Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaïre

Abstract

SummaryTo date questionnaire surveys have been the most commonly used instruments to measure hygiene behaviours related to water and sanitation. More recently, a number of studies have used structured observations to study practices related to diarrhoea. During a trial of a hygiene education intervention to reduce diarrhoea among young children in Bandundu, Zaire, both instruments were used to measure the disposal of child faeces and various hand-washing practices. Three hundred families were observed and follow-up interviews performed with 274 (91%) mothers. At the individual level, agreement between observed and reported behaviour was little better than might be expected by chance. There was evidence of over-reporting of hand-washing before food preparation (44% vs 33%; P ϭ 0.03), hand-washing before eating (76% vs 60%; P Ͻ 0.001) and disposal of the child's faeces in a latrine (75% vs 40%; P Ͻ 0.001). On the other hand, hand-washing before feeding the child was reported less often than it was observed (7% vs 64%; P Ͻ 0.001). Our data are consistent with the hypothesis that, in general, mothers over-report 'desirable' behaviours. At the same time, our data indicate that open questions may lead to underreporting of certain behaviours. The repeatability of observations at both the individual and population levels remains to be established.

Variability in Hand Contamination Based on Serial Measurements: Implications for Assessment of Hand-Cleansing Behavior and Disease Risk

“…Selfreport is not valid, because individuals typically report handwashing more frequently than is seen on observation. [1][2][3] The direct measure of structured observation, which requires a highly trained observer positioning herself in a subject's home environment for a number of hours, can be time-consuming, expensive, and invasive to the privacy of the subject and her family. Moreover, our recent work has shown that a large proportion of individuals alter their handwashing with soap when they are observed compared with when they are not observed (Ram PK and others, unpublished data).…”

Using Child Health Outcomes to Identify Effective Measures of Handwashing

“…[6][7][8] Directly observing handwashing behavior is intrusive, expensive, and generates higher prevalence of handwashing practices compared with when people do not know they are being observed. [9][10][11][12][13] Microbiological assessments of hand contamination are expensive and highly variable.…”

Epidemiologists working together with anthropologists: lessons from a study to evaluate the epidemiological impact of a city-wide sanitation program

“…However, the consistency between reported and observed behavior has been found to be low 33,34 . Behavioral patterns that are deemed to be appropriate (such as hand washing before handling food for the family or before eating) are precisely those that tend to be reported more frequently than they are observed 35 . Besides that, structured observation may be biased through reactivity, i.e.…”

“…Besides that, structured observation may be biased through reactivity, i.e. people who are under observation may modify their behavior according to what they think the observer expects 35 . To bypass this difficulty, it was decided to adopt the less intrusive spot-check observational method 36 .…”