What are the barriers and facilitators to community handwashing with water and soap? A systematic review

Abstract

Handwashing with water and soap (HWWS) is an effective method of cleaning and disinfecting the surface of the hands. HWWS is effective in infection control and prevention transmission, such as in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). However, rates of handwashing compliance vary globally. This systematic review aimed to identify the barriers and facilitators to community HWWS globally. We conducted a comprehensive search strategy in OVID Medline, OVID Embase, Web of Science Core Collection, and Scopus using keywords and subject headings related to handwashing. Studies were excluded if they reported hand hygiene among healthcare or food service workers, considered the use of alcohol rubs, or involved an intervention in a healthcare or food preparation setting. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool, and data were extracted from the articles and analyzed using the Theoretical Domains Framework and inductive thematic analysis. The search strategy yielded a total of 11,696 studies, and 46 studies met the eligibility criteria. Study dates ranged from 2003 to 2020 and included 26 countries; the most frequently represented were Bangladesh, India, and Kenya. A total of 21 barriers and 23 facilitators to HWWS were identified and organized into the Theoretical Domains Framework. The most frequently cited domains were environmental context and resources, goals, and knowledge. Nine themes emerged from these barriers and facilitators: resource availability, cost and affordability, handwash station design and infrastructure, accessibility, gender roles, champions, health promotion, time management, and knowledge, beliefs, and behaviors. This review uncovered multiple barriers and facilitators around a determinant framework to observe and create an in-depth, multidimensional image of a community-based hand hygiene situation. New comprehensive interventions and implementation strategies can be developed using the findings to target the contextual barriers and facilitators to improve and increase HWWS rates. Stakeholders (i.e., practitioners, researchers, policymakers) can use the findings to revise, design, or evaluate new or existing projects, interventions, and policies to improve HWWS. Registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO—International prospective register of systematic reviews database (Registration number: CRD42020221210).

Factors affecting hand hygiene practice during the COVID-19 pandemic in the Zimbabwean population: a qualitative study

“…These findings corroborate previous reports in which knowledge was associated with hand hygiene practices [ 20 , 26 , 27 ]. A systematic review has also identified knowledge as one of the factors affecting hand washing in the community [ 14 ]. Moreover, having knowledge about COVID-19 has been shown to increase compliance with preventive measures, including hand washing [ 28 ].…”

“…Adherence to hand washing depends on complex behavioural considerations, including social and cultural needs and environmental barriers [ 11 – 13 ]. A recent systematic review cited resource availability, cost and affordability, handwashing station design and infrastructure, accessibility, gender roles, health promotion, time management, knowledge, beliefs and behaviours as factors affecting hand washing in the community [ 14 ]. Low-income countries struggle to provide running water to many of their communities, thus compromising frequent hand washing.…”

Impact of In-Home Handwashing Stations on Hand Hygiene During the COVID-19 Pandemic in Unpiped Rural Alaska Native Homes

“…Access to a handwashing station with a functional water tap is one of the main determinants of effective hand hygiene. [29][30][31] Scholars working in low-and middle-income communities found that in infrastructure-restricted communities, in-home handwashing stations improved hand hygiene. 32,33 Our results indicated that the Mini-PASS shifted household handwashing from the washbasin to flowing water.…”

Italian National Surveillance of Alcohol-Based Hand Rub Consumption in a Healthcare Setting—A Three-Year Analysis: 2020–2022

“…In addition, studies showed that the COVID-19 pandemic has increased the use of ABHR, also improving healthcare workers’ compliance with HH [ 9 ]. However, HH remains a longstanding challenge due to concerns linked to the adherences of healthcare workers (HCWs) and the infrastructures and resources needed to focus on its enhancement [ 10 ].…”