Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh

Abstract

BackgroundTo design a maternal handwashing intervention for the newborn period, this qualitative study explored drivers of handwashing among mothers and other caregivers of neonates and infants in two rural areas of Bangladesh.MethodsWe conducted 40 semi-structured observation sessions to observe handwashing behaviors of primiparous and multiparous mothers of neonates, and to understand the contextual factors that facilitated or hampered those behaviors. We then conducted 64 interviews with mothers of neonates and mothers of infants and 6 group discussions with mothers of infants, other female caregivers and fathers to explore perceptions, beliefs, and practices related to handwashing in the neonatal period. Based on a conceptual model and the Theory of Reasoned Action/Theory of Planned Behavior, we developed a conceptual model a priori, we performed thematic analysis to explain determinants of maternal handwashing behaviors.ResultsWe conducted 200 h of observation among mothers of neonates. The age range of participating mothers varied between 17 and 25 years and their maximum education was up to 10th grade of schooling. Mothers, other female caregivers and fathers perceived a need to wash hands with or without soap before eating or before feeding a child by hand to prevent diarrhea. Mothers expressed the importance of washing their hands before holding a baby but were rarely observed doing so. All respondents prioritized using soap for visible dirt or feces; otherwise, water alone was considered sufficient. Lack of family support, social norms of infrequent handwashing, perceptions of frequent contact with water as a health threat and mothers’ restricted movement during first 40 days of neonate’s life, and childcare and household responsibilities adversely impacted handwashing behavior.ConclusionsAddressing emotive drivers of handwashing within existing social norms by engaging family members, ensuring handwashing facilities and clarifying neonatal health threats may improve maternal handwashing behavior in the neonatal period.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5365-1) contains supplementary material, which is available to authorized users.

Hygiene Along the Continuum of Care in the Early Post-Natal Period: An Observational Study in Nigeria

“…Our study also provides data on the wide range of individuals who are involved in both maternal and newborn care along this continuum, including healthcare workers, cleaners, visitors, fathers, mothers, and non-parental caregivers. Not only were hand hygiene actions rare during our observation period, similarly to other studies, hand hygiene actions were largely inadequate; for example, HCW using gloves without having washed their hands with soap before (29,34) and mothers and other caregivers rinsing hands with water only (21,22,35,36). Visitors in the health facility and non-maternal caregivers at the home accounted for the majority of observed hand hygiene opportunities, particularly around newborn care, but no hand hygiene actions were observed by these groups.…”

“…Many HCF-based studies on hand hygiene practices during maternal and newborn care in LMIC have focused on HCW hand hygiene during labour and delivery or high-risk environments such as the neonatal intensive care units (16)(17)(18)(19)(20). Community-based studies have generally focused on caregiver hygiene practices for newborns who are born outside the health facility or during the late post-natal period (>7 days after birth) (18,(21)(22)(23)(24)(25). Limited attention has been given to understanding hand hygiene compliance by the wide range of personnel and caregivers providing facility-and home-based newborn care in the immediate and early post-natal period (<8 days after birth) (26,27).. Understanding hand hygiene practices of various caregivers during this early post-natal period and how these are in uenced by multiple factors allows for the design and implementation of more effective facility-based interventions to improve behaviours.…”

Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

“…Studies on hygiene during neonatal care in the home environment focus primarily on the new mothers or birth attendants (18,23,24,46). Non-maternal caregivers are not only actively engaged in newborn care, but they are also important drivers of the mothers' handwashing behaviours (21,22). Interventions may potentially overlook the critical role and engagement of fathers and extended family members in newborn contact (47).…”

“…Many HCF-based studies on hand hygiene practices during maternal and newborn care in LMIC have focused on HCW hand hygiene during labour and delivery or high-risk environments such as the neonatal intensive care units (16)(17)(18)(19)(20). Community-based studies have generally focused on caregiver hygiene practices for newborns who are born outside the health facility or during the late post-natal period (>7 days after birth) (18,(21)(22)(23)(24)(25). Limited attention has been given to understanding hand hygiene compliance by the wide range of personnel and caregivers providing facility-and home-based newborn care in the immediate and early post-natal period (<8 days after birth) (26).…”

Impact of an Intensive Perinatal Handwashing Promotion Intervention on Maternal Handwashing Behavior in the Neonatal Period: Findings from a Randomized Controlled Trial in Rural Bangladesh

“…As shown in a companion qualitative investigation, this model was used to understand drivers of maternal handwashing in the neonatal period [11]. Consistent with the findings from the qualitative work, behavior change communicators used an interactive approach to validate the prevalent perceived susceptibility of the neonatal period.…”