A Systematic Review of Community Handwashing Interventions Leading to Changes in Hygiene Behavior in the Developing World

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A B S T R A C T Background: Educational interventions in hygienic practices have shown to be cost effective methods of controlling diarrhea and other diseases spread through poor hygiene. Hand washing is one method of breaking the chain of transmission between household contacts, and especially between mother and child. Effective interventions to promote this behavior should be expanded and encouraged in the developing world. Objectives: To determine the extent and credibility of intervention studies done to promote uptake of improved hand washing behaviors in communities. To assess these interventions on their results in terms of behavior change, and identify factors contributing to their success or failure. Methods: The investigators searched the databases SCOPUS, EMBASE (1980-2010), and Pubmed for English papers written about hygiene promotion interventions in developing countries. Interventions included were community based control trials examining the effectiveness of increased hygiene education through measured behavior change. Only studies measuring behavior change using structured observation or demonstration of hand washing skills were used. Results: The search terms: hand washing, health education, hygiene promotion, behavior change, and diarrhea were used, resulting in a total of 330 titles. The investigators scanned the titles and abstracts to narrow down to 13 hygiene interventions measuring behavior change. Only five control trial interventions met the observation measurement criteria. Behavior change measurements were compiled and compared based on the length of intervention and the degree of change noted with each study.Conclusion: Encouraging uptake of hand washing behavior is possible using educational interventions to promote improved hygiene. The most significant impacts were seen from interventions running for longer periods of time. More robust and long term control trials are necessary to gather conclusive data on the sustainability of behavior change after educational interventions. Statistically sound methods of measurement of hand washing behavior change should be encouraged in future studies.