Publication: Behavioral Determinants of Handwashing with Soap Among Mothers and Caretakers : Emergent Learning from Senegal and Peru
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2012-02
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2012-08-13
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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.
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“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.”
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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.
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