Publication: Behavioral Determinants of Handwashing with Soap Among Mothers and Caretakers : Emergent Learning from Senegal and Peru
Loading...
Date
2012-02
ISSN
Published
2012-02
Author(s)
Editor(s)
Abstract
The Water and Sanitation Program (WSP) has supported the Global Scaling up Handwashing Project in Peru, Senegal, Tanzania, and Vietnam. The project has tested whether innovative promotional approaches to behavior change can generate widespread and sustained improvements in household hygiene practices. The implementation phase of the project ended in June 2011. The project has a significant learning objective, an important component of which is to ascertain the key factors that influence behavior change. These are known as behavioral determinants. Studies such as a formative research study conducted in Kenya in 2007 have found that while knowledge around hand-washing tends to be high, practice rates are low. This finding is illustrative of the knowledge-behavior gap encountered by anti-smoking and condom-use initiatives, among others, and reflects the complexity of human behavior. More specifically, FOAM (Focus, Opportunity, Ability, and Motivation) was developed to inform the design of formative research, interventions as well as monitoring to increase the effectiveness of its behavior change program. A key feature of the project is its monitoring and evaluation component, which includes randomized control baseline and end-line studies, longitudinal surveys, periodic implementation surveys, and a comprehensive management information system (MIS) that enabled continuous monitoring and improvement. These components have been used to measure and track key indicators such as diarrhea incidence. This Learning Note aims to highlight key findings from two studies, the impact evaluation baseline study conducted in Peru in 20074 and a 'doer/non-doer' study conducted in Senegal in 2010.
Link to Data Set
Citation
“World Bank. 2012. Behavioral Determinants of Handwashing with Soap Among Mothers and Caretakers : Emergent Learning from Senegal and Peru. Water and Sanitation Program : Learning Note. © World Bank. http://hdl.handle.net/10986/11680 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The Power of Primary Schools to Change and Sustain Handwashing with Soap among Children : The Cases of Vietnam and Peru(World Bank, Washington, DC, 2011-09)Vietnam and Peru are two of four countries taking part in the Water and Sanitation Program (WSP) Global Scaling up Handwashing Project. Funded by the Bill and Melinda Gates Foundation, the Global Scaling Up Handwashing Project aims to expand handwashing practices among women of reproductive age (15-49 years) and primary school-aged children (5 to 12 in Peru; 6 to 10 in Vietnam) The project focuses on applying innovative promotional approaches to generate widespread and sustained improvement in handwashing with soap practice. Started in December 2006, the project is implemented by local and national governments with technical support from WSP, and participation from the private sector and nongovernmental organizations. The present document describes the approaches to changing children's handwashing with soap behavior, first in Vietnam, then Peru, followed by some lessons learned and conclusions.Publication Enabling Technologies for Handwashing with Soap : A Case Study on the Tippy-Tap in Uganda(World Bank, Washington, DC, 2011-02)The Water and Sanitation Program's (WSP) Global scaling up handwashing project is testing whether innovative promotional approaches to behavior change can generate widespread and sustained improvements in household hygiene and sanitation practices in Peru, Senegal, Tanzania, and Vietnam. The purpose of this study was to document the process through which tippy-taps were promoted to qualitatively explore the results and to draw out lessons for future interventions. Handwashing with soap at key times is believed to be an effective and highly cost effective means of reducing diarrhea incidence. However, global rates of handwashing with soap are frequently low, particularly among the poor, who also face the greatest threat from infectious diseases. Access to a convenient handwashing station has been found to be associated with higher rates of handwashing and decreased fingertip contamination. Tippy-taps were an acceptable means of providing a low cost enabling technology for handwashing in this population. Anecdotally they have increased rates of handwashing after latrine use. However, uptake appeared driven by the 'push' of the intervention rather than the 'pull' of the technology and the extent to which spontaneous uptake and sustained use can be achieved in the absence of intensive intervention activities is not known. Respondents in non model villages had little contact with model villages and were largely unaware of the tippy-tap. The interventions were labor intensive and probably difficult to scale-up.Publication Promoting Handwashing Behavior in Peru : The Effect of Large-Scale Mass-Media and Community Level Interventions(World Bank, Washington, DC, 2012-11)This paper analyzes a randomized experiment that uses novel strategies to promote handwashing with soap at critical times in Peru. It evaluates a large-scale intervention that includes a mass media provincial campaign and a district-level community component. The analysis finds that the mass media intervention alone had no significant effect on exposure to the handwashing promotion campaign messages, and therefore no effect on handwashing knowledge or handwashing behavior. In contrast, the community-level intervention, a more comprehensive intervention that included several community and school activities in addition to the communications campaign, was successful in reaching the target audience with handwashing promotion messages and in improving the knowledge of the treated population on appropriate handwashing behavior. Those 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 five were observed. The results are consistent with earlier literature, which indicates that substantively changing behavior to improve health is a complex task requiring intensive and more personalized interventions.Publication Integrating Hygiene Promotion Into World Bank Projects : Experiences from Colombia and Peru(World Bank, Washington, DC, 2011-05)This report has been created to provide practical tools, tips, and methodologies for project leaders to integrate hygiene components into their projects. It builds on available evidence about the contribution of behavioral change programs to the reduction of diseases, in particular hand-washing with soap initiatives, which can benefit health, environment, water, sanitation, and education projects. Project leaders should view hygiene promotion as a behavioral change process rather than a unidirectional media or education campaign. The knowledge generated from the research, enabling environment assessments, and other tools can be utilized in the early stages of project design and throughout the project cycle. It is crucial to understand the local environment to ensure that behavior change is sustainable once the project cycle is complete. Awareness of the importance of hygiene will vary in each region; therefore, every project must start with different assumptions. Water and Sanitation Program (WSP) and other partners continue to generate positive examples and lessons learned and transfer knowledge. For example, the Global Public-Private Partnership for hand-washing with soap helps countries close the gap as they strive to meet the millennium development goals. The tools and guidelines referenced in this document do not offer a strict formula, however, and should be revised and adapted to the needs of each project. The door remains open for continuous learning and improvement.Publication Handwashing Behavior Change at Scale : Evidence from a Randomized Evaluation in Vietnam(World Bank, Washington, DC, 2012-09)Handwashing with soap, which has been shown to reduce diarrhea in young children by as much as 48 percent, is frequently mentioned as one of the most effective and inexpensive ways to save children's lives. Yet rates of handwashing remain very low throughout the world. Handwashing with soap campaigns are de rigueur in developing countries, but little is known about their effectiveness. Few have been rigorously evaluated, and none on a large-scale. This paper evaluates a large-scale handwashing campaign in three provinces of Vietnam in 2010. Exposure to the campaign resulted in a slight increase in the availability of handwashing materials in the household, and caregivers in the treatment group were more likely to report washing hands at some of the times emphasized by the campaign. However, observed handwashing with soap at these times is low, and there isn't any difference between the treatment and control groups. As a result, no impact on health or productivity is found. These results suggest that even under seemingly optimal conditions, where knowledge and access to soap and water are not main constraints, behavior change campaigns that take place on a large scale face tradeoffs in terms of intensity and effectiveness.
Users also downloaded
Showing related downloaded files
Publication The Mexican Social Protection System in Health(World Bank, Washington DC, 2013-01)With a population of 113 million and a per-capita Gross Domestic Product, or GDP of US$10,064 (current U.S. dollars), Mexico is one of the largest and highest-income countries in Latin America and the Caribbean (LAC). The country has benefited from sustained economic growth during the last decade, which was temporarily interrupted by the financial and economic crisis. Real GDP is projected to grow 3.8 percent and 3.6 percent in 2012 and 2013, respectively (International Monetary Fund, or IMF 2012). Despite this growth, poverty in the country remains high; with half of the population living below the national poverty line. The country is also highly heterogeneous, with large socioeconomic differences across states and across urban and rural areas. In 2010, while the extreme poverty ratio in the Federal District and the states of Colima and Nuevo Leon was below 3 percent, in Chiapas, Guerrero, and Oaxaca it was 25 percent or higher. These large regional differences are also found in other indicators of well-being, such as years of schooling, housing conditions, and access to social services. This case study assesses key features and achievements of the Social Protection System in Health (Sistema de Proteccion Social en Salud) in Mexico, and particularly of its main pillar, Popular Health Insurance (Seguro Popular, PHI). It analyzes the contribution of this policy to the establishment and implementation of universal health coverage in Mexico. In 2003, with the reform of the General Health Law, the PHI was institutionalized as a subsidized health insurance scheme open to the population not covered by the social security schemes. Today, the PHI covers all of its intended affiliates, about 52 million peoplePublication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication Crime and Violence in Central America : A Development Challenge - Main Report(World Bank, 2011-01-01)Crime and violence are now a key development issue for Central American countries. In three nations El Salvador, Guatemala, and Honduras crime rates are among the top five in Latin America. This report argues that successful strategies require actions along multiple fronts, combining prevention and criminal justice reform, together with regional approaches in the areas of drug trafficking and firearms. It also argues that interventions should be evidence based, starting with a clear understanding of the risk factors involved and ending with a careful evaluation of how any planned action might affect future options. In addition, the design of national crime reduction plans and the establishment of national cross-sectoral crime commissions are important steps to coordinate the actions of different government branches, ease cross-sectoral collaboration and prioritize resource allocation. Of equal importance is the fact that national plans offer a vehicle for the involvement of civil society organizations, in which much of the expertise in violence prevention and rehabilitation resides. Prevention efforts need to be complemented by effective law enforcement. The required reforms are no longer primarily legislative in nature because all six countries have advanced toward more transparent adversarial criminal procedures. The second-generation reforms should instead help deliver on the promises of previous reforms by: (i) strengthening key institutions and improving the quality and timeliness of the services they provide to citizens; (ii) improving efficiency and effectiveness while respecting due process and human rights; (iii) ensuring accountability and addressing corruption; (iv) increasing inter-agency collaboration; and (v) improving access to justice, especially for poor and disenfranchised groups. Specific interventions reviewed in the report include: information systems and performance indicators as a prerequisite to improve inter-institutional coordination and information sharing mechanisms; an internal overhaul of court administration and case management to create rapid reaction, one-stop shops; the strengthening of entities that provide legal counseling to the poor and to women; and the promotion of alternative dispute-resolution mechanisms and the implementation of community policing programs.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication Guide to the Debt Management Performance Assessment Tool(Washington, DC, 2008-02-05)The purpose of this document is to provide guidance and supplemental information to assist with country assessments of debt management performance, using the Debt Management Performance Assessment (DeMPA) tool. The DeMPA is a methodology used for assessing public debt management performance through a comprehensive set of 15 performance indicators spanning the full range of government Debt Management (DeM) functions. It is based on the principles set out in the International Monetary Fund (IMF) and World Bank guidelines for public debt management, initially published in 2001 and updated in 2003. It is modeled after the Public Expenditure and Financial Accountability (PEFA) framework for performance measurement of public financial management. The DeMPA has been designed to be a user-friendly tool to undertake an assessment of the strengths and weaknesses in government DeM practices. This guide provides additional background and supporting information so that a no specialist in the area of debt management may undertake a country assessment effectively. The guide can be used by assessors in preparing for and undertaking an assessment. It is particularly useful for understanding the rationale for the inclusion of the indicators, the scoring methodology, and the list of supporting documents or evidence required, and the questions that could be asked for the assessment.