Development and Application of Novel Caregiver Hygiene Behavior Measures Relating to Food Preparation, Handwashing, and Play Environments in Rural Kenya

Abstract

Exposure to fecal pathogens results in both acute and chronic sequalae in young children. Diarrhea causes nearly 20% of all under-five mortality, while even sub-clinical enteric infections may lead to growth shortfalls. Stunting affects nearly 165 million children globally and results in lifelong and intergenerational effects for the world’s poorest populations. Caregiver hygiene behaviors, such as those surrounding handwashing and food preparation, play a critical role in exposure to fecal pathogens; standard metrics to assess these behaviors are warranted to provide a means of quantifying the impact these behaviors have on enteric infections and to evaluate the success or failure of interventions and programs. This paper documents the development of three novel caregiver hygiene behavior measures: hygienic food preparation and storage, handwashing at key times, and provision of a safe play environment for children under two years. We developed these measures using formative qualitative work, survey creation and deployment theoretically underpinned by the COM-B model of behavior change, and exploratory and confirmatory factor analysis. The final measure for hygienic food preparation and storage includes 10 items across two factors; the final measure for handwashing at key times includes 15 items across three factors; and the final measure for safe play environment contains 13 items across three factors. Future researchers may employ these measures to assess caregiver behaviors in other populations, identify specific behavioral dimensions that should be the focus of interventions, and evaluate interventions and programs.

Barriers and opportunities for cleanliness of shared sanitation facilities in low-income settlements in Kenya

“…The BCW is a framework developed from multiple models of health behaviour, and enables the systematic development of interventions for supporting behaviour change [ 14 ]. The wheel has been applied to understand behavioural determinants and design interventions aimed at instilling good hygiene habits in schools in Uganda [ 15 ], understanding and development of caregiver hygiene behaviours [ 16 , 17 ] and other health related interventions [ 18 – 24 ].…”

Barriers and opportunities for management of shared sanitation facilities in low-income settlements in Kenya

“…The BCW has been applied to understand behavioural determinants and design interventions aimed at instilling good hygiene habits in schools in Uganda [14], development of caregiver hygiene behaviour measures [15] and other health related interventions [16][17][18][19][20][21][22]. The approach involves three stages: (1) Understanding the behaviour and identifying what needs to change (2) Identifying Intervention Functions (3) Identifying content and relevant 'Delivery mode' for the intervention.…”

Barriers and opportunities for management of shared sanitation facilities in low-income settlements in Kenya

“…The BCW is a framework developed from multiple models of health behaviour which enables the systematic development of interventions for supporting behaviour change [14]. The wheel has been applied to understand behavioural determinants and design interventions aimed at instilling good hygiene habits in schools in Uganda [15], development of caregiver hygiene behaviour measures [16] and other health related interventions [17][18][19][20][21][22][23].…”