Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH)

Kristyna R S Hulland, Elli Leontsini, Robert Dreibelbis, Leanne Unicomb, Aasma Afroz, Notan Chandra Dutta, Fosiul Alam Nizame, Stephen P Luby, Pavani K Ram, Peter J Winch, Kristyna R S Hulland, Elli Leontsini, Robert Dreibelbis, Leanne Unicomb, Aasma Afroz, Notan Chandra Dutta, Fosiul Alam Nizame, Stephen P Luby, Pavani K Ram, Peter J Winch

Abstract

Background: In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations--a dedicated, convenient location where both soap and water are available for handwashing--are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour.

Methods: We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs.

Results: Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials.

Conclusions: A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

Figures

Figure 1
Figure 1
Integrated behavioural model for water, sanitation and hygiene (IBM-WASH). The IBM-WASH outlines key factors that influence behaviours in water, sanitation and hygiene interventions. These behavioural factors are organized by cell, suggesting the level and domain (Contextual, Psychosocial, Technology) in which factors operate (Dreibelbis et al. submitted for publication).
Figure 2
Figure 2
Evaluated handwashing technology designs.
Figure 3
Figure 3
Attributes of a successful handwashing station.

References

    1. Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O'Brien KL, Campbell H, Black RE. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381(9875):1405–1416. doi: 10.1016/S0140-6736(13)60222-6.
    1. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, Schmidt W-P. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol. 2010;39:i193–1205. doi: 10.1093/ije/dyq035.
    1. Aiello AECRM, Perez V, Larson EL. Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis. Am J Public Health. 2008;98(8):1372–1381. doi: 10.2105/AJPH.2007.124610.
    1. Curtis VA, Danquah LO, Aunger RV. Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res. 2009;24(4):655–673. doi: 10.1093/her/cyp002.
    1. Biran A, Tabyshalieva A, Salmorbekova Z. Formative research for hygiene promotion in Kyrgyzstan. Health Policy Plan. 2005;20(4):213–221. doi: 10.1093/heapol/czi024.
    1. Schmidt WP, Aunger R, Coombes Y, Maina PM, Matiko CN, Biran A, Curtis V. Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure. Trop Med Int Health. 2009;14(12):1534–1541. doi: 10.1111/j.1365-3156.2009.02404.x.
    1. Waterkeyn J, Cairncross S. Creating demand for sanitation and hygiene through Community Health Clubs: A cost-effective intervention in two districts in Zimbabwe. Soc Sci Med. 2005;61(9):1958–1970. doi: 10.1016/j.socscimed.2005.04.012.
    1. Aunger R, Schmidt W-P, Ranpura A, Coombes Y, Maina PM, Matiko CN, Curtis V. Three kinds of psychological determinants for hand-washing behaviour in Kenya. Soc Sci Med. 2010;70(3):383–391. doi: 10.1016/j.socscimed.2009.10.038.
    1. Scott B, Curtis V, Rabie T, Garbrah-Aidoo N. Health in our hands, but not in our heads: understanding hygiene motivation in Ghana. Health Policy Plan. 2007;22(4):225–233. doi: 10.1093/heapol/czm016.
    1. Scott BE, Lawson DW, Curtis V. Hard to handle: understanding mothers’ handwashing behaviour in Ghana. Health Policy Plan. 2007;22(4):216–224. doi: 10.1093/heapol/czm014.
    1. Luby SP, Halder AK, Tronchet C, Akhter S, Bhuiya A, Johnston RB. Household Characteristics Associated with Handwashing with Soap in Rural Bangladesh. Am J Trop Med Hyg. 2009;81(5):882–887. doi: 10.4269/ajtmh.2009.09-0031.
    1. Enabling Technologies for Handwashing with Soap. Technologies for Handwashing with Soap.
    1. Devine J. Beyond tippy-taps: The role of enabling products in scaling up and sustaining handwashing. Waterlines. 2010;29(4):304. doi: 10.3362/1756-3488.2010.033.
    1. Devine J. Global Scaling Up Handwashing Project: Insights from Designing a Handwashing Station for Rural Vietnamese Households. 2010. (Water and Santiation Program: Learning Note).
    1. Halder AK, Tronchet C, Akhter S, Bhuiya A, Johnston R, Luby SP. Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh. BMC Public Health. 2010;10(Journal Article):545.
    1. Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB. The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study. PLoS Med. 2011;8(6):e1001052. doi: 10.1371/journal.pmed.1001052.
    1. Dreibelbis R, Winch PJ, Leontsini E, Hulland K, Ram PK, Unicomb L, Luby SP. The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. (icddr,b and The Johns Hopkins University Bloomberg School of Public Health; Submitted for publication).
    1. Dickin KGM, Piwoz E. Designing by Dialogue. A Program Planner's Guide to Consultative Research for Improving Young Child Feeding. 1997. (Support for Analysis and Research in Africa. Washington, DC: Academy for Educational Development).
    1. Kanashiro HC, Fukumoto M, Bentley ME, Jacoby E, Verzosa C, Brown KH. Use of recipe trials and anthropological techniques for the development of a home-prepared weaning food in the central highlands of peru. J Nutr Educ. 1991;23(1):30–35. doi: 10.1016/S0022-3182(12)80453-5.
    1. Harvey SA, Olórtegui MP, Leontsini E, Asayag CR, Scott K, Winch PJ. Trials of Improved Practices (TIPs): A Strategy for Making Long-Lasting Nets Last Longer? Am J Trop Med Hyg. 2013;88(6):1109–1115. doi: 10.4269/ajtmh.12-0641.
    1. Harvey SA, Winch PJ, Leontsini E, Torres Gayoso C, L√ ≥ pez Romero S, Gilman RH, Oberhelman RA. Domestic poultry-raising practices in a Peruvian shantytown: implications for control of Campylobacter jejuni-associated diarrhea. Acta Trop. 2003;86(1):41–54. doi: 10.1016/S0001-706X(03)00006-8.
    1. Verplanken B, Wood W. Interventions to Break and Create Consumer Habits. J Public Policy Mark. 2006;25(1):90–103. doi: 10.1509/jppm.25.1.90.
    1. Coombes Y, Devine J. Introducing FOAM: A Framework to Analyze Handwashing Behaviors to Design Effective Handwashing Programs. 2010. (Water and Santiation Program: Working Paper).
    1. Devine J. Introducing SaniFOAM: A Framework to Analyze Sanitation Behaviors to Design Effective Sanitation Programs, in Water and Sanitation Program: Working Paper. Washington DC: World Bank, Water and Sanitation Program; 2009.
    1. Mosler H-J. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. Int J Environ Health Res. 2012;22(5):431–449. doi: 10.1080/09603123.2011.650156.
    1. Gilman RMGS, Ventura G, Campos M, Spira W, Diaz F. Water cost and availability: key determinants of family hygiene in a Peruvian shantytown. Am J Public Health. 1995;83(11):1554–1558.
    1. Curtis V, Kanki B, Mertens T, Traoré E, Diallo I, Tall F, Cousens S. Potties, pits and pipes: explaining hygiene behaviour in Burkina Faso. Soc Sci Med. 1994;41(3):383–393.
    1. Fisher J. Women in water supply, sanitation and hygiene programmes. Proc ICE Munic Eng. 2008;161(4):223–229. doi: 10.1680/muen.2008.161.4.223.
    1. Figueroa ME, Kincaid DL. Social, Cultural and Behavioral Correlates of Household Water Treatment and Storage. Center Publication HCI 2010-1: Health Communication Insights. Baltimore: Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs; 2010.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner