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Changing handwashing behaviour in southern Ethiopia: A longitudinal study on infrastructural and commitment interventions

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  • Contzen, Nadja
  • Meili, Iara Helena
  • Mosler, Hans-Joachim

Abstract

Improved hand hygiene efficiently prevents the major killers of children under the age of five years in Ethiopia and globally, namely diarrhoeal and respiratory diseases. Effective handwashing interventions are thus in great demand. Evidence- and theory-based interventions, especially when matched to the target population's needs, are expected to perform better than common practice. To test this hypothesis, we selected two interventions drawing on a baseline questionnaire-study that applied the RANAS (Risk, Attitudes, Norms, Abilities, Self-regulation) approach and focused on the primary caregivers of households in four rural, water-scarce kebeles (smallest administrative units of Ethiopia) in southern Ethiopia (N = 462). The two interventions were tested in combination with a standard education intervention in a quasi-experiment, as follows: kebele 1, education intervention, namely an f-diagram exercise, (n = 23); kebele 2, education intervention and public-commitment (n = 122); kebele 3, education intervention and tippy-tap-promotion (i.e. handwashing-station-promotion; n = 150); kebele 4, education intervention, public-commitment and tippy-tap-promotion (n = 113). In kebeles 3 and 4, nearly 100% of the households followed the promotion and invested material and time to construct for themselves a tippy-tap. Three months after intervention termination, the tippy-taps were in use with water and soap being present in up to 83% of the households (kebele 4). Pre-post data analysis on self-reported handwashing revealed that the population-tailored interventions, and especially the tippy-tap-promotion, performed better than the standard education intervention. Tendencies in observed behaviour and a recently developed implicit self-measure pointed to similar results. Changing people's hand hygiene is known to be a challenging task, especially in a water-scarce environment. The present project suggests not only to apply theory and evidence to improve handwashing interventions' effectiveness, but also emphasizes the relevance of tailoring interventions to the target population.

Suggested Citation

  • Contzen, Nadja & Meili, Iara Helena & Mosler, Hans-Joachim, 2015. "Changing handwashing behaviour in southern Ethiopia: A longitudinal study on infrastructural and commitment interventions," Social Science & Medicine, Elsevier, vol. 124(C), pages 103-114.
    • Handle: RePEc:eee:socmed:v:124:y:2015:i:c:p:103-114
    DOI: 10.1016/j.socscimed.2014.11.006
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    References listed on IDEAS

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    1. Friedrich, Max N.D. & Kappler, Andreas & Mosler, Hans-Joachim, 2018. "Enhancing handwashing frequency and technique of primary caregivers in Harare, Zimbabwe: A cluster-randomized controlled trial using behavioral and microbial outcomes," Social Science & Medicine, Elsevier, vol. 196(C), pages 66-76.
    2. Inauen, Jennifer & Lilje, Jonathan & Mosler, Hans-Joachim, 2020. "Refining hand washing interventions by identifying active ingredients: A cluster-randomized controlled trial in rural Zimbabwe," Social Science & Medicine, Elsevier, vol. 245(C).
    3. YuJung Julia Lee & Tiffany Radcliff, 2021. "Community interactions and sanitation use by the urban poor: Survey evidence from India’s slums," Urban Studies, Urban Studies Journal Limited, vol. 58(4), pages 715-732, March.
    4. Monica Nzanga & Mindy Panulo & Tracy Morse & Kondwani Chidziwisano, 2022. "Adherence to Hand Hygiene among Nurses and Clinicians at Chiradzulu District Hospital, Southern Malawi," IJERPH, MDPI, vol. 19(17), pages 1-11, September.
    5. Watson, Julie & Cumming, Oliver & MacDougall, Amy & Czerniewska, Alexandra & Dreibelbis, Robert, 2021. "Effectiveness of behaviour change techniques used in hand hygiene interventions targeting older children – A systematic review," Social Science & Medicine, Elsevier, vol. 281(C).
    6. Jurgita Slekiene & Kondwani Chidziwisano & Tracy Morse, 2022. "Does Poor Mental Health Impair the Effectiveness of Complementary Food Hygiene Behavior Change Intervention in Rural Malawi?," IJERPH, MDPI, vol. 19(17), pages 1-12, August.
    7. Anna E. Gamma & Jurgita Slekiene & Hans-Joachim Mosler, 2019. "The Impact of Various Promotional Activities on Ebola Prevention Behaviors and Psychosocial Factors Predicting Ebola Prevention Behaviors in the Gambia Evaluation of Ebola Prevention Promotions," IJERPH, MDPI, vol. 16(11), pages 1-18, June.
    8. Aaron Lawson & Marie Vaganay-Miller, 2019. "The Effectiveness of a Poster Intervention on Hand Hygiene Practice and Compliance When Using Public Restrooms in a University Setting," IJERPH, MDPI, vol. 16(24), pages 1-12, December.
    9. Kondwani Chidziwisano & Elizabeth Tilley & Tracy Morse, 2020. "Self-Reported Versus Observed Measures: Validation of Child Caregiver Food Hygiene Practices in Rural Malawi," IJERPH, MDPI, vol. 17(12), pages 1-14, June.
    10. Jonathan Lilje & Hans-Joachim Mosler, 2016. "Continuation of Health Behaviors: Psychosocial Factors Sustaining Drinking Water Chlorination in a Longitudinal Study from Chad," Sustainability, MDPI, vol. 8(11), pages 1-20, November.
    11. Harter, Miriam & Inauen, Jennifer & Mosler, Hans-Joachim, 2020. "How does Community-Led Total Sanitation (CLTS) promote latrine construction, and can it be improved? A cluster-randomized controlled trial in Ghana," Social Science & Medicine, Elsevier, vol. 245(C).
    12. Robert Dreibelbis & Anne Kroeger & Kamal Hossain & Mohini Venkatesh & Pavani K. Ram, 2016. "Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh," IJERPH, MDPI, vol. 13(1), pages 1-7, January.
    13. Tracy Morse & Kondwani Chidziwisano & Elizabeth Tilley & Rossanie Malolo & Save Kumwenda & Janelisa Musaya & Sandy Cairncross, 2019. "Developing a Contextually Appropriate Integrated Hygiene Intervention to Achieve Sustained Reductions in Diarrheal Diseases," Sustainability, MDPI, vol. 11(17), pages 1-17, August.
    14. Kim Dockx & Hans Van Remoortel & Emmy De Buck & Charlotte Schelstraete & An Vanderheyden & Tiene Lievens & John Thomas Kinyagu & Simon Mamuya & Philippe Vandekerckhove, 2019. "Effect of Contextualized Versus Non-Contextualized Interventions for Improving Hand Washing, Sanitation, and Health in Rural Tanzania: Study Design of a Cluster Randomized Controlled Trial," IJERPH, MDPI, vol. 16(14), pages 1-12, July.

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