Identifying behavioural determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe

Abstract

BackgroundThis article presents the development of a school handwashing programme in two different sub-Saharan countries that applies the RANAS (risk, attitudes, norms, ability, and self-regulation) systematic approach to behaviour change.MethodsInterviews were conducted with 669 children enrolled in 20 primary schools in Burundi and 524 children in 20 primary schools in Zimbabwe. Regression analyses were used to assess the influence of the RANAS behavioural determinants on reported handwashing frequencies.ResultsThe results revealed that, in both countries, a programme targeting social norms and self-efficacy would be most effective. In Burundi, raising the children’s perceived severity of the consequences of contracting diarrhoea, and in Zimbabwe, increasing the children’s health knowledge should be part of the programme.ConclusionsThe school handwashing programme should create awareness of the benefits of handwashing through educational activities, raise the children’s ability and confidence in washing hands at school through infrastructural improvements, and highlight the normality of washing hands at school through events and poster creation.

Evaluating children’s handwashing in schools: an integrative review of indicative measures and measurement tools

“…• Self-report (children reporting on themselves) was used to measure (i) in thirty-one studies occurrence and frequency of handwashing to indicate behaviour (O'Reilly et al 2008;Snow et al 2008;Lopez-Quintero et al 2009; Nandrup-Bus 2009; Nandrup-Bus 2011; Özyazıcıoğlu et al 2011;Freeman et al 2012;Patel et al 2012;Setyautami et al 2012;Bieri et al 2013;Gyorkos et al 2013;Pickering et al 2013;Sibiya & Gumbo 2013;Xuan & Hoat 2013;Zhang et al 2013;Al-Delaimy et al 2014;Grimason et al 2014;Peltzer & Pengpid 2014;Johansen et al 2015;Mohamed Moussa et al 2015;Zhou et al 2015;Azuogu et al 2016;Ranasinghe et al 2016;Susanto et al 2016;Tamilarasi et al 2016;ALBashtawy 2017;Hetherington et al 2017;Karon et al 2017;Seimetz et al 2017;Thakadu et al 2018) (ii) illness prevalence manifest in absence in seven studies (Lopez-Quintero et al 2009; Nandrup-Bus 2009; Nandrup-Bus 2011; Freeman et al 2012;Gerald et al 2012;Pickering et al 2013;Chard & Freeman 2018) and / or sickness in four studies (Gerald et al 2012;Freeman et al 2013;Pickering et al 2013;Zhang et al 2013) to indicate a health outcome.…”

Water, sanitation and hygiene (WASH) behaviour change research: why an analysis of contingencies of reinforcement is needed

“…Self-efficacy is sometimes presented as a behavioural determinant with little discussion about its own environmental determinants, leaving it up to the reader to guess what caused self-efficacy and how it is to be increased (e.g. Seimetz et al 2017). Others have questioned whether behaviour itself may be determining self-efficacy (Aboud and Singla 2012).…”

Child handwashing in an internally displaced persons camp in Northern Iraq: A qualitative multi-method exploration of motivational drivers and other handwashing determinants

“…To achieve success, behaviour change interventions must effectively identify and address the determinants (factors that influence behaviour) of the behaviour in question [19]. There have been a number of formative studies of the determinants of handwashing in stable settings [17,[20][21][22] however, these have largely focused on adult populations and to a lesser extent, children in schools [23][24][25]. There are as yet no published studies on the determinants of children's handwashing behaviour in a humanitarian context.…”