Abstract:Handwashing with soap effectively prevents diarrhoea, a leading cause of death in infants. Theory-based interventions are expected to promote handwashing more successfully than standard approaches. The present article investigates the underlying change processes of theory-based handwashing interventions. A nonrandomised field study compared a standard approach to two theory-based interventions that were tailored to the target population, the inhabitants of four villages in southern Ethiopia (N = 408). Data wer… Show more
“…The remaining studies were judged to be of moderate (1) and serious (3) bias. Andrade, 2013Arnold et al, 2009Contzen et al, 2015aDickey et al, 2015Kochurani et al, 2009Pinfold, 1999Seimetz et al, 2016Waterkeyn & Cairncross, 2005Younes et al, 2015 green: low; yellow: no information; orange: moderate; red: serious; dark red: critical…”
Section: Quasi-experimental (N=8) and Observational Studies (N=2)mentioning
confidence: 99%
“…In this way, the effect of specific additional elements to a promotional approach could be studied. We discuss the different comparisons below (Contzen et al, 2015a(Contzen et al, /2015bDickey et al, 2015;Graves et al, 2011;Guiteras et al, 2015a;Lhakhang et al, 2015;Zhang et al, 2013).…”
Section: Comparison Of Different Promotional Approachesmentioning
confidence: 99%
“…Taken together, we identified 46 references to quantitative studies (individual quantitative and mixed-methods studies), and 28 references to qualitative studies (individual qualitative and mixedmethods studies). For the quantitative papers published by Contzen et al (2015a and, Galiani et al (2012 and, and Patil et al (2013 and, two separate references (with complementary information) for each study were included resulting in a total number of 41 quantitative studies (from 45 references). The study selection flowchart can be found in Figure 3.…”
This Campbell Systematic Review examines the effectiveness of different approaches for promoting handwashing and sanitation behaviour change, and factors affecting implementation, in low and middle‐income countries. The review summarises evidence from 42 impact evaluations, and from 28 qualitative studies.
Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components.
Sanitation and hygiene messaging with a focus on handwashing with soap has an effect after the intervention has ended, but there is little impact on sanitation outcomes. However, these effects are not sustainable in the long term. Using elements of psychosocial theory in a small‐scale handwashing promotion intervention, or adding theory‐based elements such as infrastructure promotion or public commitment to an existing promotional approach, seem promising for handwashing with soap.
None of the approaches described have consistent effects on behavioural factors such as knowledge, skills and attitude. There are no consistent effects on health.
Plain language summary
Community‐based approaches are most effective in promoting changes in hygiene practices, but sustainability is a challengeCommunity‐based approaches to promote handwashing and sanitation efforts seem to work better than social marketing, messaging and interventions based on psychosocial theory. Programs combining hygiene and sanitation measures appears to have a larger impact than either one alone.
What is this review about?Diarrhoeal diseases are very common causes of death in low and middle‐income countries. Improved sanitation and hygiene reduce diarrhoea, but adoption remains a challenge.This review assesses the evidence for two questions: (1) how effective are different approaches to promote handwashing and sanitation behaviour change; and (2) what factors influence the implementation of these approaches?
What studies are included?Studies of effectiveness had to be impact evaluations using an experimental or quasi‐experimental design and analytical observational studies. Implementation studies used qualitative designs.Forty‐two quantitative studies and 28 qualitative studies met the inclusion criteria. The quantitative studies were conducted in LMICs worldwide, with the majority of the studies in South Asia and Sub‐Saharan Africa.
What are the main findings of this review?Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components.Sanitation and hygiene messaging with a focus on hand...
“…The remaining studies were judged to be of moderate (1) and serious (3) bias. Andrade, 2013Arnold et al, 2009Contzen et al, 2015aDickey et al, 2015Kochurani et al, 2009Pinfold, 1999Seimetz et al, 2016Waterkeyn & Cairncross, 2005Younes et al, 2015 green: low; yellow: no information; orange: moderate; red: serious; dark red: critical…”
Section: Quasi-experimental (N=8) and Observational Studies (N=2)mentioning
confidence: 99%
“…In this way, the effect of specific additional elements to a promotional approach could be studied. We discuss the different comparisons below (Contzen et al, 2015a(Contzen et al, /2015bDickey et al, 2015;Graves et al, 2011;Guiteras et al, 2015a;Lhakhang et al, 2015;Zhang et al, 2013).…”
Section: Comparison Of Different Promotional Approachesmentioning
confidence: 99%
“…Taken together, we identified 46 references to quantitative studies (individual quantitative and mixed-methods studies), and 28 references to qualitative studies (individual qualitative and mixedmethods studies). For the quantitative papers published by Contzen et al (2015a and, Galiani et al (2012 and, and Patil et al (2013 and, two separate references (with complementary information) for each study were included resulting in a total number of 41 quantitative studies (from 45 references). The study selection flowchart can be found in Figure 3.…”
This Campbell Systematic Review examines the effectiveness of different approaches for promoting handwashing and sanitation behaviour change, and factors affecting implementation, in low and middle‐income countries. The review summarises evidence from 42 impact evaluations, and from 28 qualitative studies.
Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components.
Sanitation and hygiene messaging with a focus on handwashing with soap has an effect after the intervention has ended, but there is little impact on sanitation outcomes. However, these effects are not sustainable in the long term. Using elements of psychosocial theory in a small‐scale handwashing promotion intervention, or adding theory‐based elements such as infrastructure promotion or public commitment to an existing promotional approach, seem promising for handwashing with soap.
None of the approaches described have consistent effects on behavioural factors such as knowledge, skills and attitude. There are no consistent effects on health.
Plain language summary
Community‐based approaches are most effective in promoting changes in hygiene practices, but sustainability is a challengeCommunity‐based approaches to promote handwashing and sanitation efforts seem to work better than social marketing, messaging and interventions based on psychosocial theory. Programs combining hygiene and sanitation measures appears to have a larger impact than either one alone.
What is this review about?Diarrhoeal diseases are very common causes of death in low and middle‐income countries. Improved sanitation and hygiene reduce diarrhoea, but adoption remains a challenge.This review assesses the evidence for two questions: (1) how effective are different approaches to promote handwashing and sanitation behaviour change; and (2) what factors influence the implementation of these approaches?
What studies are included?Studies of effectiveness had to be impact evaluations using an experimental or quasi‐experimental design and analytical observational studies. Implementation studies used qualitative designs.Forty‐two quantitative studies and 28 qualitative studies met the inclusion criteria. The quantitative studies were conducted in LMICs worldwide, with the majority of the studies in South Asia and Sub‐Saharan Africa.
What are the main findings of this review?Community‐based approaches which include a sanitation component can increase handwashing with soap at key times; use of latrines and safe disposal of faeces; and reduce the frequency of open defecation. Social marketing seems less effective. The approach mainly shows an effect on sanitation outcomes when interventions combine handwashing and sanitation components.Sanitation and hygiene messaging with a focus on hand...
“…The RANAS model has been successfully applied to predict and change the frequency of handwashing at key handwashing situations in several countries. [24][25][26][27] Taken together, washing hands with an effective technique is recommended by various institutions. However, what drives individuals to do so or prevents them from actually applying effective handwashing techniques remains largely unknown.…”
Abstract. Handwashing has been shown to considerably reduce diarrhea morbidity and mortality. To decontaminate hands effectively, the use of running water, soap, and various scrubbing steps are recommended. This study aims to identify the behavioral determinants of effective handwashing. Everyday handwashing technique of 434 primary caregivers in high-density suburbs of Harare, Zimbabwe, was observed and measured as an 8-point sum score of effective handwashing technique. Multiple linear and logistic regression analyses were performed to predict observed handwashing technique from potential contextual and psychosocial determinants. Knowledge of how to wash hands effectively, availability of a handwashing station with functioning water tap, self-reported frequency of handwashing, perceived vulnerability, and action planning were the main determinants of effective handwashing technique. The models were able to explain 39% and 36% of the variance in overall handwashing technique and thoroughness of handscrubbing. Memory aids and guided practice are proposed to consolidate action knowledge, and personalized risk messages should increase the perceived vulnerability of contracting diarrhea. Planning where, when, and how to maintain a designated place for handwashing with sufficient soap and water is proposed to increase action planning. Since frequent self-reported handwashing was associated with performing more effective handwashing technique, behavior change interventions should target both handwashing frequency and technique concurrently.
“…Behavior change strategies based on psychosocial surveys which are tailored to the local populations' mindsets have been shown to outperform standard approaches, which often only address risk awareness and a few other factors such as knowledge of disease prevention [13]. Several factors at the personal and social level-such as social norms, status, self-efficacy convictions, and the like-have been shown to be important predictors for the success of promotion campaigns targeting a range of health-relevant behaviors [14][15][16][17].…”
Abstract:Behavior that has changed following promotion campaigns is usually not maintained at its initial level. Psychosocial factors for initiating behavior are often not the same as for the continuation of health behaviors such as water treatment and are much less understood. Better knowledge of factors for behavioral continuation would help to improve programs, both in the design of strategies for sustainable behavior change and by defining stronger criteria for the evaluation of sustainability. This study compared the mindsets of caregivers who continuously performed household drinking water treatment over time with individuals that stopped doing so in a population sample from Chad. Several factors from health psychology based on the Risks, Attitudes, Norms, Abilities, and Self-Regulation (RANAS) model were used to compare the two groups and examine their differing development. Normative factors such as others' behavior, personal obligation, social support and discourse, perceived self-efficacy convictions, action control, and intention best discriminated between the two groups and developed significantly more positively over time for continuers of water treatment. These factors should be considered when designing future interventions intended to lead to sustainable behavior change.
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