Abstract
BackgroundThis article reports on formative research into the context and practice of handwashing with soap by new mothers, which can substantially impact child morbidity and mortality. New mothers are an important target group for handwashing interventions: they are considered particularly susceptible to behaviour change and their actions can directly affect a child’s health.MethodsTwenty-seven mothers of infants (including neonates) from urban and rural sub-districts of Serang were recruited and filmed over a period of eight hours. Video footage was used to identify handwashing occasions and to understand the context in which behaviour took place. Each woman was subsequently interviewed.ResultsHandwashing with soap was found to be infrequent, typically occurring after eating, cooking and household chores or after cleaning a child’s bottom. Handwashing before preparing food or eating was rare. Pre-pregnancy routines were reported to have been disrupted. Advice on child care comes from many sources, particularly the midwife and new child’s grandmother.ConclusionsDeveloping interventions to change perceptions and practice of handwashing would seed an important behaviour and could save lives. New mothers represent an ideal target group for such an intervention. We suggest that interventions target an increase in handwashing with soap after contact with own and a baby’s faecal matter as part of the post-defecation hygiene routines. As the child’s grandmother is an authoritative source of information about parenting, interventions focussed on improving newborn care could target grandmothers as well as midwives.
Highlights
This article reports on formative research into the context and practice of handwashing with soap by new mothers, which can substantially impact child morbidity and mortality
The benefits associated with handwashing with soap largely stem from reductions in diarrhoeal diseases [2,3,4], a common cause of morbidity and a leading cause of death among children under-five [5]
It may be possible to optimise the effectiveness of an intervention by concentrating efforts during a “teachable moment”, a concept from education describing a naturally-occurring event or life-stage that motivates a person to acquire new behaviours [7]
Summary
This article reports on formative research into the context and practice of handwashing with soap by new mothers, which can substantially impact child morbidity and mortality. New mothers are an important target group for handwashing interventions: they are considered susceptible to behaviour change and their actions can directly affect a child’s health. Interventions that promote handwashing with soap are vitally important to public health, yet changing behaviour is notoriously difficult. In 2002, McBride and colleagues examined the evidence for teachable moments using the example of smoking cessation [8]. They developed a model that characterised a teachable moment as an event which i) increases a person’s risk perception, ii) triggers a strong affective or emotional response, and iii) redefines their social role or self-concept. Hospitalisation and pregnancy were identified as teachable moments
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