Provision versus promotion to develop a handwashing station: the effect on desired handwashing behavior

Abstract

BackgroundDiarrhea prevalence increases from around the time that complementary foods are introduced. Improving caregiver’s hand hygiene during food preparation could reduce complementary food contamination and enteric pathogen transmission. Washing hands with soap is more common when water and soap are together at a convenient location. We conducted a three-month pilot intervention to evaluate two options for setting up handwashing stations: i) provide a handwashing station, or ii) help the family to make their own from available materials. Additionally, we assessed the feasibility of this intervention to be integrated with a child feeding program.MethodsWe conducted the intervention among two groups; 40 households received a free of cost handwashing station and another 40 households were motivated to place their own soap/soapy-water and water vessel near the food preparation and child feeding area. Community health workers encouraged caregivers to wash hands with soap/soapy-water before food preparation and feeding a child. They either assisted study participants to install the study-provided handwashing station at the recommended place or encouraged caregivers to develop their own. Field researchers assessed placement and composition of handwashing stations and the feasibility of integrating handwashing and nutrition messages.ResultsBy end of the trial, 39/40 households developed their own handwashing station, comprising a bucket, mug and bar soap/soapy-water of which 60% (6/10) households were observed with a functional and complete handwashing station set. Observed handwashing with soap was detected among 8/10 households from the study-provided handwashing station group and 5/10 among households who had made their own handwashing station. Sixty-seven of the 76 caregivers recalled integrated intervention messages on social and health benefits of infant and young child feeding correctly; and all recalled key handwashing with soap times, before food preparation and feeding a child.ConclusionEncouraging households to develop their own handwashing station with soap and water to place at a food preparation/child feeding location is feasible over the short term. In the absence of large-scale provision of handwashing stations, caregivers can be encouraged to create and use their own. Integrating handwashing with soap into a nutrition intervention was feasible and acceptable and should be considered by policy makers.

Achieving behaviour change at scale: Alive & Thrive's infant and young child feeding programme in Bangladesh

“…However, providing stations on a large scale was not sustainable (Biswas et al . ). The same study also showed that complementary feeding indicators improved alongside handwashing indicators when a single integrated package of interventions was implemented (Unicomb et al .…”

Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh

“…Further research on how handwashing can be promoted in the absence of intense interpersonal communication and without free provision of supplies is a priority area for handwashing research. The popularity of soapy water suggests it may be a promising component [ 57 ].…”

Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia

“…These interventions might have been effective at reducing transmission [48]. Evidence from stable settings certainly supports the initial choice among many humanitarian organisations to prioritise infrastructure [49][50][51][52]. Provision of handwashing infrastructure has also proved effective in protracted crises and cholera outbreaks, but in these contexts was strengthened by a 'soft' behaviour change-focused intervention [53,54].…”