BRAC Institute of Governance and Development-Hygiene Behavioural Change and Coalition ((BIGD-HBCC))

The Effect of Public Handwashing Stations on Health Behaviour and Outcomes During COVID-19

In line with BRAC's overall goals to limit the COVID19 transmission, BRAC has constructed 1,000 handwashing stations coupled with other supports i.e. in-person demonstration, hygiene meetings, and soap distribution in Bangladesh. The purpose of this study is to assess the impact of public handwashing stations (HWSs) on people's hygiene behavior and health outcomes in response to the COVID-19 situation. For this, at the household level, we will collect information on self-reported handwashing practices, income, health status, and HWSs along with other relevant socio-demographic variables in detail. In addition, we will observe people's mobility, mask usage at public places, and the HWSs usage; and will associate the observed HWSs usage with their self-reported health outcomes. This study will conduct surveys on households (7,760) and public (5,820) in 20 sub-districts of Mymensingh, Khulna, and Dhaka divisions.

Overall, this study is expected to directly benefit study participants and their communities by unveiling new evidence to inform BRAC's existing hygiene behavioral change programming in these communities. In addition, this information will yield future societal benefits by generating evidence on how to effectively implement and disseminate infrastructure and information that people can trust, believe, and use to form healthy hygiene habits.

Study Overview

• Status: Active, not recruiting
• Conditions: Hygiene Practices and Knowledge
• Intervention / Treatment: Behavioral: Handwashing stations at the public places and no soap; Behavioral: No activities of the HBCC project and also no soap (Pure Control); Behavioral: Soap distributed but no activities of the HBCC project; Behavioral: HBCC project and Soap

Detailed Description

In line with the overall goals of HBCC for reducing the transmission of COVID-19 via rapid response interventions to raise awareness and enacting long-term behaviour change regarding people's personal and environmental hygiene habits, BRAC has taken an adaptive approach under the Hygiene and Behaviour Change Collation (HBCC) platform. The aim of this project is to systematically change the behaviour of people across communities in Bangladesh via interventions such as setting up handwashing stations and broadcasting behaviourally-informed messages to nudge people to adopt healthier prevention and response practices.

To achieve the overall goals of the project and positively impact the lives of over 10 million people in communities across Bangladesh, BRAC primarily chose 20 sub-districts from 3 divisions (out of a total of 8 divisions) for implementing the interventions, namely Dhaka, Mymensingh and Khulna. The prime activity is to install 1,000 handwashing stations across these sub-districts to increase the access of communities to handwashing facilities. The BRAC handwashing stations have been designed to enhance both availability and inclusiveness, fitted with foot-operated pedals for dispensing water and liquid soap, to reduce contact with sink surfaces and thereby reduce probability of transmission from the device surface. They have been fitted with posters, promoting handwashing with proper technique, and have also been designed to allow hand-washers to maintain social distance while using the devices.

In addition to these handwashing stations, there are other supports available in the intervention areas i.e. in-person demonstration, hygiene meetings, and soap distribution. After the economy opened up in Bangladesh after a long lockdown, the community engagement activities in the form of in-person communication and forum discussions, to motivate people to uptake safe hygiene behaviours including but not limited to regular handwashing. In these demonstrations and meetings, the participants are motivated to adopt recommended hygiene behaviours such as handwashing with soap, mask usage and disposal, sneezing etiquette, social distancing, etc. Along with the BRAC staff, the WASH entrepreneurs who are members of the local community whom BRAC traditionally supports with free training in entrepreneurship and market development to improve the communities' access and knowledge of hygiene products. The HBCC project empowers them with responsibilities to disseminate the messages of the recommended behaviours and distribute the soap in the communities across the intervention areas, especially the poorest of the poor community and the participants who attend the meetings regularly.

Primary Outcomes (end points)

The main outcome variables of interest in this study are:

i) daily handwashing frequency ii) likelihood of using soap when handwashing iii) prevalence of transmissible diseases in the past 15 days Primary Outcomes (explanation) i) constructed using the self-reported daily frequency of handwashing and typical handwashing times ii) constructed using self-report (times out of 10), rapid observation of the presence of soap near handwashing facilities, and self-reported expenditure on soap iii) constructed using self-report of symptoms and specific diseases Secondary Outcomes i) knowledge of handwashing practices ii) attitudes towards handwashing iii) use of public handwashing stations and alternatives to public handwashing stations iii) frequency of mask-wearing

• Study Type: Interventional
• Enrollment (Actual): 3840
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Bangladesh
  • Dhaka, Bangladesh
    • BRAC, Bangladesh

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Must live in the villages where BRAC is implementing the interventions

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: HBCC and no soap; BRAC has built 1000 handwashing stations in 20 sub-districts from 3 divisions (out of a total of 8 divisions), namely Dhaka, Mymensingh and Khulna, to increase the access of communities to handwashing facilities. In addition to these handwashing stations, there are other supports available in the intervention areas i.e. in-person demonstration, hygiene meetings, and soap distribution from BRAC. However, this group did not receive any soap from the research team.	Behavioral: Handwashing stations at the public places and no soap; BRAC has built 1000 handwashing stations in 20 sub-districts from 3 divisions (out of a total of 8 divisions), namely Dhaka, Mymensingh and Khulna, to increase the access of communities to handwashing facilities. In addition to these handwashing stations, there are other supports available in the intervention areas i.e. in-person demonstration, hygiene meetings, and soap distribution from BRAC. However, this group did not receive any soap from the research team.; Other Names: In-person demonstration
Experimental: No HBCC project and no soap; In these randomly selected villages, BRAC did not implement any activity of its HBCC project. Also, the research team did not distribute soap to these households	Behavioral: No activities of the HBCC project and also no soap (Pure Control); In these randomly selected villages, BRAC did not implement any activity of its HBCC project. Also, the research team did not distribute soap to these households
Experimental: Soap received but no HBCC; In these randomly selected villages, BRAC did not implement any activity of its HBCC project but the research team randomly selected this group for soap distribution.	Behavioral: Soap distributed but no activities of the HBCC project; In these randomly selected villages, BRAC did not implement any activity of its HBCC project but the research team randomly selected this group for soap distribution.
Experimental: Both HBCC project and Soap received; These households belong to those villages where the HBCC project has been implemented and also received the soap from the research team.	Behavioral: HBCC project and Soap; These households belong to those villages where the HBCC project has been implemented and also received the soap from the research team.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Daily handwashing frequency	Constructed using the self-reported daily frequency of handwashing and typical handwashing times	One day
Likelihood of using soap when handwashing	Constructed using self-report (times out of 10), rapid observation of the presence of soap near handwashing facilities, and self-reported expenditure on soap	One day
Prevalence of transmissible diseases in the past 15 days	Constructed using self-report of symptoms and specific diseases	In last 15 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knowledge of handwashing practices	Self-reported knowledge on handwashing practices	3 months
Attitudes	Attitudes towards handwashing	3 months
Handwashing at the public places	Use of public handwashing stations and alternatives to public handwashing stations	3 months
Mask usage	Frequency of mask-wearing	3 months

Collaborators and Investigators

• Sponsor: BRAC University
• Collaborators: Brac; The Behavioural Insights Team

Study record dates

Study Major Dates

• Study Start (Actual): September 19, 2020
• Primary Completion (Anticipated): May 1, 2021
• Study Completion (Anticipated): May 1, 2021

Study Registration Dates

• First Submitted: February 11, 2021
• First Submitted That Met QC Criteria: February 11, 2021
• First Posted (Actual): February 15, 2021

Study Record Updates

• Last Update Posted (Actual): May 12, 2021
• Last Update Submitted That Met QC Criteria: May 9, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Keywords: Handwashing station; mask usage; behvaioural change
• Other Study ID Numbers: BIGD2021

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No