sector, the voices and opinions of female WASH staff are under-represented in this work and merits further exploration.…”

Section: Limitationsmentioning

confidence: 98%

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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How is hygiene behaviour affected by conflict and displacement? A qualitative case study in Northern Iraq

Cited by 7 publications

References 60 publications

How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo

How does handwashing behaviour change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo

Mapping the association between mental health and people’s perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review

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

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