Hand Washing Behavior Research Articles

A pilot study of a portable hand washing station for recently displaced refugees during an acute emergency in Benishangul-Gumuz Regional State, Ethiopia

BackgroundDiarrheal disease is a common cause of morbidity and mortality. Displaced populations are especially vulnerable due to overcrowded camps and limited access to water and sanitation facilities, increasing the risk for outbreaks. Hand washing with soap is effective against disease transmission, and studies suggest access to a convenient hand washing station may be the key to increasing hand washing behavior. This pilot study evaluated the acceptability, durability and use of a novel hand washing bag (HWB) at the household level among Sudanese refugees immediately following an acute emergency.MethodsWe distributed one HWB to every household (n = 874) in Adamazin Transit Center in western Ethiopia. The evaluation consisted of baseline and endline surveys, three monthly monitoring visits and focus group discussions (FGDs) over a six month period. FGD data were analyzed using the Risk, Attitudes, Norms, Abilities, and Self-Regulatory model. Survey and monitoring data were analyzed using SPSS. Note: Residents were resettled to Bambasi Refugee Camp during the study period where the endline survey was conducted.ResultsBaseline data suggested water quantity and availability of soap were below SPHERE standards, however participants responded positively to the HWB. At the end of the monitoring period, 73.9 % of the same households retained their original HWBs and 66.7 % of bags had water at the time of the visit. The mean lifespan of the HWB during the monitoring period was 2.73 months. From a new sample of households selected for the endline evaluation, 93.0 % had an original HWB, but only 39.4 % had water in the bag. Endline FGD participants felt the HWB was useful, but reported insufficient soap and hygiene messaging.ConclusionThe HWB performed well during the early phases of the emergency, however longer term results in this setting are unclear. The low levels of reported use measured by proxy indicators at six months indicated decreasing acceptability over time or a reflection of potential differences between the two sites. It is also unknown whether the HWB influenced hand washing behavior. Study findings were shared with the manufacturer in an effort to improve the bag’s acceptability, utility, and durability.

Disgust, Shame, and Soapy Water: Tests of Novel Interventions to Promote Safe Water and Hygiene

AbstractLack of access to clean water is among the most pressing environmental problems in developing countries, where diarrheal disease kills nearly 700,000 children per year. While inexpensive and effective practices such as chlorination and hand washing with soap exist, efforts to motivate their use by emphasizing health benefits have seen only limited success. This paper measures the effect of messages appealing to negative emotions (disgust at consumption of human feces) and social pressure (shame at being seen consuming human feces) on hand-washing behavior and use of and willingness to pay for water chlorination among residents of slum compounds in Dhaka, Bangladesh. Neither the traditional, health-based message nor the new disgust-and-shame message led to high levels of chlorination during a free trial, nor to high willingness to pay for the chlorine at the end of the free trial. Provision of low-cost hand-washing facilities did increase hand washing, although the effect size is modest.

PERILAKU MENCUCI TANGAN DAN KEJADIAN KECACINGAN PADA SISWA SEKOLAH DASAR DI KECAMATAN PETANAHAN KABUPATEN KEBUMEN

Children are the nation’s investment. The future quality of a nation is determined in the children’s current quality. The prevalence of worm infestation in Indonesia is quite high between 60-80% and especially attacks on elementary school children. A long term worm infestation can reduce health that impairs the ability to learn. Risk factors of worm disease include poor environmental sanitation, education level, socio-economic conditions, and health habits such as bowel movement in any places, lack of awareness in hand washing, no footwear as well as geographical conditions.Objective: To know the relationship of hand washing behavior with the incidence of worm on elementary school students in Petanahan Sub-District Kebumen District.The research was observational analytic with a cross sectional design. Sampling was done with a two-level clustering method. The sample size was 213 elementary school students in Grades 3, 4, and 5 that met the inclusion and exclusion criteria. The data was collected using a questionnaire and the results of laboratory tests. Hypothesis testing used chi-square with p <0.05 and 95% Confidence Interval. Data analysis used univariable, bivariable, and multivariable.There was a relationship between worm infestation and hand washing behavior seen from the results that the students who did not wash their hands and were positive with worm infestation were 66 students or 59.46%, while the students that performed hand washing and were negative with worm infestation were 72 students or 70.59%. Statistical test result was significant seen from the p value of 0.0001 and the prevalence ratio of 2.02 (95% CI 1.44 to 2.83).Hand washing behavior on elementary school students of Petanahan District, Kebumen, showed that 52.11% of the students did not wash their hands. There was a relationship between hand washing and worm infestation on elementary school students of Petanahan Sub-District, Kebumen District. Keywords: hand washing behavior, the incidence of worm infestation

Household practices related to disease transmission between animals and humans in rural Cambodia.

BackgroundZoonotic diseases are disproportionately affecting poor societies in low-income countries and pose a growing threat to public health and global food security. Rural Cambodian households may face an increased likelihood of exposure to zoonotic diseases as people there live in close association with livestock. The objectives of the study was to identify practices known to influence zoonosis transmission in rural Cambodian households and relate the practices to agro-ecological region, socio-economic position, demographics, livestock management and zoonosis awareness.MethodsThe study was conducted in three different agro-ecological regions of Cambodia; 10 villages each in the central lowlands, north-west wetlands and on the south coast, where information was obtained in questionnaires administered to 300 households, and 30 village heads and animal health workers.ResultsDescriptive analysis revealed a gender difference in responsibility for livestock and that the main purpose of raising livestock was for sale. Few respondents (6%) perceived a likelihood of disease transmission in their village between livestock, humans and wildlife, despite household practices related to zoonosis transmission being common. More than one-forth of households practised behaviours such as culling sick animals for consumption, eating animals found dead and allowing animals to enter sleeping and food preparation areas. Associations between household practices and possible explanatory factors were analysed with multivariable models using generalised estimation equations to account for clustering of practices within villages. Factors found to influence household practices were agro-ecological region, socio-economic position, number of people in the household, livestock species reared and awareness of zoonoses.ConclusionsCambodia has experienced numerous fatal human cases of zoonotic influenza and extensive influenza information campaigns have been run, yet only a few of the households surveyed here reported the threat of zoonosis to be a concern in their village. Zoonosis awareness was positively related to hand washing behaviour, but other practices associated with an increased or decreased likelihood of exposure to zoonotic pathogens were unaffected by awareness. The findings indicate a knowledge-to-action gap among rural farmers and highlight the necessity for reconstructed interventions in zoonotic disease control.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1811-5) contains supplementary material, which is available to authorized users.

Automated Video Analysis of Handwashing Behavior as a Potential Marker of Cognitive Health in Older Adults.

The identification of different stages of cognitive impairment can allow older adults to receive timely care and plan for the level of caregiving. People with existing diagnosis of cognitive impairment go through episodic phases of dementia requiring different levels of care at different times. Monitoring the cognitive status of existing patients is, thus, critical to deciding the level of care required by older adults. In this paper, we present a system to assess the cognitive status of older adults by monitoring a common activity of daily living, namely handwashing. Specifically, we extract features from handwashing trials of participants diagnosed with different levels of dementia ranging from cognitively intact to severe cognitive impairment, as assessed by the mini-mental state exam (MMSE). Based on videos of handwashing trials, we extract two classes of features: one characterizing the occupancy of different sink regions by the participant, and the other capturing the path tortuosity of the motion trajectory of participant's hands. We perform correlation analysis to assess univariate capacity of individual features to predict MMSE scores. To assess multivariate performance, we use machine learning methods to train models that predict the cognitive status (aware, mild, moderate, severe), as well as the MMSE scores. We present results demonstrating that features derived from hand washing behavior can be potential surrogate markers of a person's dementia, which can be instrumental in developing automated tools for continuously monitoring the cognitive status of older adults.

Applying a biopsychosocial perspective to address hand washing behaviors among young learners in Limpopo, South Africa

Applying a biopsychosocial perspective to address hand washing behaviors among young learners in Limpopo, South Africa

Household-level risk factors for influenza among young children in Dhaka, Bangladesh: a case-control study.

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. We conducted a case-control study using existing active surveillance for respiratory illness. Cases were children aged 12-59 months with laboratory-confirmed influenza. Controls were children frequency-matched by age group with no respiratory illness in the prior 6 months. We interviewed caregivers and observed household handwashing behaviour. Soap consumption was estimated by summing weight differences of three bars of soap sequentially left in each household. We measured concentrations of airborne particulate matter <2.5 μg in diameter (PM2.5) in a subset of households. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI). We enrolled 145 cases and 341 controls between March 2009 and April 2010. Case and control household members were observed to wash hands with similar frequency during a 5-h period (mean, 0.64 events vs. 0.63, P = 0.87), and similar daily soap consumption per capita (mean 2.92 grams vs. 2.93, P = 0.92). Case households were more likely than controls to have crowded (≥4 persons) sleeping areas (aOR = 1.67, CI: 1.06-2.63) and cross-ventilated cooking spaces (aOR = 1.75, CI: 1.16-2.63). Case and control households had similar median 24-h geometric mean PM2.5 concentrations in the cooking (69.2 vs. 69.6 μg/m(3), P = 0.45) and sleeping (65.4 vs. 67.4 μg/m(3), P = 0.19) spaces. Handwashing with soap was practiced infrequently and was not associated with paediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

일부 중학생의 보건교육경험에 따른 칫솔질과 손 씻기 실천의 연관성

Objectives: The purpose of this study was to investigate the relationship between toothbrushing and hand washing according to health education experience in middle school students. Methods: The subjects were 480 students of four middle schools in Y region. This is a cross sectional study and the study instrument was adapted from the knowledge, attitude and practice of hand washing and toothbrushing in elementary school students by Jung. Cronbach’s alpha was 0.87 in the study. The questionnaire consisted of 5 questions of the general characteristics of the subjects, 5 questions of hand washing knowledge, 3 questions of hand washing behavior, 3 questions of health education experience. Toothbrushing questionnaire consisted of 10 questions of knowledge, 5 questions of behavior, 5 questions of health education experience, and 5 questions of dental health care facilities within schools. Data were analyzed by PASW 20.0 program. Results: Toothbrushing more than three times a day accounted for 76.8%. Those who receiving health education in elementary school accounted for 41.5% and those who had not accounted for 58.5%. Health education experience(75.8%) led to toothbrushing after meal(p<0.05). Those who receiving health education in elementary schools had 1.76 times of toothbrushing after meal than those who had not(p<0.01). Conclusions: Middle school students receiving health education had a tendency to do toothbrushing and hand washing frequently.

Effect of a Parasite Game on the Hand-Washing Behavior of Children with Disabilities

Self-hygiene is considered one of the most essential self-management skills necessary for children with disabilities to acquire and perform independently. With this in mind, we developed an Android-based mobile application intended to teach children how to eliminate parasites. To assess its effectiveness, three children with developmental disabilities were tested prior to and after playing the game. The results indicated that the children’s knowledge of health behaviors and health-related self-efficacy improved after playing the game. Implications for health education and management are discussed.

Hand-Washing Behavior and Hygiene-Related Facilities among School Adolescents in Palestine

Although, the importance of hand hygiene in reducing the infection cannot be underestimated; it is not enough when other hygienic resources and facilities are inadequate or unavailable. To determine the prevalence of hand-washing behaviors and hygienic facilities among school adolescents in Tarqumia, Palestine. A descriptive Cross-sectional study was conducted, and data was collected on hand-washing behavior and hygienic facilities from 720 seventh- through eleventh-grade students in 4 schools in Tarrqumia by anonymous self-administered questionnaire. Overall, only 6.25% of the sample never or rarely washed their hands before eating during the past 30 days; 8.06% never or rarely washed their hands after using the toilet or latrine. This study demonstrates the prevalence of proper hand washing was very high among the school adolescents. Lack of adequate hygienic facilities in schools in Tarqumia prevents students from adopting proper hygienic behavior and impedes health promotion efforts.

Using Smartphone Technology to Assess the Food Safety Practices of Farmers’ Market Foodservice Employees

Due to the danger of food-borne illnesses associated with temporary foodservice establishments coupled with the increasing popularity of farmers’ markets, there is a growing need for an authentic examination of employees’ food safety practices. This study adopted a technology-based observational tool to assess whether farmers’ market foodservice employees performed proper hand-washing behaviors. Using smartphones, a total of 73 farmers’ market employees were observed, with their hand-washing behaviors compared to the Indiana State Health Code and County Health Inspector’s requirements. Results indicated that the frequency of hand washing varies depending on employee’s role, market location, and market size.

Hand washing and disgust response to handling different food stimuli between two different cultures

Increasing compliance with proper hand washing among consumers and foodservice workers during food handling and preparation is an effective strategy to minimize the spread of bacteria and disease. At home and in the food industry contributing factors and barriers exist that lead to low rates of compliance with proper hand hygiene. Recently, researchers have begun to emphasize the importance of internal motivational factors such as the emotion of disgust and how it affects hygiene behaviors. This study was designed to determine the influence of disgust and other motives on hand washing among participants when handling common foods in the foodservice industry, and if these responses are culturally dependent. A preliminary survey that showed differing levels of consumers' disgust among 21 foods commonly handled in the food industry was conducted. In the main part of the study, representatives from two cultures, Caucasian and Hispanic, were observed while they handled four common foods; apple, bread, chicken and fish. Results from this study showed that hand washing behavior was affected by the type of food being handled and the intensity of the emotion of disgust. Individuals tended to wash their hands more frequently for foods they perceived as more hazardous, and their motives to wash varied among variables of gender (self-protection for men, carryover effects for women), culture (self-protection for Caucasians, texture for Hispanics) and the type of food (self-protection for chicken, smell for fish). Additionally, as the feeling of disgust increased among individuals their probability to wash their hands also increased. Factors that did not show an influence on hand washing included the culture and gender of the participant, and whether they had past foodservice experience. These findings, in combination other studies, should be considered when designing motivation and training strategies to increase consumer or foodservice employee hand washing behaviors.

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

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.

Associations of hand-washing frequency with incidence of acute respiratory tract infection and influenza-like illness in adults: a population-based study in Sweden.

BackgroundFrequent hand-washing is standard advice for avoidance of respiratory tract infections, but the evidence for a preventive effect in a general community setting is sparse. We therefore set out to quantify, in a population-based adult general population cohort, the possible protection against acute respiratory tract infections (ARIs) conferred by a person’s self-perceived hand-washing frequency.MethodsDuring the pandemic influenza season from September 2009 through May 2010, a cohort of 4365 adult residents of Stockholm County, Sweden, reported respiratory illnesses in real-time. A questionnaire about typical contact and hand-washing behaviour was administered at the end of the period (response rate 70%).ResultsThere was no significant decrease in ARI rates among adults with increased daily hand-washing frequency: Compared to 2–4 times/day, 5–9 times was associated with an adjusted ARI rate ratio (RR) of 1.08 (95% confidence interval [CI] 0.87-1.33), 10–19 times with RR = 1.22 (CI 0.97-1.53), and ≥20 times with RR = 1.03 (CI 0.81-1.32). A similar lack of effect was seen for influenza-like illness, and in all investigated subgroups. We found no clear effect modification by contact behaviour. Health care workers exhibited rate ratio point estimates below unity, but no dose-risk trend.ConclusionsOur results suggest that increases in what adult laymen perceive as being adequate hand-washing may not significantly reduce the risk of ARIs. This might have implications for the design of public health campaigns in the face of threatening outbreaks of respiratory infections. However, the generalizability of our results to non-pandemic circumstances should be further explored.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-509) contains supplementary material, which is available to authorized users.

Self-Reported Hand Washing Behaviors and Foodborne Illness: A Propensity Score Matching Approach

Hand washing is a simple and effective but easily overlooked way to reduce cross-contamination and the transmission of foodborne pathogens. In this study, we used the propensity score matching methodology to account for potential selection bias to explore our hypothesis that always washing hands before food preparation tasks is associated with a reduction in the probability of reported foodborne illness. Propensity score matching can simulate random assignment to a condition so that pretreatment observable differences between a treatment group and a control group are homogenous on all the covariates except the treatment variable. Using the U.S. Food and Drug Administration's 2010 Food Safety Survey, we estimated the effect of self-reported hand washing behavior on the probability of self-reported foodborne illness. Our results indicate that reported washing of hands with soap always before food preparation leads to a reduction in the probability of reported foodborne illness.

An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities

To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children's school absenteeism. We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm). Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (-25%, 95% confidence intervals [CI] = -37%, -2%), ARIs (-15%, 95% CI = -30%, -8%), school absences due to illnesses (-27%, 95% CI = -41%, -18%) and eye infections (-46%, 95% CI = -58%, -31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for 'whole families' (-31%, 95% CI = -37%, -5%; and -14%, 95% CI = -23%, -6%, respectively), 6- to 15-year-olds (-30%, 95% CI = -39%, -7%; and -15%, 95% CI = -24%, -6%) and under 5 s (-32%, 95% CI = -41%, -4%; and -20%, 95% CI = -29%, -8%). Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.

Actual vs. Reported Behavior

Past research has failed to adequately address the reasons behind the lack of handwashing in public restrooms. The present study explores possibilities for using psychology to design effective handwashing interventions. Specifically, the current study examines whether (1) the frequency of reported handwashing differs from that of actual handwashing behavior and (2) the presence of a sign increases handwashing behavior. Participants self-reported their handwashing behavior and/or their handwashing was observed in a public restroom. In the observation portion of the study, the experimenters either observed participants’ natural behavior or posted a sign in the restroom that read “Washing your hands after going to the bathroom reduces your risk of catching or spreading infectious diseases such as salmonella or hepatitis A” before observing their handwashing behavior. The experimenters recorded whether participants washed their hands with water and soap, with water but no soap, or not at all. Participants reported significantly higher rates of handwashing than were observed. Additionally, the reported and observed handwashing behavior of women exceeded that of men. Finally, men used soap more when presented with the sign than when no sign was present. In all, this study suggests that many serious diseases and illnesses can be avoided by increasing handwashing by posting signs in public restrooms reminding people to wash their hands.

Promoting Handwashing Behavior: The Effect of Large-Scale Community and School-Level Interventions

Washing one’s hands with soap at critical points in time is a simple practice that helps to prevent serious infectious diseases. However, less than a third of the population in the developing world does it on a routine basis. The main economic question that this observation poses is how this behavior can be promoted in a cost-effective way. This paper analyzes a randomized experiment that uses novel strategies to promote handwashing with soap at critical points in time in Peru. It evaluates a large-scale comprehensive initiative which involved both community and school activities in addition to communication campaigns. The analysis indicates that the initiative was successful in reaching the target audience and in increasing the treated population’s knowledge about appropriate handwashing behavior. These improvements translated into higher self-reported and observed handwashing with soap at critical junctures. However, no significant improvements in the health of children under the age of 5 were observed. The results go one step further than the assessments of other promotion campaigns that have been based solely on mass-media, but they also suggest that changing behavior in any substantive way that will improve people’s health status is a complex task that requires intensive and more personalized interventions. This conclusion is in line with earlier contributions to the literature on the topic.

TARGETED INTERVENTIONS OF ULTRA-POOR WOMEN IN RURAL RANGPUR, BANGLADESH: DO THEY MAKE A DIFFERENCE TO APPROPRIATE COOKING PRACTICES, FOOD HABITS AND SANITATION?

This study aimed to assess whether teaching good cooking practices, food habits and sanitation to ultra-poor rural women in four rural communities of Rangpur district, Bangladesh, with a high density of extremely poor households, would improve the overall health of the community. The sample size was 200 respondents combined from the target and control areas. In the target area, twelve in-depth interviews and four focus group discussions were undertaken for knowledge dissemination. Descriptive and mixed-model analyses were performed. The results show that washing hands with soap was 1.35 times more likely in the target than the control group (p<0.01). Further, after intervention, there was a significant improvement in hand-washing behaviour: before cutting vegetables, preparing food, feeding a child and eating, and after defecating and cleaning a baby (p<0.05). Also, the target group was more likely to moderately and briefly boil their vegetables and were 19% less likely to use maximum heat when cooking vegetables than the control group (p<0.01). Improved knowledge and skills training of ultra-poor women reduces the loss of nutrients during food preparation and increases their hygiene through hand-washing in every-day life.

Money, moral transgressions, and blame

Two experiments tested participants' attributions for others' immoral behaviors when conducted for more versus less money. We hypothesized and found that observers would blame wrongdoers more when seeing a transgression enacted for little rather than a lot of money, and that this would be evident in observers' hand-washing behavior. Experiment 1 used a cognitive dissonance paradigm. Participants (N=160) observed a confederate lie in exchange for either a relatively large or a small monetary payment. Participants blamed the liar more in the small (versus large) money condition. Participants (N=184) in Experiment 2 saw images of someone knocking over another to obtain a small, medium, or large monetary sum. In the small (versus large) money condition, participants blamed the perpetrator (money) more. Hence, participants assigned less blame to moral wrong-doers, if the latter enacted their deed to obtain relatively large sums of money. Small amounts of money accentuate the immorality of others' transgressions.