Nadja Contzen

Over-Reporting in Handwashing Self-Reports: Potential Explanatory Factors and Alternative Measurements.

Handwashing interventions are a priority in development and emergency aid programs. Evaluation of these interventions is essential to assess the effectiveness of programs; however, measuring handwashing is quite difficult. Although observations are considered valid, they are time-consuming and cost-ineffective; self-reports are highly efficient but considered invalid because desirable behaviour tends to be over-reported. Socially desirable responding has been claimed to be the main cause of inflated self-reports, but its underlying factors and mechanisms are understudied. The present study investigated socially desirable responding and additional potential explanatory factors for over-reported handwashing to identify indications for measures which mitigate over-reporting. Additionally, a script-based covert recall, an alternative interview question intended to mitigate recall errors and socially desirable responding, was developed and tested. Cross-sectional data collection was conducted in the Borena Zone, Ethiopia, through 2.5-hour observations and 1-hour interviews with the primary caregivers in households. A total sample of N = 554 was surveyed. Data were analysed with correlation and multiple regression analyses and dependent t-tests. Over-reporting of handwashing was associated with factors assumed to be involved in (1) socially desirable responding, (2) encoding and recall of information, and (3) dissonance processes. The latter two factor groups explained over-reported handwashing beyond socially desirable responding. The alternative interview question—script-based covert recall—reduced over-reporting compared to conventional self-reports. Although the difficulties involved in measuring handwashing by self-reports and observations are widely known, the present study is the first to investigate the factors which explain over-reporting of handwashing. This research contributes to the limited evidence base on a highly important subject: how to evaluate handwashing interventions efficiently and accurately.

Impact of different promotional channels on handwashing behaviour in an emergency context: Haiti post-earthquake public health promotions and cholera response

AimIn a disaster context, where risk for diarrhoeal disease is elevated, personal hygiene, i.e. handwashing with soap, is especially relevant. However, to date, the promotion of hygiene in an emergency context has not been adequately addressed in the literature. The aim of the present study is to evaluate the effectiveness of hygiene promotions in post-earthquake Haiti.Subject and MethodsCross-sectional data was collected by means of structured interviews in camps and neighbourhoods in which three affiliates of a well-known relief organisation had conducted hygiene promotions. Primary caregivers were targeted. A total sample of 811 was obtained. Data was analysed using multiple linear regression and mediation analysis.ResultsAnalysis revealed six promotional channels with positive associations with handwashing behaviour: hygiene radio spots, radio programs with experts answering listener’s questions, material distributions with instructions for use, information from friends or neighbours, hygiene theatres, and community clubs. However, five of the promotional channels were negatively related with handwashing. Respondents who experienced a focus group, stickers, posters and paintings, hygiene songs, special hygiene days and home visits tended to wash their hands less often.ConclusionsBy revealing positive but also negative associations between hygiene promotions and handwashing behaviour, the study underlines the need to apply theory-driven emergency hygiene promotions which are subjected to in-depth evaluation. Only through doing this, is it ensured that effective hygiene promotions are implemented for the most vulnerable people—those affected by a humanitarian disaster.

Identifying the psychological determinants of handwashing: Results from two cross-sectional questionnaire studies in Haiti and Ethiopia

BACKGROUND Diarrheal disease kills around 760,000 infants every year. Many of these deaths could have been prevented by handwashing with soap. However, the whole range of psychological factors encouraging handwashing is not yet identified and handwashing campaigns are often limited to awareness-raising and education. The purpose of this article was to identify the psychological determinants of handwashing in Haiti (study 1) and Ethiopia (study 2). METHODS Data were collected cross-sectionally by administering face-to-face interviews with the primary caregiver in a participating household (NHaiti = 811; NEthiopia = 463). Hierarchical multiple regression analyses were performed on self-reported handwashing. RESULTS In both countries, risk factors-meaning awareness and health knowledge-accounted for only 11%-19% of variance in handwashing and were not consistently associated with handwashing. The inclusion of additional factor-groups, namely attitude, norm, ability, and self-regulation factors, led to significant increases in explained variance (P ≤ .01), accounting for 25%-44% of additionally explained variance. The attitude factor disgust, the norm factor, the ability factors motivational self-efficacy and perceived impediments, and the self-regulation factors coping planning and commitment emerged as especially relevant. CONCLUSIONS Handwashing campaigns should focus especially on attitudes and norms and not only on risk.