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Rizk O, Bick S, White B, Chidziwisano K, Dreibelbis R. Assessing the reliability and validity of pictorial-assisted 24-h recall for measuring hand hygiene and child faeces disposal: A cross-sectional study in Malawi. Int J Hyg Environ Health 2025; 264:114516. [PMID: 39778401 DOI: 10.1016/j.ijheh.2024.114516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 12/16/2024] [Accepted: 12/19/2024] [Indexed: 01/11/2025]
Abstract
Whilst improving hygiene and sanitation behaviours is key to cost-effective and sustainable water, sanitation and hygiene interventions, measuring behaviour change remains a challenge. This study assessed the validity and reliability of pictorial 24-h recall (P24 hR), a novel method using unprompted recall of past activities through pictures, compared to structured observation for measuring handwashing with soap (HWWS) and safe child faeces disposal in rural Malawi. Data were collected from 88 individuals across 74 households in Chiradzulu district using both methods over a two-day period, with the recall period of the P24 hR corresponding to the period of structured observation completed the previous day. Results showed poor agreement between P24 hR and observations in detection of hygiene opportunities and behaviours. P24 hR under-reported handwashing opportunities when frequency was high and over-reported them when frequency was low. The 95% limits of agreement for handwashing opportunities estimated through Bland-Altman analysis (-7.62 to 4.89) were unacceptably wide given median 5 opportunities observed per participant. P24 hR also over-reported HWWS and safe child faeces disposal, and kappa statistics indicated agreement no better than by chance. Structured observation remains the better method for measuring hygiene behaviours as compared to the P24 hR method despite its known limitations, including potential reactivity bias.
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Affiliation(s)
- Olivier Rizk
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Bick
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Blessings White
- WASHTED Centre, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Kondwani Chidziwisano
- WASHTED Centre, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Lewis-Smith H, Ahuja L, Hasan F, Gentili C, White P, Diedrichs PC. A comic-based body image intervention for adolescents in semi-rural Indian schools: A randomised controlled trial. Int J Clin Health Psychol 2025; 25:100546. [PMID: 39911164 PMCID: PMC11795790 DOI: 10.1016/j.ijchp.2025.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 01/16/2025] [Indexed: 02/07/2025] Open
Abstract
Adolescents in India experience body dissatisfaction and its associated adverse impacts on physical and mental health and gender equality. However, evidence-based interventions are scarce. Mental health interventions worldwide have traditionally relied upon delivery by expert providers. However, this prevents scalability, particularly in rural settings, where resources are often lacking. Therefore, this study evaluated the efficacy of a low-resource teacher-delivered mixed-gender comic-based body image intervention among adolescents in semi-rural Indian schools. A randomised controlled trial was conducted among 2631 students (50 % girls; classes 6 to 8; Mage = 12.03 years, SD = 1.22) across 41 schools around the Jaipur district in Rajasthan. Each school was randomly allocated to receive six comic-based intervention sessions (n = 1347) or lessons-as-usual (n = 1284; control). The primary outcome of body esteem and related secondary and exploratory outcomes assessing mental health and gender stereotyping were assessed at baseline, 1 week-post-intervention, and 3-months follow-up (ClinicalTrials.gov, NCT04317755). Linear Mixed Model analyses revealed that compared to the control group, intervention students reported significantly higher body esteem and skin shade satisfaction, and significantly lower eating pathology, internalisation of appearance ideals, and gender stereotyping, with all effects maintained at follow-up. Compared to control group, boys in the intervention group also demonstrated significantly higher body image-related life engagement and body hair satisfaction at follow-up. Both students and teachers indicated high intervention acceptability via quantitative and qualitative findings. These findings present the first effective teacher-delivered school-based body image intervention in India, which can be implemented at scale using minimal resources, and thus indicates promise regarding broader dissemination across urban and rural settings.
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Affiliation(s)
- Helena Lewis-Smith
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS161QY, UK
| | - Latika Ahuja
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS161QY, UK
| | - Farheen Hasan
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS161QY, UK
| | - Caterina Gentili
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS161QY, UK
| | - Paul White
- Applied Statistics Group, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS161QY, UK
| | - Phillippa C. Diedrichs
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS161QY, UK
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Appiah-Brempong E, Appiah-Brempong M. Examining the psychosocial drivers of handwashing behaviour among school children. Health Psychol Behav Med 2024; 12:2391932. [PMID: 39165273 PMCID: PMC11334745 DOI: 10.1080/21642850.2024.2391932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 08/05/2024] [Indexed: 08/22/2024] Open
Abstract
Aim Handwashing with soap remains the single most cost-effective strategy for reducing the spread of infectious diseases. From our scoping search, no study was identified which examined the predictors of children's handwashing behaviour within the context of the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB) combined. This paper contributes to bridging this gap in literature. We sought to examine variables emanating from the HBM and TPB which could potentially predict handwashing behaviour; determine whether behavioural intention will potentially predict behaviour; and identify school children's motivation for proper handwashing behaviour. Subject and Methods Data were collected from 717 school children recruited from four basic schools. A structured questionnaire was used for data collection. Data were analysed using multi-variable linear regression models. Results Participants' knowledge of hand hygiene failed to predict behavioural intention and handwashing behaviour. As regards participants' perception of severity, there was an association with behavioural intention in a crude model, but this was not so in an adjusted model. Also, perception of severity was not associated with handwashing behaviour. Attitude to handwashing (β = 0.120, 95% CI [0.00, 0.24] p = 0.046), possession of handwashing skills (β = 0.037, 95% CI [0.01, 0.07] p = 0.008), and subjective norms (β = 0.263, 95% CI [0.20, 0.33] p < 0.001) were among the psychosocial variables that showed potential for predicting both behavioural intention and behaviour. The TPB's intention-behaviour relationship was corroborated by our results. Among others, motivation for adherence to proper handwashing behaviour included the desire to make hands smell better. Conclusion Interventions targeting the handwashing behaviour of school children should consider strategies that move beyond mere knowledge improvement, but rather target attitude and skill enhancement strategies implemented in partnership with 'significant others' such as teachers, and adult peers.
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Affiliation(s)
- Emmanuel Appiah-Brempong
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Miriam Appiah-Brempong
- Department of Civil Engineering, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Watson J, Osman IME, Amon-Tanoh M, Deola C, MacDougall A, Cumming O. A cluster-randomised controlled equivalence trial of the Surprise Soap handwashing intervention among older children living in a refugee settlement in Sudan. BMJ Glob Health 2023; 8:e012633. [PMID: 37827726 PMCID: PMC10583099 DOI: 10.1136/bmjgh-2023-012633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Increasing handwashing with soap (HWWS) among older children in emergency settings can have a large public health impact, however, evidence on what works is limited. One promising approach is the 'Surprise Soap' intervention in which a novel soap with an embedded toy is delivered to children in a short, participatory household session that includes a glitter game and HWWS practice. Here, we evaluate this intervention against a standard intervention in a complex emergency setting. METHODS A cluster-randomised controlled equivalence trial was conducted in Naivasha refugee settlement, Sudan. Blinding was not possible. 203 randomly selected households, with at least one child aged 5-12, were randomised to receive the Surprise Soap intervention (n=101) or a standard intervention comprising a short household session with health messaging and plain soap distribution (n=102). The primary outcome was the proportion of prespecified potential HWWS events observed for children aged 5-12, accompanied by HWWS, at baseline, 4, 12 and 16 weeks post intervention delivery. RESULTS 200 households were included in the analyses: 101 intervention and 99 control. No difference in intervention effectiveness was observed at any follow-up (4 weeks: adjusted rate ratio (RR) 1.2, 95% CI 0.8 to 1.7; 12 weeks: RR 0.8, 95% CI 0.5 to 1.1; 16 weeks: RR 1.1, 95% CI 0.8 to 1.5). However, we observed increased HWWS in both arms at 4 weeks (27 and 23 percentage point increase in the intervention and control arm, respectively) that was sustained at 16 weeks. CONCLUSIONS We find that the Surprise Soap intervention is no more effective at increasing older children's HWWS than a standard, household-level, health-based intervention in this complex humanitarian emergency. There appears to be no marginal benefit in terms of HWWS that would justify the additional cost of implementing the Surprise Soap intervention. Further trials that include a passive control arm are needed to determine the independent effects of each intervention and guide future intervention design.
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Affiliation(s)
- Julie Watson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maud Amon-Tanoh
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Amy MacDougall
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Watson J, Amon-Tanoh MA, Deola C, Haji MA, Sheikh MR, Mohamud FA, Ali SY, MacDougall A, Cumming O. Effect of a novel hygiene intervention on older children's handwashing in a humanitarian setting in Kahda district, Somalia: A cluster-randomised controlled equivalence trial. Int J Hyg Environ Health 2023; 250:114163. [PMID: 37011505 DOI: 10.1016/j.ijheh.2023.114163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Improving handwashing with soap (HWWS) among children in humanitarian emergencies has the potential to reduce the transmission of several important infectious diseases. However, there is limited evidence on which approaches are effective in increasing HWWS among children in humanitarian settings. One recent innovation - the "Surprise Soap" intervention - was shown to be successful in a small-scale efficacy trial in a humanitarian setting in Iraq. This intervention includes soap with embedded toys delivered through a short household session comprising a glitter game, instruction of how and when to wash hands, and HWWS practice. Whilst promising, this approach has not been evaluated at programmatic scale in a complex humanitarian setting. METHODS We conducted a cluster-randomised controlled equivalence trial of the Surprise Soap intervention in IDP camps in Kahda district, Somalia. Proportionate stratified random sampling was employed to recruit 200 households, with at least one child aged 5-12, across the camps. Eligible households were randomly allocated to receive the Surprise Soap intervention (n = 100) or an active comparator handwashing intervention in which plain soap was delivered in a short household session comprising standard health-based messaging and instruction of how and when to wash hands (n = 100). The primary outcome was the proportion of pre-specified occasions when HWWS was practiced by children aged 5-12 years, measured at baseline, 4-weeks, 12 weeks, and 16 weeks post invention delivery. RESULTS HWWS increased in both groups (by 48 percentage points in the intervention group and 51 percentage points in the control group, at the 4-week follow up), however, there was no evidence of a difference in HWWS between the groups at the 4-week (adjusted RR (aRR) = 1.0, 95% CI 0.9-1.1), 12-week (aRR = 1.1, 95% CI 0.9-1.3), or 16-week (aRR = 1.0, 95% CI 0.9-1.2) follow-up. CONCLUSIONS In this complex humanitarian setting, where soap availability and past exposure to handwashing promotion was low, it appears that well-designed, household-level targeted handwashing interventions that include soap provision can increase child HWWS and potentially reduce disease risk, but the Surprise Soap intervention offers no marginal benefit over a standard intervention that would justify the additional costs.
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Watson J, Cumming O, Dreibelbis R. Nongovernmental Organization Practitioners' Perspectives on the Challenges and Solutions to Changing Handwashing Behavior in Older Children: A Qualitative Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00231. [PMID: 36853630 PMCID: PMC9972390 DOI: 10.9745/ghsp-d-22-00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increasing handwashing with soap (HWWS) among older children (aged 5-14 years) can achieve a substantial public health impact. However, HWWS interventions targeting older children have had mixed success. Recent research has attempted to quantitatively identify effective intervention techniques; however, success is likely also influenced by the wider context of implementation. We explore nongovernmental organization (NGO) practitioners' perspectives on the challenges and solutions to HWWS interventions targeting older children to enhance understanding of what is required, beyond intervention content, for them to be effective. METHODS We conducted in-depth, semistructured interviews in April-November 2020 with 25 practitioners employed across 11 NGOs and involved in HWWS interventions targeting older children in development and humanitarian settings. We used purposive and snowball sampling to recruit participants in roles at the global, national/regional, and local levels. Interviews were audio-recorded, transcribed, and thematically analyzed to identify challenges and solutions to HWWS interventions targeting older children. Results were organized according to program development cycle stages. RESULTS Twelve themes relating to perceived challenges emerged: (1) lack of prioritization, (2) funding inconsistency, (3) insufficient formative research, (4) demand on resources, (5) unengaging intervention content, (6) non-enabling physical environments, (7) availability of skilled implementers, (8) reaching out-of-school children, (9) community mistrust, (10) lack of coordination, (11) lack of evaluation rigor, and (12) failure to assign older children's HWWS as a primary outcome in evaluations of hygiene interventions. Recommended solutions were at the intervention, organization, and sector levels. CONCLUSION Intervention design and delivery are important for the success of HWWS interventions for older children, but contextual factors, such as the availability of human and material resources and the level of coordination within and beyond the NGO sector, should also be considered. NGOs need to prioritize HWWS promotion among older children and support programs accordingly.
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Affiliation(s)
- Julie Watson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Melaku A, Addis T. Handwashing Practices and Associated Factors Among School Children in Kirkos and Akaki Kality Sub-Cities, Addis Ababa, Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231156299. [PMID: 36860580 PMCID: PMC9969475 DOI: 10.1177/11786302231156299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Provision of handwashing facilities and proper practices are essential for preventing fecal-oral and acute respiratory infectious diseases. The aim of this study was to assess availability of handwashing facilities and predictors to students' good hygiene practices in Addis Ababa, Ethiopia. METHODS A mixed-methods study design was conducted in schools of Addis Ababa from January to March 2020 in 384 students, 98 school directors, 6 health clubs, and 6 school administrators. Data were collected using pretested interviewer-administered questionnaires, interview guide, and observational checklists. The quantitative data were entered into EPI Info version 7.2.2.6 and analyzed using SPSS 22.0. A bivariable at P < .2 and multivariable logistic regression analysis at P < .05 for quantitative and thematic analysis for qualitative data were used. RESULTS Handwashing stations were available in 85 (86.7%) of the schools. However, 16 (16.3%) schools had neither water nor soap near the handwashing facilities while 33 (38.8%) of schools had both. There was no high school that had both soap and water. Approximately one-third (135, 35.2%) of students practiced proper handwashing, among which 89 (65.9%) were from private schools. The handwashing practices were significantly associated with gender (AOR = 2.45, 95% CI: (1.66-3.59)), having trained coordinator (AOR = 2.16, 95% CI: (1.32-2.48)) and health education program (AOR = 2.53, 95% CI: (1.73-3.59)), school ownership (AOR = 0.49, 95% CI: (0.33-0.72)), and training (AOR = 1.74, 95% CI: (1.82-3.69)). Water supply interruption, and lack of budget, adequate space, training, health education, maintenance, and coordination were the main barriers that prevent students from practicing proper handwashing. CONCLUSIONS Handwashing facilities and materials provision and good handwashing practices of students were low. Moreover, providing soap and water for handwashing was insufficient to promote good hygiene practices. There should be regular hygiene education, training, maintenance, and better coordination among stakeholders to create a healthy school environment.
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Affiliation(s)
- Abayneh Melaku
- Abayneh Melaku, Ethiopian Institute of
Water Resources, Addis Ababa University, P.O.Box 1176, Addis Ababa 1176,
Ethiopia.
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Bilal S, Misra S, Hussain S, Tan SS, Priya E. Do Right, Be Bright: A Protocol on the Development of an Inter-Professional Health Intervention Model for Pre-School Children Through a Community-Based Service-Learning Initiative. J Multidiscip Healthc 2023; 16:1301-1310. [PMID: 37197578 PMCID: PMC10183355 DOI: 10.2147/jmdh.s405031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/06/2023] [Indexed: 05/19/2023] Open
Abstract
An inter-professional project with a collaborative endeavor between the programs of Dentistry, Nutrition and Medicine was carried out with the aim to emphasise oral health maintenance, making the right nutritional choices and effective hand washing among pre-school children. The purpose of this paper is to share a detailed description of the design, development process, implementation, and planned evaluation of an interprofessional school-based health promotion intervention model "Do Right, Be Bright". This model is part of a quasi-experimental study, targeting pre-school children as the "Targets of Change" through the empowerment of school teachers as the "Agents of Change". The program design was based on Bartholomew's Intervention Mapping Approach, which proposes a direction for developing a theory-based health promotion intervention and on the most extensively applied theories of health behavior, the Health Belief Model. Therefore, based on a thorough literature review and needs assessment, three key areas of needs were identified for the targeted preschool children: oral hygiene, hand hygiene and nutrition. The efficacy of this model will be pilot tested in a preschool in Kuala Lumpur Malaysia.
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Affiliation(s)
- Sobia Bilal
- Division of Prevention and Public Health Sciences, Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, Chicago, IL, USA
| | - Snigdha Misra
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
- Correspondence: Snigdha Misra, Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia, Tel +603-2731 7608; +6016-617 9247, Fax +603-8656 7229, Email
| | - Sumaira Hussain
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Seok Shin Tan
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Ekta Priya
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312535. [PMID: 34886261 PMCID: PMC8657428 DOI: 10.3390/ijerph182312535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 01/02/2023]
Abstract
Diarrheal diseases and respiratory infections (RI) are two leading causes of childhood mortality in low and middle-income countries. Effective handwashing at critical time-points may mitigate these diseases. However, there is a lack of published data investigating this association in school-aged children in India. This study is part of a larger prospective handwashing intervention study in a low-income community in New Delhi, India examining the associations between handwashing behavior and diarrhea and RI in schoolchildren. This current study reports the findings of the baseline survey administered to 272 mother–child dyads. Children aged 8–12 years, and their mothers, were recruited from six schools. A baseline questionnaire was used to collect sociodemographic data, handwash behavior, and mother-reported recent diarrhea and RI incidence among the children. Handwashing before and after preparing food, after defecation, and after cleaning dishes significantly reduced the odds of diarrhea by over 70%, and of RI by over 56%. Using a clean cloth after handwashing lowered odds of diarrhea and RI by 72% and 63% respectively. Around 60% of the participants believed that handwashing could prevent diarrhea and RI in their children. There was a low prevalence of handwashing at critical time-points and a poor perception regarding handwashing benefits. To improve handwashing behavior, hygiene promotion programs need to understand what motivates and hinders handwashing in vulnerable populations.
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Winter JC, Darmstadt GL, Lee SJ, Davis J. The potential of school-based WASH programming to support children as agents of change in rural Zambian households. BMC Public Health 2021; 21:1812. [PMID: 34625029 PMCID: PMC8501527 DOI: 10.1186/s12889-021-11824-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/20/2021] [Indexed: 02/01/2023] Open
Abstract
Background Water, sanitation, and hygiene (WASH) interventions frequently assume that students who learn positive WASH behaviors will disseminate this information to their families. This is most prominent in school-based programs, which rely on students to act as “agents of change” to translate impact from school to home. However, there is little evidence to support or contradict this assumption. Methods We conducted a quasi-experimental, prospective cohort study in 12 schools in rural, southern Zambia to measure the impact of WASH UP!, a school-based WASH program designed by the creators of Sesame Street. WASH UP! is an educational program that uses stories and interactive games to teach students in grades 1–4 about healthy behaviors, such as washing hands and using the latrine. We completed in-person interviews with grade 1 and 4 students (N = 392 and 369, respectively), their teachers (N = 24) and caregivers (N = 729) using structured surveys containing both open- and closed-ended questions. We measured changes in knowledge and whether students reported sharing WASH-related messages learned in school with their caregivers at home. Results Student knowledge increased significantly, but primarily among students in grade 1. Overall rates of students reporting that they shared messages from the curriculum with their caregivers rose from 7 to 23% (p < 0.001). Students in grade 4 were 5.2 times as likely as those in grade 1 to report sharing a WASH-related message with their caregivers (ARR = 5.2, 95% C.I. = (2.3, 8.9); p < 0.001). Conclusions Although we measured only modest levels of student dissemination of WASH UP! messages from the school to the home, students in grade 4 showed significantly more promise as agents of change than those in grade 1. Future work should prioritize developing curricula that reflect the variability in needs, capabilities and support in the home and community among primary school students rather than a single approach for a wide range of ages and contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11824-3.
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Affiliation(s)
- James C Winter
- Department of Civil and Environmental Engineering, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA.
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
| | - Samantha J Lee
- Department of Civil and Environmental Engineering, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA
| | - Jennifer Davis
- Department of Civil and Environmental Engineering, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA.,Woods Institute for the Environment, Stanford University, Yang and Yamazaki Environment and Energy Building, 473 Via Ortega, Office 161, Stanford, CA, 94305, USA
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Basch CH, Fera J, Pellicane A, Basch CE. Handwashing videos on TikTok during the COVID-19 pandemic: Potential for disease prevention and health promotion. Infect Dis Health 2021; 27:31-37. [PMID: 34690108 PMCID: PMC8495082 DOI: 10.1016/j.idh.2021.09.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/24/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022]
Abstract
Background Handwashing has long been promoted to maintain health and in preventing disease transmission. One of the most valuable ways to convey messages related to handwashing is through visual display, such as video for educational purposes and to enhance learning. Social media is an important and popular way to disseminate messages to a wide audience. Methods In this cross-sectional, descriptive study, two hashtags, #WashYourHands and #SafeguardSplash were used to select the sample of 100 from available TikTok videos. In order to code each video, the same coding categories were used for both hashtags, including (1) wetting and rinsing hands (2) lathering soap (3) time used for scrubbing (4) drying hands (5) mentions COVID-19 (6) mentions using hand sanitizer instead of soap (7) mentions how germs spread (8) mentions key times to wash hands (9) and actual depiction of washing hands. Additional descriptive categories were coded as well. The observations recorded were tabulated and descriptive statistics were performed. Independent one-tailed t-tests (α = .05) were calculated to determine if a video's hashtag had a significant association with its garnered views, likes, and/or comments. Results In total, the 100-video sample received 1,990,834,567 views, 40,355,468 likes, and 173,422 comments. Despite the fact that each hashtag made up an equal proportion (50%) of the total sample, videos with #WashYourHands accounted for 93.3% of the total views. Coverage of the important steps involved in handwashing, such as drying hands, was minimal as was relevant background information. Conclusion The results indicate that while this opportunity is being realized to some degree, the majority of videos did not cover topics related important concepts of hand hygiene. Given the high engagement of younger audiences with TikTok, this could be a powerful mechanism for demonstrating and encouraging proper handwashing, especially in a population with low rates of handwashing.
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Affiliation(s)
- Corey H Basch
- Department of Public Health, William Paterson University, Wayne, NJ 07470, USA.
| | - Joseph Fera
- Department of Mathematics, Lehman College, The City University of New York Bronx, NY, USA
| | - Alessia Pellicane
- Department of Public Health, William Paterson University, Wayne, NJ 07470, USA
| | - Charles E Basch
- Department of Health and Behavior Studies, Teachers College, Columbia University New York, NY 10027, USA
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Handwashing Knowledge, Attitudes, and Practices among Students in Eastern Province Schools, Saudi Arabia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:6638443. [PMID: 34567132 PMCID: PMC8457965 DOI: 10.1155/2021/6638443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/23/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
Background. Lack of knowledge about appropriate handwashing practices has caused great concerns for human health, especially in the risk of many communicable diseases. The objective of the current study is to determine the level of handwashing knowledge, attitudes, and practices among school students in Eastern Province Schools, Saudi Arabia. A cross-sectional survey was recruited from November 2019 to March 2020 to assess the level of the students' handwashing knowledge. A reliable questionnaire was prepared (Cronbach's alpha = 0.608) and conducted using a two-stage sampling technique. A total of 271 students participated in the study from primary, middle, and high schools; 80% were boys, most of whom displayed an acceptable level of knowledge on hand hygiene. Nearly 75% and 74% of boys and girls, respectively, gained knowledge about hand hygiene practices from their parents. Only 46% of the students thought that handwashing is a potential protective measure against diseases, whereas 34% thought it only removes dirt. Prevalence of handwashing with soap after using the toilet was recognized among 52% of the students. Additionally, 93% of the students used water and soap to wash their hands (p value < 0.001) and 97% suggested that soap and water are the best methods to wash their hands (p value < 0.001). There was a positive correlation between the mother's education and hand hygiene practices (p value = 0.044). Results collectively indicated that handwashing knowledge and practices among school students in the Eastern Province are acceptable interventions in preventing the transmission of infectious diseases such as COVID-19. Indeed, further improvement conducted through specific health education programs to emphasize the role of handwashing in health hygiene is highly recommended.
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Schmidtke KA, Drinkwater KG. A cross-sectional survey assessing the influence of theoretically informed behavioural factors on hand hygiene across seven countries during the COVID-19 pandemic. BMC Public Health 2021; 21:1432. [PMID: 34289816 PMCID: PMC8293513 DOI: 10.1186/s12889-021-11491-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Human hygiene behaviours influence the transmission of infectious diseases. Changing maladaptive hygiene habits has the potential to improve public health. Parents and teachers can play an important role in disinfecting surface areas and in helping children develop healthful handwashing habits. The current study aims to inform a future intervention that will help parents and teachers take up this role using a theoretically and empirically informed behaviour change model called the Capabilities-Opportunities-Motivations-Behaviour (COM-B) model. METHODS A cross-sectional online survey was designed to measure participants' capabilities, opportunities, and motivations to [1] increase their children's handwashing with soap and [2] increase their cleaning of surface areas. Additional items captured how often participants believed their children washed their hands. The final survey was administered early in the coronavirus pandemic (May and June 2020) to 3975 participants from Australia, China, India, Indonesia, Saudi Arabia, South Africa, and the United Kingdom. Participants self-identified as mums, dads, or teachers of children 5 to 10 years old. ANOVAs analyses were used to compare participant capabilities, opportunities, and motivations across countries for handwashing and surface disinfecting. Multiple regressions analyses were conducted for each country to assess the predictive relationship between the COM-B components and children's handwashing. RESULTS The ANOVA analyses revealed that India had the lowest levels of capability, opportunity, and motivation, for both hand hygiene and surface cleaning. The regression analyses revealed that for Australia, Indonesia, and South Africa, the capability component was the only significant predictor of children's handwashing. For India, capability and opportunity were significant. For the United Kingdom, capability and motivation were significant. Lastly, for Saudi Arabia all components were significant. CONCLUSIONS The discussion explores how the Behaviour Change Wheel methodology could be used to guide further intervention development with community stakeholders in each country. Of the countries assessed, India offers the greatest room for improvement, and behaviour change techniques that influence people's capability and opportunities should be prioritised there.
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Affiliation(s)
- K. A. Schmidtke
- Medical School, Warwick Medical School, University of Warwick, Coventry, UK
| | - K. G. Drinkwater
- Psychology Department, Manchester Metropolitan University, Manchester, UK
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Anthonj C, Githinji S, Höser C, Stein A, Blanford J, Grossi V. Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: Disconnect, integration or opportunities? Int J Hyg Environ Health 2021; 235:113756. [PMID: 34004452 DOI: 10.1016/j.ijheh.2021.113756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Schools, depending on their access to and quality of water, sanitation and hygiene (WASH) and the implementation of healthy behaviours, can be critical for the control and spread of many infectious diseases, including COVID-19. Schools provide opportunities for pupils to learn about the importance of hygiene and WASH-related practice, and build healthy habits and skills, with beneficial medium- and long-term consequences particularly in low- and middle-income countries: reducing pupils' absenteeism due to diseases, promoting physical, mental and social health, and improving learning outcomes. WASH services alone are often not sufficient and need to be combined with educational programmes. As pupils disseminate their acquired health-promoting knowledge to their (extended) families, improved WASH provisions and education in schools have beneficial effects also on the community. International organisations frequently roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours. How such interventions relate to local school education on WASH, health promotion and disease prevention knowledge, whether and how such knowledge and school books are integrated into WASH education interventions in schools, are knowledge gaps we fill. METHODS We analyzed how Kenyan primary school science text book content supports WASH and health education by a book review including books used from class 1 through class 8, covering the age range from 6 to 13 years. We then conducted a rapid literature review of combined WASH interventions that included a behaviour change or educational component, and a rapid review of international policy guidance documents to contextualise the results and understand the relevance of books and school education for WASH interventions implemented by international organisations. We conducted a content analysis based on five identified thematic categories, including drinking water, sanitation, hygiene, environmental hygiene & health promotion and disease risks, and mapped over time the knowledge about WASH and disease prevention. RESULTS The books comprehensively address drinking water issues, including sources, quality, treatment, safe storage and water conservation; risks and transmission pathways of various waterborne (Cholera, Typhoid fever), water-based (Bilharzia), vector-related (Malaria) and other communicable diseases (Tuberculosis); and the importance of environmental hygiene and health promotion. The content is broadly in line with internationally recommended WASH topics and learning objectives. Gaps remain on personal hygiene and handwashing, including menstrual hygiene, sanitation education, and related health risks and disease exposures. The depth of content varies greatly over time and across the different classes. Such locally available education materials already used in schools were considered by none of the WASH education interventions in the considered intervention studies. CONCLUSIONS The thematic gaps/under-representations in books that we identified, namely sanitation, hygiene and menstrual hygiene education, are all high on the international WASH agenda, and need to be filled especially now, in the context of the current COVID-19 pandemic. Disconnects exist between school book knowledge and WASH education interventions, between policy and implementation, and between theory and practice, revealing missed opportunities for effective and sustainable behaviour change, and underlining the need for better integration. Considering existing local educational materials and knowledge may facilitate the buy-in and involvement of teachers and school managers in strengthening education and implementing improvements. We suggest opportunities for future research, behaviour change interventions and decision-making to improve WASH in schools.
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Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands; Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
| | | | - Christoph Höser
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
| | - Alfred Stein
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Justine Blanford
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Valentina Grossi
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
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