Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia

Abstract

Background: Hygiene promotion is a cornerstone of humanitarian response during infectious disease outbreaks. Despite this, we know little about how humanitarian organisations design, deliver or monitor hygiene programmes, or about what works to change hygiene behaviours in outbreak settings. This study describes humanitarian perspectives on changing behaviours in crises, through a case study of hygiene promotion during the 2014-2016 Liberian Ebola outbreak. Our aim was to aid better understanding of decision making in high-stress situations where there is little precedent or evidence, and to prompt reflection within the sector around how to improve and support this. Methods: We conducted in-depth, semi-structured interviews with fourteen purposively-sampled individuals (key informants) from international organisations involved in hygiene behaviour change during the outbreak. Through thematic analysis we identified the decisions that were made and processes that were followed to design, deliver and monitor interventions. We compared our findings with theory-driven processes used to design behaviour change interventions in non-outbreak situations. Results: Humanitarians predominantly focussed on providing hygiene products (e.g. buckets, soap, gloves) and delivering messages through posters, radio and community meetings. They faced challenges in defining which hygiene behaviours to promote. Assessments focused on understanding infrastructural needs, but omitted systematic assessments of hygiene behaviours or their determinants. Humanitarians assumed that fear and disease awareness would be the most powerful motivators for behaviour change. They thought that behaviour change techniques used in non-emergency settings were too 'experimental', and were beyond the skillset of most humanitarian actors. Monitoring focussed on inputs and outputs rather than behavioural impact. Conclusions: The experiences of humanitarians allowed us to identify areas that could be strengthened when designing hygiene programmes in future outbreaks. Specifically, we identified a need for rapid research methods to explore behavioural determinants; increased skills training for frontline staff, and increased operational research to explore behaviour change strategies that are suited to outbreak situations.

COVID-19 salgını sırasında Türk toplumunun sosyal el yıkama bilgi ve tutumunun değerlendirilmesi

“…Kişisel bilgi formu hazırlanırken Ebola, Influenza, Norovirüs ve SARS salgınlarında el yıkamaya dair yapılmış araştırmalar gözden geçirilmiştir. [4,6,10,11] Katılımcının cinsiyeti, yaşı, medeni hali, öğrenim ve çalışma durumu, aylık gelir düzeyi, yerleşim yeri, el yıkama sıklığı, el yıkama esnasında kullanılan materyaller, el yıkamaya bağlı ellerde gelişebilecek belirtibulgular (el kuruluğu, çatlak, kaşıntı, ağrı, el egzaması) hakkında sorular içermektedir.…”

“…Bu nedenle, Dünya Sağlık Örgütü, pandeminin yayılımını önlemek için uygun kişisel koruyucu ekipman kullanmak ve ellerin düzenli olarak sabun ve su ile yıkanması gerektiğini vurgulamaktadır. [1] Ellerin, ağız veya burun yoluyla burun mukozasına, konjonktiva ya da yeni konakçılara solunum patojenlerini taşıdığı ve bu nedenle el yıkamanın özellikle solunum yolu enfeksiyonu salgınlarında bulaşmayı önlemede en önemli girişim olduğu belirtilmektedir.. [4][5][6][7] Pandemi ile başetmede en etkili yöntemlerden biri olan el yıkama, antimikrobiyal özelliği olmayan sabun ile ellerin yıkanmasıdır. Burada amaç derideki geçici flora elemanlarını ve eldeki gözle görünür kiri tamamen ortamdan uzaklaştırmaktır.…”

How to set up government-led national hygiene communication campaigns to combat COVID-19: a strategic blueprint

“…1 2 In the pressured environment of a public health emergency, it is especially hard to carry out the strategic communications planning that is needed for effective programming, since immediate and urgent responses tend to be prioritised. 3 Furthermore, it is becoming increasingly clear that communications about COVID-19 will need to be sustained and to evolve until vaccines or other means of bringing it under control can be found. All governments need the capacity to engage in strategic public health communications, emergency or no.…”

“… 1 2 In the pressured environment of a public health emergency, it is especially hard to carry out the strategic communications planning that is needed for effective programming, since immediate and urgent responses tend to be prioritised. 3 …”

Miten saada ihmiset noudattamaan epidemian leviämisen estämiseen liittyviä suosituksia? Käyttäytymistieteiden anti

“…Toistaiseksi psykologista tai sosiaalipsykologista tutkimusta on käytetty pandemioiden ja epidemioiden yhteydessä käyttäytymisen ohjaamisessa suhteellisen vähän eikä empiiristä evidenssiä juuri COVID-19-tilanteesta vielä ole tätä kirjoitettaessa (huhti-kesäkuu 2020). Esimerkiksi ebolan hallinnasta tehty tutkimus osoitti, että käyttäytymistieteitä käytettiin suppeasti -lähinnä riskitiedon välittämiseen -sillä toimijoilla ei ollut osaamista eikä aikaa muuhun (Czerniewska & White, 2020).…”