Psychosocial Factors Mediating the Effect of the CHoBI7 Intervention on Handwashing With Soap: A Randomized Controlled Trial

George, Christine Marie; Biswas, Shwapon; Jung, Danielle; Perin, Jamie; Parvin, Tahmina; Monira, Shirajum; Saif‐Ur‐Rahman, K. M.; Rashid, Mohammad Junaebur; Bhuyian, Sazzadul Islam; Thomas, Elizabeth; Dreibelbis, Robert; Begum, Farzana; Zohura, Fatema; Zhang, Xiaolin; Sack, David A.; Alam, Munirul; Sack, R. Bradley; Leontsini, Elli; Winch, Peter J.

doi:10.1177/1090198116683141

Cited by 68 publications

(26 citation statements)

References 42 publications

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“…Using a theory-based approach, the CHoBI7 intervention program was informed by components of Protection Motivation Theory, IBM-WASH, and the RANAS Model [25, 27, 29]. Using these theories and models, we developed behavior change techniques for the CHoBI7 intervention program targeting remembering, perceived susceptibility and severity, cholera awareness, disgust, response efficacy, convenience, and self-efficacy (based on previous studies [18, 21, 30, 41–43]), and used Likert scale statements to measure these psychosocial factors (methods are published in George et al [44]). By measuring these psychosocial factors during our recent RCT of CHoBI7, we were able to investigate the underlying mechanism of change that led to the high handwashing with soap behavior observed among intervention participants.…”

Section: Introductionmentioning

confidence: 99%

“…By measuring these psychosocial factors during our recent RCT of CHoBI7, we were able to investigate the underlying mechanism of change that led to the high handwashing with soap behavior observed among intervention participants. Response efficacy (judgments about the efficacy of a preventive response that will avert the perceived threat [29]) was found to mediate the intervention’s effect on handwashing with soap habit formation at the 1-week follow-up, whereas disgust, convenience, and cholera awareness were mediators of habit maintenance at the 6 to 12-month follow-up [44]. Our study was the first RCT of a WASH intervention that conducted a mediation analysis to investigate the underlying mechanism of change in a low-income country.…”

Section: Introductionmentioning

confidence: 99%

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Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

et al. 2019

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Background The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery. Methods Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed. Results A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others. Conclusion This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings. Electronic supplementary material The online version of this article (10.1186/s12889-019-7144-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

et al. 2019

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“…12 Furthermore, in our recent analysis of psychosocial factors associated with handwashing with soap in the RCT of CHoBI7, we found disgust messages focusing on feces as a transmission route for cholera to significantly mediate the effect of the CHoBI7 intervention at the 6-to 12-month follow-up. 29 Therefore, CHoBI7 presents an effective approach to increase awareness on key times for handwashing with soap, transmission routes for cholera, and observed handwashing with soap behavior.…”

Section: Discussionmentioning

confidence: 99%

Promotion of Cholera Awareness Among Households of Cholera Patients: A Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7 Days (CHoBI7) Intervention

Saif‐Ur‐Rahman

Parvin

Bhuyian

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Previous studies have demonstrated that household contacts of cholera patients are highly susceptible to cholera infections for a 7-day period after the presentation of the index patient in the hospital. However, there is no standard of care to prevent cholera transmission in this high-risk population. Furthermore, there is limited information available on awareness of cholera transmission and prevention among cholera patients and their household contacts. To initiate a standard of care for this high-risk population, we developed the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which delivers a handwashing with soap and water treatment intervention to household contacts during the time they spend with the admitted cholera patient in the hospital and reinforces these messages through home visits. To test CHoBI7, we conducted a randomized controlled trial among 302 intervention cholera patient household members and 302 control cholera patient household members in Dhaka, Bangladesh. In this study, we evaluated the effectiveness of the CHoBI7 intervention in increasing awareness of cholera transmission and prevention, and the key times for handwashing with soap. We observed a significant increase in cholera knowledge score in the intervention arm compared with the control arm at both the 1-week follow-up {score coefficient = 2.34 (95% confidence interval [CI] = 1.96, 2.71)} and 6 to 12-month follow-up period (score coefficient = 1.59 [95% CI = 1.05, 2.13]). This 1-week hospital- and home-based intervention led to a significant increase in knowledge of cholera transmission and prevention which was sustained 6 to 12 months post-intervention. These findings suggest that the CHoBI7 intervention presents a promising approach to increase cholera awareness among this high-risk population.

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“…The authors of the RANAS theory of behaviour argue that it is common for health promotion messages in emergency settings to focus on increasing the 'perceived susceptibility and perceived severity of contracting a disease, and factual knowledge about the possibility of being affected' [33] p.561, forgetting other behavioural factors that are also important predictors of behaviour. Other studies have even shown that behaviour can change during disease outbreaks without people feeling any increased sense of infection risk [55].…”

Section: Limited Attention To Behavioural Determinantsmentioning

confidence: 99%

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

Czerniewska

White

2020

BMC Public Health

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Background: Hygiene promotion is a cornerstone of humanitarian response during infectious disease outbreaks. Despite this, we know little about how humanitarian organisations design, deliver or monitor hygiene programmes, or about what works to change hygiene behaviours in outbreak settings. This study describes humanitarian perspectives on changing behaviours in crises, through a case study of hygiene promotion during the 2014-2016 Liberian Ebola outbreak. Our aim was to aid better understanding of decision making in high-stress situations where there is little precedent or evidence, and to prompt reflection within the sector around how to improve and support this. Methods: We conducted in-depth, semi-structured interviews with fourteen purposively-sampled individuals (key informants) from international organisations involved in hygiene behaviour change during the outbreak. Through thematic analysis we identified the decisions that were made and processes that were followed to design, deliver and monitor interventions. We compared our findings with theory-driven processes used to design behaviour change interventions in non-outbreak situations. Results: Humanitarians predominantly focussed on providing hygiene products (e.g. buckets, soap, gloves) and delivering messages through posters, radio and community meetings. They faced challenges in defining which hygiene behaviours to promote. Assessments focused on understanding infrastructural needs, but omitted systematic assessments of hygiene behaviours or their determinants. Humanitarians assumed that fear and disease awareness would be the most powerful motivators for behaviour change. They thought that behaviour change techniques used in non-emergency settings were too 'experimental', and were beyond the skillset of most humanitarian actors. Monitoring focussed on inputs and outputs rather than behavioural impact. Conclusions: The experiences of humanitarians allowed us to identify areas that could be strengthened when designing hygiene programmes in future outbreaks. Specifically, we identified a need for rapid research methods to explore behavioural determinants; increased skills training for frontline staff, and increased operational research to explore behaviour change strategies that are suited to outbreak situations.

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Psychosocial Factors Mediating the Effect of the CHoBI7 Intervention on Handwashing With Soap: A Randomized Controlled Trial

Cited by 68 publications

References 42 publications

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

Promotion of Cholera Awareness Among Households of Cholera Patients: A Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7 Days (CHoBI7) Intervention

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

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