Effect of Two Complementary Mass-Scale Media Interventions on Handwashing with Soap among Mothers

Abstract

Poor handwashing behavior is a major cause of morbidity and mortality globally. We evaluated two complementary mass-scale media interventions targeting mothers to increase the frequency of handwashing with soap; one using TV advertising, and the other mobile phone messaging. Television Commercials (TVCs): Mothers of 4–12 year-old children (n = 756) were randomly allocated among four arms: Three different branded TVCs and a fourth, control TVC unrelated to handwashing. TVCs were embedded in blocks of unrelated commercials and shown once a week over four weeks in participants’ own homes. Mobile messages: New mothers (n = 598) and mothers of 4–7 year-old children (n = 501) were enrolled in a treatment or control arm. Mothers in the treatment arm received branded mobile phone messages twice weekly for 8 weeks (new mothers) or 4 weeks (mothers of 4–7 year-olds). For TVCs, there were higher rates of handwashing with soap at key occasions in the first (RR: 1.33, p = .002) and second (RR: 1.26, p = .041) of three treatment arms, or 0.4 additional handwashes with soap on key occasions daily. In the mobile study, new mothers (adj-RR: 1.04, p = .035) and general mothers (RR: 1.07, p = .007) receiving the intervention were more likely to wash their hands with soap on key occasions than those in the control group, corresponding to 1.3 and 1.0 more occasions daily. These interventions were associated with significantly greater handwashing with soap, consistent with the hypothesis that branded mass communications can impact habitual lifestyle behaviors relevant to public health.