Hygiene Behaviour Change Research Articles

Measuring the frequency and determinants of COVID-19 prevention behaviours: a cross-sectional assessment of large-scale programmes in seven countries, late 2020

ObjectivesThis multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The...

Effect of a Homestead Food Production and Food Hygiene Intervention on Biomarkers of Environmental Enteric Dysfunction in Children Younger Than 24 Months in Rural Bangladesh: A Cluster-Randomized Controlled Trial.

Poor sanitation and hygiene practices and inadequate diets can contribute to environmental enteric dysfunction (EED). We evaluated the impact of a combined homestead food production and food hygiene intervention on EED biomarkers in young children in rural Bangladesh. The analysis was conducted within the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial in Sylhet, Bangladesh. The FAARM trial enrolled 2,705 married women and their children younger than 3 years of age in 96 settlements (geographic clusters): 48 intervention and 48 control. The 3-year intervention (2015-2018) included training on gardening, poultry rearing, and improved nutrition practices and was supplemented by an 8-month food hygiene behavior change component, implemented from mid-2017. We analyzed data on 574 children age 0 to 24 months with multilevel linear regression. We assessed fecal myeloperoxidase (MPO), neopterin (NEO), and alpha-1-antitrypsin (AAT) as biomarkers of EED, and serum C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) as biomarkers of systemic inflammation, using ELISA. There was no intervention effect on NEO, AAT, CRP, and AGP concentrations, but, surprisingly, MPO levels were increased in children of the intervention group (0.11 log ng/mL; 95% CI, 0.001-0.22). This increase was greater with increasing child age and among intervention households with poultry that were not kept in a shed. A combined homestead food production and food hygiene intervention did not decrease EED in children in our study setting. Small-scale poultry rearing promoted by the intervention might be a risk factor for EED.

Risks Factors of Scabies Incidence in Islamic Boarding School in Eastern Java Faktor Risiko Insiden Skabies di Pesantren in Jawa Timur

With the highest Muslim population in the world, Indonesia has more than 26,000 Islamic boarding schools. Studies have found that scabies incidence is high in these schools. This study aims to identify factors affecting scabies incidence among 90 students in Islamic boarding schools in Eastern Java. Knowledge, personal hygiene, and residential sanitation are significantly associated with the scabies incidence. Students who have poor knowledge, have poor personal hygiene, and live in poor sanitation condition are more likely to suffer from scabies at 12.02 times, 8 times, and 4.34 times, respectively, compared to students who have good knowledge, good personal hygiene, and good sanitation. Moreover, more female students have good personal hygiene compared to male students. We suggest strengthening education and hygiene behaviour change strategies involving kyai, school administrators, and peer examples in Islamic boarding schools. Kata Kunci: skabies, pesantren, Indonesia, higiene, sanitasi

Baseline soil-transmitted helminth and schistosome infection in the Geshiyaro project, Ethiopia: A unique transmission interruption project using biometric fingerprinting for longitudinal individual analysis.

The Geshiyaro project aims to assess the feasibility of interrupting transmission of soil-transmitted helminths (STH) and schistosome (SCH) infection in the Wolaita zone of southern Ethiopia through high coverage community-wide mass drug administration (MDA), in combination with improved water, sanitation, and hygiene services and behaviour change communication delivered through the existing health care infrastructure. To accurately measure treatment coverage a population census was conducted enrolling individuals with biometric fingerprinting and barcoded ID cards. This paper details the baseline census and parasitology surveys conducted before the start of any interventions. The census was conducted in five of the 15 Wolaita districts between October 2018 and December 2019, enrolling all consenting participants from every household. Simultaneously, a cross-sectional parasitology survey was conducted in 130 out of 361 randomly selected communities from all 15 districts, with 100 individuals across all age groups (infant to adult) per community providing stool and urine for analysis by duplicate Kato-Katz and a point-of-care circulating cathodic antigen (POC-CCA) to test for Schistosoma mansoni and STH, and microhaematuria and urine filtration for Schistosoma haematobium. Of the 130 communities, 30 were randomly selected for annual, longitudinal parasitological monitoring, with 150 randomly selected individuals from infant to adult providing two days of stool and urine samples for analysis by the same diagnostic tests per community. In total 97,919 households participated in the baseline census enrolling 466,071 individuals, with parasitological data obtained from 10,785 people. At baseline, 15.5% were infected with at least one STH species, with Ascaris lumbricoides (9.5%), followed by hookworm (7.2%) and Trichuris trichiura (1.8%). Substantial heterogeneity in STH prevalence was observed between communities ranging from 0% to 61% where most infections were low intensity. Schistosoma mansoni infection was the dominant schistosome infection (0.85% by Kato-Katz and 13.3% by POC-CCA trace negative and 21.5% trace positive), with few Schistosoma haematobium infections identified (2.77% haematuria positive and 0.13% positive by urine filtration). While the national control program in Ethiopia has made good progress in reducing prevalence of STH and SCH in Wolaita since it was launched in 2015, there remain areas of persistent infection suggesting the existence of environmental or behavioural risk factors that contribute to ongoing transmission. This project aims to identify the most efficient intervention strategies to reduce community burden and reach interruption of transmission.

Health and Sanitation Condition of Pregnant Women: A Case of Arghakhanchi District

This paper aims to explore the situation of sanitation and changing the behaviour of married Nepalese women of reproductive age (15-49). A concurrent mixed-method (qual-quan) research design was employed in this research under the pragmatism worldview. The data are collected through a questionnaire survey, in-depth interviews, and a transect walk. Arghakhanchi district was selected purposively in this study. Diffusion of innovation theory was applied to understand the factors influencing sanitation and hygiene behavior change. The key research participants were the pregnant women of reproductive age (15-45) in the study. A thematic framework was used to analyze qualitative data, while bivariate analysis was performed to show the association between the background variables of sanitation and the health condition of pregnant women. It was found that most of the women used soap and water for hand washing before each meal and after the toilet. There is the provision of soap at hand washing stations and toilets among the study population. However, sufficient hand washing and toilet facilities were not available and 23% of the women reported being scratchy with the use of soap and water regularly.

Impact of the COVID-19 pandemic on Clostridioides difficile infection in a tertiary healthcare institution in Belgium

ABSTRACT Objectives Clostridioides difficile infection (CDI) causes the greatest number of healthcare-associated infectious diarrhoea. CDIs are transmitted by direct and indirect patient-to-patient contact and risk increases with the use of antibiotics. Since early 2020, the COVID-19 pandemic has affected healthcare systems in many ways including substantial changes in hygiene behaviour. The aim of this study was to assess whether CDI incidence differed during the COVID-19 pandemic compared to a year before. Methods All tests for suspected CDI cases were recorded for a hospital in Brussels, Belgium. The percentage of CDI-positive results and incidences (total and healthcare-associated (HA)-CDI)) for years 2019, 2020, 2021, and 2022 were calculated. Antibiotic consumption was analysed for years 2019 and 2020. Results Since the COVID-19 pandemic struck, a significant reduction of up to 39% was observed in the number of Clostridioides difficile stool tests in our hospital. A significant decrease in the percentage of positive tests and a 50% decrease in the incidence of CDI (total and HA-CDI) was found for 2020 compared with 2019 and confirmed for years 2021 and 2022. The decrease in CDI incidence was mostly marked in haematology, nephrology, and gastroenterology units. No significant change in the use of antibiotics was found. Conclusion The global decrease in CDI incidence observed in our hospital was not associated with a change in the use of antibiotics. The control measures implemented to prevent COVID-19 transmission may explain a reduction in CDI incidence. An underdiagnosis of CDI cannot be excluded.

Quality and safety of pork sold in the informal urban street markets of the Cape Metropole, South Africa

Pork in the informal market significantly contributes to food, nutrition and income security in low-income countries' urban areas but is a safety concern to value chain actors and public authorities due to potential contamination by pathogens. To evaluate the physicochemical quality, microbial and oxidative profiles of pork sold from the informal urban street market, 50 samples were collected from 40 street vendors and 10 supermarkets in five different low-income, high-density suburbs in the Cape Metropole District, South Africa. Results showed no differences (P > 0.05) in pH, colour, proximate attributes (except for lipid content), antioxidant activity, lipid oxidation, and Escherichia coli counts in pork collected from the formal and informal markets, and open-air and enclosed market stalls. Lipid content, Enterobacteriaceae, and total bacterial counts of pork collected from the informal market were higher (P ≤ 0.05) than those from the formal market. Positive cases of Listeria monocytogenes (6–8%) and Salmonella spp. (4%) were reported for pork sampled in the informal market, especially in open-air stalls. It was concluded that higher levels of microbial contamination in the informal market, particularly in open-air stalls compared to the formal market require constant monitoring, provision of appropriate market infrastructure, and hygiene behaviour change of vendors to ensure pork safety.

Developing better understanding of hygiene is key to developing hygiene behaviour change in home and everyday life settings

Polling indicates the public has fairly good knowledge of times when hygiene is needed in their homes and everyday life in public spaces, but limited understanding of hygiene risk; this results in omitting some key behaviours and incorrectly applying untargeted behaviours. This poll explores how the public responded to government advice, and information from other sources, to address a specific disease threat - that is, COVID-19 infection. An online poll was developed, and data were collected from 1730 respondents in England aged 18 and above. Data suggest that the UK public has a high level of concern about the importance of hygiene to prevent spread of COVID-19. They had good recall of advice given during the pandemic and were able to identify routes of infection transmission. When asked to identify key times for handwashing, most people (86%-90%) identified 'after coughing, sneezing etc., before eating food with fingers, after touching contact surfaces and when returning home', but a similar number also identified using the toilet, food handling and pet handling, despite the fact that government advice does not identify these as risk actions for COVID-19. This suggests they were unable to use their knowledge of how the virus spreads to make informed decisions about when to practice hygiene. Despite government guidance, public practices are still influenced by a conviction that deep cleaning, including non-targeted disinfectant usage on environmental surfaces, gives added protection, leading them to practise additional cleaning and disinfection in situations where there is little benefit. New insights from public polling, together with the nine moments Targeted Hygiene approach, offer a more robust communications approach to enable the public to make cognitive links between when, where, how and why to practise good hygiene, and in doing so, promote more effective and sustainable behaviours.

Health changes during Covid-19: a nationwide study with dental students.

To assess the changes in stress levels, social behavior, dietary and parafunctional habits, oral hygiene, among other conditions perceived by dental students in Brazil during the Covid-19 pandemic and evaluated the correlations between stress level and other variables. An online questionnaire was developed and validated. Undergraduates enrolled in private and public dental schools were recruited by convenience sampling. Data were collected on the perceived changes regarding stress levels, financial and social characteristics, dietary habits, oral hygiene, health conditions, and parafunctional habits. Quantitative variables were expressed as absolute and relative frequencies. Wilcoxon test evaluated comparisons between perceived changes, and correlations between changes in stress levels and other variables were analyzed by Spearman correlation (α = 0.05). A total of 638 dental students, mean age of 22.95 ± 4.10 years, participated in the study. During the pandemic, the reported stress levels increased while household income decreased (p < 0.05). Late dinners and mindless eating increased in frequency, whereas oral hygiene decreased (p < 0.05). Most of the health conditions and parafunctional habits assessed changed (p < 0.05). Perceived stress levels showed poor negative correlations with household income (rS = -0.14), poor positive correlations with the pressure to contribute financially in the household (rS = 0.19), and poor positive correlations with food choice frequency (rS = 0.15) (p < 0.05). Dental students reported perceived changes in stress levels, dietary habits, oral hygiene, health conditions, parafunctional habits, and social behavior. Moreover, the results showed poor correlations, as students with higher stress levels tended to have the lowest household income, feel pressured to contribute financially in the household, and present a high meal intake frequency.

Influence of Seasonal Hazards on Water, Sanitation, and Hygiene-Related Behavior and Implications for Cholera Transmission in Bangladesh.

Most cholera outbreaks in Bangladesh are seasonal, peaking in the dry and post-monsoon periods. Therefore, we investigated whether changes in water, sanitation, and hygiene (WASH) behavior in three populations in Bangladesh during the year could help explain why these two periods are particular to cholera transmission. The study used a mixed-method design, including a repeated cross-sectional study, focus group discussions, and key informant interviews. Through a repeated cross-sectional study, WASH-related variables were assessed during the dry, monsoon, and control seasons in 600 households from coastal Satkhira, inland Sirajganj, and the Dhaka slums. Seasonal behavioral changes were observed in all study areas. Dhaka and Satkhira had an increased mean distance to water sources during the dry and monsoon seasons (Dhaka: control season, 12 m [95% CI, 11-13]; dry season, 36 m [95% CI, 18-55]; and monsoon season, 180 m [95% CI, 118-243]; Satkhira: control season, 334 m [95% CI, 258-411]; dry season, 669 m [95% CI, 515-822]; and monsoon season, 2,437 m [95% CI, 1,665-3,209]). The participants attributed this to pollution of the usual water source. Perceived water quantity was lowest during the dry season in Dhaka and Sirajganj, and during the monsoon season in Satkhira. Handwashing with soap declined in all areas during the dry and monsoon seasons. Open defecation was frequent among children younger than 5 years, increasing during seasonal climate hazards. Results show that WASH-related behavior changed seasonally, increasing the risk of cholera transmission through multiple hygiene-related transmission pathways. Future research would benefit by ensuring that the length of studies covers all seasons throughout the year and also by looking in more detail at people's behavior and hygiene practices.

A randomised controlled trial evaluating the impact of oral health advice on gingival health using intra oral images combined with a gingivitis specific toothpaste

ObjectivesDoes a complex intervention of oral hygiene advice (OHA) delivered with intra-oral scanner images, anti-gingivitis toothpaste and motivational reminders, improve oral health more than a standard of care control arm of fluoride toothpaste, with OHA without scanner images? MethodsAdult participants with pre-existing gingivitis were randomised to intervention or control. Following enrolment, baseline and each subsequent visit (V) (3-weeks, V2; 3-months, V3; 6-months, V4) followed the same schedule. Bleeding on Probing (BOP) was assessed and Intra Oral Scan IOS(1) recorded. Plaque was disclosed, scored and re-scanned (IOS(2)). The intervention group received OHA with IOS images, control group receiving OHA without IOS images. Participants brushed with their allocated toothpaste (fluoride, control; anti-gingivitis, intervention), IOS(3) was recorded. Between visits participants brushed with their allocated toothpaste, intervention group received motivational reminders. ResultsBOP scores from baseline were significantly improved in the intervention group compared to control at all visits for all surfaces (p<0.001); differences at V4 were 0.292 (all), 0.211 (buccal/labial) and 0.375 (lingual/palatal). Plaque scores from baseline pre-brushing to each visit pre- and post-brushing also favoured the intervention group, the difference always significant on lingual/palatal surfaces (p<0.05), significant for all but pre-brushing-V4 (p<0.05) on all surfaces, but only significant for pre-brushing-V3 (p<0.05) buccally/labially. Differences from baseline to post-brushing at V4 were: 0.200 (all), 0.098 (buccal/labial) and 0.291 (lingual/palatal). ConclusionA complex intervention comprising OHA delivered with IOS-images, anti-gingivitis toothpaste and motivational reminders improved gingival health more than existing standard of care-OHA together with a standard fluoride toothpaste over a 6-month period. Clinical Significance StatementIntra-oral scans (IOS) are now frequently used in general dental practice for a variety of purposes. IOS use, in combination with motivational texts and an anti-gingivitis toothpaste, could be further deployed to promote oral hygiene behaviour change in patients and improve gingival health, in a cost-effective manner.

Hygiene Behavior and COVID-19 Pandemic: Opportunities of COVID-19-Imposed Changes in Hygiene Behavior.

In Ethiopia, the WHO strategies to stop coronavirus transmission were implemented rapidly. As a result, there was a rapid change in hygiene behavior, which are basic for preventing COVID-19 and other contagious diseases. This research was designed to examine the sustainability of the COVID-19 imposed hygiene behaviors for future challenges. The study was conducted in 2 major nexus areas in Addis Ababa. The data were collected using a questionnaire and spot-check from 622 respondents selected by systematic random sampling. The questionnaire was given at every 15th interval in several spots of the site. Observational hygiene-check was done through observing key personal hygiene conditions. Proportion, χ2 test, and Poisson's regression were applied for the analysis. The χ2-test analyses showed that the hand washing frequency before, during, and post-COVID-19 was statistically significant (P < .005). Findings from the spot-check also show that the hands of 76.8%, the nails of 68.7%, and the hairs of 70.7% of the respondents were clean. The major driving factors for the rapid changes in hygiene behavior were the awareness developed (95%), the fear and panic (90%), and increased access to water and soap (63%). Nevertheless, the major reasons for failing to continue the COVID-19-imposed good hygiene practice in the post-COVID-19 times include the decline in infection and death rates (26%) and the decline in facility access (20%). Hand washing frequency significantly changed during the COVID-19 pandemic indicating that the practice as part of the preventive strategy was successful. However, as this was mainly due to the fear and panic in the community, the COVID-19 imposed hand washing practice did not bring real and sustainable behavioral changes. This indicates that for long-lasting changes in hygiene behavior, continuous and better approach need to be introduced.

Hand hygiene behavior change: a review and pilot study of an automated hand hygiene reminder system implementation in a public hospital.

To review and study implementation of an automated hand hygiene reminder system (AHHRS). Prospective, nonrandomized, before-after quality improvement pilot study conducted over 6 months. Medical-surgical unit (MSU) and medical intensive care unit (MICU) at a public hospital in New York City. There were 2,642 healthcare worker observations in the direct observation (DO) period versus 265,505 in the AHHRS period, excluding AHHRS observations collected during the 1-month crossover period when simultaneous DO occurred. We compared hand hygiene adherence (HHA) measured by DO prior to the pilot and after AHHRS implementation. We compared changes in HHA and potential cross-contamination events (CCEs) (room exit and subsequent entry without HHA) from baseline for each biweekly period during the pilot. Engagement, education/training, data transparency, and optimization period resulted in successful implementation and adoption of the AHHRS. Observations were greater utilizing AHHRS than DO (265,505 vs 2,642, P < .01). Due to the expected Hawthorne effect, HHA was significantly less for AHHRS than DO in MSU (90.99% vs 97.21%, P < .01) and MICU (91.21% vs 98.65%, P < .01). HHA significantly improved from 86.47% to 89.68% in MSU (P < .001) and 85.93% to 91.24% in the MICU (P < .001) from the first biweekly period of AHHRS utilization to the last. CCE decreased from 73.42% to 65.11% in the MSU and significantly decreased from 81.22% to 53.19% in the MICU (P < .05). We describe how an AHHRS approach was successfully implemented at our facility. With ongoing feedback and system optimization, AHHRS improved HHA and reduced CCE over time.

Does Poor Mental Health Impair the Effectiveness of Complementary Food Hygiene Behavior Change Intervention in Rural Malawi?

Mental disorders have the potential to affect an individual’s capacity to perform household daily activities such as water, sanitation, and hygiene (food hygiene inclusive) that require effort, time, and strong internal motivation. However, there is limited detailed assessment about the influence of mental health on food hygiene behaviors at household level. We conducted a follow-up study to detect the effects of mental health on food hygiene behaviors after food hygiene intervention delivery to child caregivers in rural Malawi. Face-to-face interviews, based on the Risk, Attitude, Norms, Ability, and Self-regulations (RANAS) model, were conducted with 819 participants (control and intervention group) to assess their handwashing and food hygiene-related behaviors. Mental health was assessed using the validated Self-Reporting Questionnaire. Study results showed a significant negative relationship between mental health and handwashing with soap behavior (r = −0.135) and keeping utensils in an elevated place (r = −0.093). Further, a significant difference was found between people with good versus poor mental health on handwashing with soap behavior (p = 0.050) among the intervention group. The results showed that the influence of the intervention on handwashing with soap behavior was mediated by mental health. Thus, integration of mental health in food hygiene interventions can result in improved outcomes for caregivers with poor mental health.

What influences individuals to invest in improved sanitation services and hygiene behaviours in a small town? A formative research study in Babati, Tanzania.

Sub-Sahara African countries face immense challenges in ensuring adequate sanitation and hygiene behaviours to the rapidly growing populations. Attempts to address these challenges require empirical evidence to inform policy and planning. We contribute toward that goal by unveiling findings of formative research conducted in Babati, a rapidly growing town in Tanzania. We conducted a cross-sectional study involving 486 households, to unwind motives and barriers for individuals to invest in improved sanitation services and hygiene behaviour change. We used several methods including household survey, focus group discussions, behaviour observations and spot checks. The findings revealed that households derive their motivation to invest in improved sanitation and hygiene practices from comfort, raising social status, and the need for personal safety and privacy. Other motives include fear of penalties and fines and fear of disease outbreaks, whilst the barriers include, limited water availability and accessibility, environmental factors, property rights, cultural issues, financial constraints, and a person’s attitude. Quantitative data were subjected to multivariate analysis to identify determinants of households to invest in sanitation and hygiene practices. The logistic regression analyses revealed that sources of water, property rights, and education level were the main determinants of households to invest in sanitation and hygiene facilities, while household income was the main determinant for households to invest in both construction of handwashing facility and water treatment. We argue that the initiative to promote sanitation and hygiene behaviour change in small towns should focus on promoting motivation factors and abating the determinant factors identified in this study.

Achieving handwashing with Social Art for Behaviour Change: the experience of the Lazos de Agua programme in Latin America

Abstract The effectiveness of different hygiene behaviour change approaches is inconsistent. Proven effective elements of behaviour promotion include the following: involving the community, adding psychosocial theory-derived elements and using interpersonal communication with active teaching methods and innovative and culturally sensitive messaging. The One Drop Foundation Social Art for Behaviour Change (SABC) approach encompasses those elements and is embedded in a system-strengthening approach involving users, service providers and policymakers within the Lazos de Agua Programme. Halfway into the programme, the SABC approach has been implemented in more than 280 rural and urban communities in five Latin American countries. According to its midline outcome measurement, the programme's efforts have contributed to a 15% point increase in the population practising proper handwashing within intervention areas. Story-based interviews revealed that SABC interventions are believed to have caused lasting changes in behaviour, perception and skills which transcend beyond the individual and are felt at the household and community levels. While the SABC approach is mostly limited to addressing psychosocial factors, the experience of this programme proves that artists can serve as behaviour change facilitators to accompany water, sanitation and hygiene (WASH) system projects. The SABC approach builds capacity, both within artist groups as permanent local institutions which can act as behaviour change facilitation service providers, and within service users, who become empowered and can continue influencing behaviour change among their peers.

Does poor mental health impair the effectiveness of complementary food hy-giene behavior change intervention in rural Malawi? Inclusion of child care-givers with poor mental health in humanitarian action

Does poor mental health impair the effectiveness of complementary food hy-giene behavior change intervention in rural Malawi? Inclusion of child care-givers with poor mental health in humanitarian action

Design, delivery, and determinants of uptake: findings from a food hygiene behavior change intervention in rural Bangladesh

BackgroundMicrobial food contamination, although a known contributor to diarrheal disease and highly prevalent in low-income settings, has received relatively little attention in nutrition programs. Therefore, to address the critical pathway from food contamination to infection to child undernutrition, we adapted and integrated an innovative food hygiene intervention into a large-scale nutrition-sensitive agriculture trial in rural Bangladesh. In this article, we describe the intervention, analyze participation and uptake of the promoted food hygiene behaviors among intervention households, and examine the underlying determinants of behavior adoption.MethodsThe food hygiene intervention employed emotional drivers, engaging group activities, and household visits to improve six feeding and food hygiene behaviors. The program centered on an ‘ideal family’ competition. Households’ attendance in each food hygiene session was documented. Uptake of promoted behaviors was assessed by project staff on seven ‘ideal family’ indicators using direct observations of practices and spot checks of household hygiene conditions during household visits. We used descriptive analysis and mixed-effect logistic regression to examine changes in household food hygiene practices and to identify determinants of uptake.ResultsParticipation in the food hygiene intervention was high with more than 75% attendance at each session. Hygiene behavior practices increased from pre-intervention with success varying by behavior. Safe storage and fresh preparation or reheating of leftover foods were frequently practiced, while handwashing and cleaning of utensils was practiced by fewer participants. In total, 496 of 1275 participating households (39%) adopted at least 5 of 7 selected practices in all three assessment rounds and were awarded ‘ideal family’ titles at the end of the intervention. Being an ‘ideal family’ winner was associated with high participation in intervention activities [adjusted odds ratio (AOR): 11.4, 95% CI: 5.2–24.9], highest household wealth [AOR: 2.3, 95% CI: 1.4–3.6] and secondary education of participating women [AOR: 2.2, 95% CI: 1.4–3.4].ConclusionThis intervention is an example of successful integration of a behavior change food hygiene component into an existing large-scale trial and achieved satisfactory coverage. Future analysis will show if the intervention was able to sustain improved behaviors over time and decrease food contamination and infection.

Change in oral hygiene behaviour after non-surgical periodontal therapy - A retrospective analyses.

This retrospective analysis investigates changes in daily oral hygiene behaviour after the initial phase of non-surgical periodontal therapy (NSPT). This retrospective study includes 189 consecutive periodontitis patients treated for moderate to severe periodontitis. The authors used the oral hygiene behaviour questionnaire (OHB-9) to assess and evaluate the oral hygiene self-care practices at both intake and evaluation after an active phase of NSPT which consisted of repeated oral hygiene instruction (OHI), supra- and subgingival debridement and polishing. In addition, data on pocket probing depth and bleeding upon pocket probing (BOP) were extracted and PISA and PESA scores were collected. All these parameters are descriptive of the periodontal status at intake and the clinical response to NSPT. The OHB-9 showed an increased oral hygiene self-care level after the active phase of NSPT. At the evaluation, 85% of patients used a power toothbrush (PTB), representing an increase of 26% as compared with the intake. In addition, 64% reported brushing 3min or longer, representing an increase of 33%. The use of woodsticks (WS) and interdental brushes (IDB) at least once a day increased with 15% and 40% respectively. The distribution changes on the answering scale were significant for IDB, WS and brushing duration. However, no significant relationship was found between oral hygiene behaviour at the evaluation and the improvement of the gingival inflammation evaluated by BOP percentage. The finding of the OHB-9 questionnaire reported was an increase of patients who brushed longer and used the PTB, WS and IDB on a daily basis. The observed improvements in gingival inflammation assessed as bleeding on probing tendency were not significantly associated with oral hygiene behaviour at the evaluation of NSPT.

Randomised controlled trial demonstrating the impact of behaviour change intervention provided by dental professionals to improve gingival health

AimsTo determine impact of oral hygiene behaviour change intervention compared to the prevailing standard of oral hygiene advice provided in general dental practice, on bleeding on probing (BOP) in gingivitis patients, over 3-months. The effect of providing power-brushes was also evaluated. Materials and methodsNHS dental practices were cluster-randomised to intervention or control (2:1). Dentists at intervention sites received behaviour modification training. Participants were stratified to high (≥20% BOP) or low (<20% BOP) presence of gingivitis and a subset assigned a power-brush. BOP and plaque scores were assessed at baseline and 3-months. ResultsA total of 538 participants (369:169; intervention: control) completed the study. BOP reduced in both gingivitis groups with significantly greater reduction in intervention compared to control group (BOP:38% vs 19%, p = 0.0236); Borderline significance favouring the intervention was demonstrated for the low gingivitis group (BOP:37% vs 15%, p = 0.0523). A highly significant reduction in BOP (intervention vs control) was demonstrated for volunteers who swapped from manual to power-brush (44% vs 37%, p = 0.0039). Plaque score improved more in control than intervention group (Plaque:37% vs 44%, p = 0.00215). ConclusionsBehaviour change techniques were readily mastered by the dental professional researchers. The introduction of an oral hygiene behaviour change intervention significantly reduced gingivitis in volunteer patients compared to control at 3 months. Swapping to a power-brush significantly favoured BOP reduction compared to manual brush continuation although plaque reduction did not follow expectation in comparison to BOP scores. Behaviour change techniques should routinely be considered in patient care. Clinical significancePlaque-induced gingivitis is highly prevalent in the UK despite being preventable with good oral hygiene. Its continuum, periodontitis, negative impacts quality of life. This study suggests oral hygiene behavioural interventions (GPS) significantly reduce gingivitis and that GPS introduction will improve oral health and may improve quality of life.