Effectiveness of behaviour change techniques used in hand hygiene interventions targeting older children – A systematic review

Julie Watson,Oliver Cumming,Amy Macdougall,Alexandra Czerniewska,Robert Dreibelbis

doi:10.1016/j.socscimed.2021.114090

Julie Watson, Oliver Cumming + Show 3 more

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https://doi.org/10.1016/j.socscimed.2021.114090

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Abstract

BackgroundPromoting good hand hygiene in older children is an important measure to reduce the burden of common diseases such as diarrhoea and acute respiratory infections. The evidence around what works to change this behaviour, however, is unclear. ObjectivesTo aid future intervention design and effective use of resources, this review aims to identify the individual components used in hand hygiene interventions and assesses their contribution to intended behavioural change. MethodsWe systematically searched seven databases for experimental studies evaluating hand hygiene interventions targeting children (age 5–12) and quantitively reporting hand hygiene behaviour. Interventions in each study were categorised as ‘promising’, or ‘non-promising’ according to whether they led to a positive change in the targeted behaviour. Behaviour change techniques (BCTs) were identified across interventions using a standard taxonomy and a novel promise ratio calculated for each (the ratio of promising to non-promising interventions featuring the BCT). ‘Promising’ BCTs were those with a promise ratio of ≥2. BCTs were ranked from most to least promising. ResultsOur final analysis included 19 studies reporting 22 interventions across which 32 unique BCTs were identified. The most frequently used were ‘demonstration of the behaviour’, ‘instruction on how to perform the behaviour’ and ‘adding objects to the environment’. Eight BCTs had a promise ratio of ≥2 and the five most promising were ‘demonstration of the behaviour’, ‘information about social and environmental consequences’, ‘salience of consequences’, ‘adding objects to the environment’, and ‘instruction on how to perform the behaviour’. ConclusionsOur findings suggest that hand hygiene interventions targeting older children should employ a combination of promising BCTs that ensure children understand the behaviour and the consequences of their hand hygiene habits, appropriate hardware is available, and social support is provided. Researchers are encouraged to consistently and transparently describe evaluated interventions to allow promising components to be identified and replicated.

Highlights

Hand hygiene is a critical measure for the prevention of communi cable disease
The greatest burden of diarrhoea and acute respiratory infections (ARIs) is borne by children under-five, these diseases are some of the leading causes of mortality among older children; they account for over 19% of all deaths in this age group globally (World Health Orga nization, 2020)
After de-duplication, a total of 3360 articles were screened by title and abstract and 94 articles were selected for full-text screening

Summary

Introduction

Hand hygiene is a critical measure for the prevention of communi cable disease. Handwashing with soap alone can reduce both diarrhoea and acute respiratory infections (ARIs) by over 20% (Aiello et al, 2008; Cairncross et al, 2010; Freeman et al, 2014; Wolf et al, 2018) and has been linked to the reduction of certain neglected tropical diseases such as trachoma (Stocks et al, 2014) and some soil-transmitted helminth infections (Strunzet al., 2014). Older children - children age 5–14 as often defined in Global Burden of Disease studies (Kyuet al., 2018) - are an important target group for hand hygiene interventions. Many habits established during childhood years can persist through to adulthood (Kelderet al., 1994; Movassagh et al, 2017; Pressman et al, 2014) For these reasons, effective interventions targeting older children which aim to improve their hand hygiene behaviour are likely to achieve significant public health impacts. Conclusions: Our findings suggest that hand hygiene interventions targeting older children should employ a combination of promising BCTs that ensure children understand the behaviour and the consequences of their hand hygiene habits, appropriate hardware is available, and social support is provided. Researchers are encouraged to consistently and transparently describe evaluated interventions to allow promising components to be identified and replicated

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