Exploring behavioral determinants of handwashing with soap after defecation in an urban setting in Bangladesh: findings from a barrier analysis

Kalam, Abul; Davis, Thomas W.; Islam, Md. Ariful; Islam, Shahidul; Kittle, Bonnie L.; Casas, Marc Pérez

doi:10.2166/washdev.2021.070

Cited by 14 publications

(11 citation statements)

References 22 publications

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“…A key feature of the BA is that responses from those doing a behaviour ("Doers" or "Acceptors") are compared with responses from those who are not (the "Non-doers" or "Non-acceptors") so that the most-important behavioural determinants can be identified [8]. The other details of the BA approach can be found elsewhere [8,[29][30][31][32].…”

Section: Study Approachmentioning

confidence: 99%

Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries

Davis¹,

Yimam²,

Kalam³

et al. 2022

Vaccines

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Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.

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Section: Study Approachmentioning

confidence: 99%

Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries

Davis¹,

Yimam²,

Kalam³

et al. 2022

Vaccines

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“…In the DBC approach, based on the health belief model and theory of planned behaviour (Kalam, Davis, Shano, et al, 2021), barrier analysis (BA) is used to identify determinants, influencing groups and inform activities for behaviour change. The BA is a rapid assessment tool using doer/non‐doer methodology that identifies the barriers and enablers, and the most important behavioural determinants associated with a particular behaviour (Kalam, Davis, Islam, et al, 2021). Comparative data are collected from doers (individuals who perform the behaviour) and non‐doers (individuals who do not perform the behaviour) using both open‐ended and close‐ended questions (Davis, 2010; Gibbs & Collett, 2016; The TOPS Program, 2016).…”

Section: Methodsmentioning

confidence: 99%

Use of designing for behaviour change framework in identifying and addressing barriers to and enablers of animal source feeding to children ages 8–23 months in Bandarban Hill District in Bangladesh: Implications for a nutrition‐sensitive agriculture programme

Kalam

Asif

Stormer

et al. 2023

Maternal & Child Nutrition

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Inadequate diet quality is a cause of undernutrition among children 6-23 months of age in Bangladesh, particularly in remote and isolated areas such as Bandarban District. Feeding animal source foods can help to combat stunting and wasting problems among children, but it may not be accessible or acceptable. A barrier analysis using the Designing for Behavior Change Framework was conducted in Bandarban district with participants from 4 ethnic groups, to explore potential barriers and key motivators by examining 12 behavioural determinants of consumption of animal-source food in complementary feeding for children 8-23 months. Data were collected from 45 mothers of children 8-23 months, who provided animal-source foods to their children (doers), and from 45 mothers who did not (non-doers), for a total of 90 interviews. Nine determinants were statistically significantly different between doers and non-doers as follows: self-efficacy, positive consequences, negative consequences, social norms, access, reminders, perceived risk, perceived severity and perceived action efficacy. Nearby access to purchase animal-source foods, rearing poultry or livestock at home and the support of household and community members are enablers to feeding animal-source food. In contrast, these same factors are barriers for non-doers. The lack of money to spend on animal-source foods is also a barrier. An integrated nutrition-sensitive and gender-transformative animal-based food production, and inclusive market programme could increase access to meat and eggs at the household level, increase opportunities to earn income and support gender-equitable household workloads and decision-making for optimal child feeding.

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“…Furthermore, there might be lack of active participation in promoting hand hygiene if individuals do not believe in the value of hand hygiene in the prevention of infections. [24][25][26] Due to its surfactants, the use of soap with water greatly improves elimination of bacteria from the hands compared with that accomplished by washing with water alone. In low-income societies in developing countries, where soap or alcohol-based agents are not usually available due to cost, soil, mud and ash are sometimes used as a zero-cost alternative to soap.…”

Section: Open Accessmentioning

confidence: 99%

Effects of local handwashing agents on microbial contamination of the hands in a rural setting in Northwest Ethiopia: a cluster randomised controlled trial

et al. 2022

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ObjectiveTo evaluate the effectiveness of handwashing with water and wood ash in reducing faecal contamination of the hands.DesignA cluster randomised controlled trial was employed with two arms: handwashing with water and wood ash versus handwashing with water alone.SettingRural households of East Dembiya District, Central Gondar Zone, Amhara National Regional State, Ethiopia.Participants440 mothers and caregivers of children younger than 5 years assigned (1:1, 220 in each group) in clusters, with buffer zones between each cluster.InterventionHealth education on effective handwashing was given to the intervention and control groups. Participants in the intervention group used wood ash of the same quantity (ie, one closed palm).Outcome measuresThe primary outcome was microbial contamination of the hands, measured by means of Escherichia coli counts before and after handwashing.ResultsAt baseline, 75.9% and 67.7% of the participants in the intervention and control groups, respectively, had dirt on their fingernails, and the hands of all participants in both groups were contaminated with E. coli. The mean E. coli counts recovered at baseline were 3.07 log10 colony forming unit (CFU)/swab in the intervention group and 3.03 log10 CFU/swab in the control group, while at endline it was 1.4 log10 CFU/swab in the intervention group and 3.02 log10 CFU/swab in the control group. The mean E.coli counts was reduced by 1.65 log10 due to the intervention (difference-in-differences: β= −1.65, 95% CI= −1.84 to –1.46).ConclusionTwo-thirds of the swab samples tested positive for E. coli after handwashing with water and wood ash, which indicates wood ash is not very effective in terms of completely removing micro-organisms on the hands. However, wood ash was significantly better than water alone in reducing the concentration of faecal coliform organisms on the hands. Local health authorities should primarily promote handwashing with soap. However, in the absence of soap, use of wood ash over water alone might be appropriate.Trial registration numberPACTR202011855730652.

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Exploring behavioral determinants of handwashing with soap after defecation in an urban setting in Bangladesh: findings from a barrier analysis

Cited by 14 publications

References 22 publications

Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries

Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries

Use of designing for behaviour change framework in identifying and addressing barriers to and enablers of animal source feeding to children ages 8–23 months in Bandarban Hill District in Bangladesh: Implications for a nutrition‐sensitive agriculture programme

Effects of local handwashing agents on microbial contamination of the hands in a rural setting in Northwest Ethiopia: a cluster randomised controlled trial

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