Evaluating approaches to designing effective Co-Created hand-hygiene interventions for children in India, Sierra Leone and the UK

Abstract

Effective and culturally appropriate hand-hygiene education is essential to promote healthrelated practices to control and prevent diseases such as Diarrhoea, Ebola and COVID-19. In this paper we outline and evaluate the Co-Creation processes underpinning a handwashing intervention for young children (A Germ's Journey) developed and delivered in India, Sierra Leone and the UK, and consider the implications surrounding Imperialist/Colonial discourse and the White Saviour Complex. The paper focuses both on the ways Co-Creation was conceptualised by our collaborators in all three countries and the catalysts and challenges encountered. Qualitative data have been drawn from in-depth interviews with five key stakeholders, focus group data from 37 teachers in Sierra Leone and responses to open-ended questionnaires completed by teachers in India (N = 66) and UK (N = 63). Data were analysed using thematic analysis and three themes, each with three constituent subthemes are presented. In the theme 'Representations of and Unique Approaches to Co-Creation' we explore the ways in which Co-Creation was constructed in relation to teamwork, innovative practice and more continuous models of evaluation. In 'Advantages of Co-Creation' we consider issues around shared ownership, improved outcomes and more meaningful insights alongside the mitigation of risks and short-circuiting of problems. In 'Challenges of Co-Creation' we discuss issues around timing and organisation, attracting and working with appropriate partners and understanding the importance of local context with inherent social, economic and structural barriers, especially in low-and-middle-income countries. We consider how theoretical elements of Co-Creation can inform effective international public health interventions; crucial during a global pandemic in which handwashing is the most effective method to control the transmission of COVID-19. Finally we reflect on some of the methodological challenges of our own work and in managing the potentially conflicting goals of the ethical and participatory values of Co-Creation with pragmatic considerations about ensuring an effective final 'product'.

Community engagement in water, sanitation and hygiene in sub-Saharan Africa: does it WASH?

“…Within sub-Saharan Africa, where the paper focuses, the literature advocates community participation in water access (Kamara et al 2017;Adams & Boateng 2018;Nastar et al 2018;Hovden et al 2020), water management (Tantoh & Simatele 2017;Kelly et al 2018;Tantoh et al 2021;Arimoro & Musa 2020;Hassenforder et al 2020;Nyam et al 2020;Zambrano et al 2020;Shields et al 2021), sanitation promotion (Crocker et al 2016), sanitation at school (Person et al 2016;Hetherington et al 2017), sanitation for community health (Kariuki et al 2012;Kema et al 2012;Banana et al 2015;Kefeni & Yallew 2018), waste management (Holm et al 2021) hand hygiene (Crosby et al 2020) and menstrual hygiene (Scorgie et al 2016). This indicates that when it comes to community engagement in WASH, hygiene is identified as a key area with more gaps and therefore potential for innovation.…”

“…In terms of sanitation and hygiene, education is equally critical for the promotion and acceptance of WASH, as many community members are not aware of the causes of water contamination, the health effects of using contaminated water or the effects of open defaecation or littering (Silvestri et al 2018). Several studies have underscored the importance of health education and promotion in the improvement of hygiene practice (Kariuki et al 2012;Aduro & Ebenso 2019;Crosby et al 2020). Community members have the potential to solve their health problems, but lack awareness of their potentials (Kema et al 2012).…”

“…Community-based and participatory approaches have been proven effective in tackling WASH issues in sub-Saharan countries (Kariuki et al 2012;Bisung et al 2015;Crosby et al 2020;Nyam et al 2020). More precisely, they have led to increased water accessibility in Malawi (Adams & Boateng 2018); helped improve the effectiveness of multi-level participatory water governance in Uganda (Hassenforder et al 2020) and to identify solutions to WASH issues affecting rural communities in resource-poor settings in Uganda (O'Donovan et al 2020); helped solve problems related to water management and agricultural development in South Africa (Nyam et al 2020) and the development of more sustainable and effective interventions for the control of schistosomiasis in Tanzania (Person et al 2016).…”

What are the social and personal drivers to engage in co-creation? A study of UK 7–13-year-olds

“…However, these contributions have invariably used adult samples (Sarkar and Banerjee, 2019), limiting what is known about children’s co-creative behaviours, despite the acknowledgement in the literature that brand-user characteristics impact upon co-creation activity (Trischler et al , 2017). A review of the extant literature presents an array of empirical papers that indicate that children do engage in co-creation, or “participatory design” (Slingerland et al , 2020), but scrutiny of this body of work indicates that these investigations are highly contextual, and centred within education and educational policy (Breive, 2020; Catala et al , 2018; Clement, 2019; Novlianskaya, 2020; Paracha et al , 2019; Sharma et al , 2020), child development (Slingerland et al , 2020), developmental disorders (Alsem et al , 2017; Huijnen et al , 2017; Whelan et al , 2015) and social learning paradigms (Bevelander et al , 2019; Crosby et al , 2020). Moreover, several of the above studies fail to incorporate children (Crosby et al , 2020; Sharma et al , 2020) and none of the works explore children and co-creation in the context of the marketing literature.…”

“…A review of the extant literature presents an array of empirical papers that indicate that children do engage in co-creation, or “participatory design” (Slingerland et al , 2020), but scrutiny of this body of work indicates that these investigations are highly contextual, and centred within education and educational policy (Breive, 2020; Catala et al , 2018; Clement, 2019; Novlianskaya, 2020; Paracha et al , 2019; Sharma et al , 2020), child development (Slingerland et al , 2020), developmental disorders (Alsem et al , 2017; Huijnen et al , 2017; Whelan et al , 2015) and social learning paradigms (Bevelander et al , 2019; Crosby et al , 2020). Moreover, several of the above studies fail to incorporate children (Crosby et al , 2020; Sharma et al , 2020) and none of the works explore children and co-creation in the context of the marketing literature. To date, only Daems et al (2019) have looked at co-creation through a consumption lens, exploring advertising literacy, but even this contribution capitalised on “four co-creation workshops” that were controlled (reflecting earlier work by Catala et al , 2018) and school based, and that did not capture volitional participation in the product design.…”