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" Social Norms, Behavior Change Interventions, and Hand Hygiene Practice in Household, School and Community Settings "
Wichaidit, Wit
Ram, Pavani K.
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Latin Dissertation
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English
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| Record Number
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1104131
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| Doc. No
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TLpq2194370784
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| Main Entry
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Ram, Pavani K.
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Wichaidit, Wit
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| Title & Author
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Social Norms, Behavior Change Interventions, and Hand Hygiene Practice in Household, School and Community Settings\ Wichaidit, WitRam, Pavani K.
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| College
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State University of New York at Buffalo
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| Date
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2019
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| student score
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2019
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| Degree
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Ph.D.
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| Page No
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164
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| Abstract
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Low and middle-income countries face a high burden of infectious diseases, especially among young children. Hand hygiene, the act of washing one's hands with water and soap or cleaning the hands with waterless hand cleanser, disrupts pathogen transmission and prevents infectious disease. However, handwashing is infrequently practiced in households, schools and communities due to a number of physical and psychosocial factors. Physical factors include lack of access to water and soap, and difficulty in maintaining bar soap due to theft or loss. Psychosocial factors include low level of disgust, lack to motivation of wash hands, lack of handwashing habit formation, and lack of social norms on handwashing. Social norms are defined as informal rules that govern individuals’ behaviors. Social norms consist of two components: the perceived extent to which relevant others engage in the behavior (“empirical expectation”), and the perceived extent to which relevant others think the individual ought to engage in the behavior (“normative expectation”). However, several knowledge gaps remain. Firstly, no previous study has quantitatively measured social norms for handwashing, or assessed the association between social norms and handwashing outcomes. Secondly, there is a knowledge gap with regard to the effect of combined intervention that included a hardware component to improve access to water and soap and a behavior change component that aimed to increase disgust for unwashed hands and increase social norms for handwashing on handwashing outcomes in schools. Lastly, there are few evaluations of large-scale handwashing behavior change field trials that describe the effect of the intervention on handwashing outcomes in community settings. To address the above gaps, this dissertation had three specific aims: (1) To assess the association between normative expectation, one of the two components of social norms, and indicators of handwashing in the household; (2) To describe the effect of a social norms-based intervention and soapy water technology on availability of handwashing materials in schools and handwashing behavior among schoolchildren; (3) To describe the effect of a large-scale behavior change intervention on availability of handwashing materials and handwashing behavior in the community. For Specific Aim 1, we used data from the baseline survey of the Public Private Partnership for Handwashing (PPPHW) programme in Nepal. The survey collected data from 1,021 caregivers of children under 5 year of age and included 6 questions with statements pertaining to normative expectation on handwashing, with response options of "Agree", "Disagree" or "Neither agree nor disagree". The survey also measured the following outcomes: 1) Observed presence/absence of soap in household’sation handwashing place, and; 2) observed handwashing behavior of household members. Approximately 75% of the respondents answered "Agree" on all questions and were considered to have a "high" level of normative expectation. All other responses were assigned "low" normative expectation. Relative risk ratio (RRR) was calculated using multinomial regression analyses to assess the association between normative expectation and the outcomes. The presence of soap and water at primary handwashing place did not differ between households with high and low normative expectation (prevalence 46% vs. 39%; Adjusted RRR = 1.21, 95% CI = 0.74, 1.99). The prevalence of observed handwashing with soap and water after toilet use in households with high and low normative expectation was 35% vs. 17%, respectively (Adjusted RRR = 1.46, 95% CI = 0.94, 2.28). Observation of handwashing behavior was made days after the interview, thus reactivity among observed household members cannot be disregarded. Response acquiescence, the tendency for survey respondents to indicate agreement with a statement regardless of its content, could have made the participants prone to answer normative expectation measurement questions with "Agree". For Specific Aim 2, we used data from the Povu Poa (“Cool Foam”) stepped-wedge cluster randomized trial in 30 schools in western Kenya, which were divided into 3 groups of 10 schools. The intervention included delivery of handwashing stations that dispensed soapy water, and school-wide behavior change intervention based on disgust and social norms changes. During each follow-up visit, outcome data were collected from schools that had received the intervention and schools that had not yet received the intervention. The outcomes included: 1) availability of handwashing materials at handwashing places, and; 2) observed handwashing behavior after toilet use among schoolchildren. Log-binomial regression analyses were used to calculate prevalence ratio (PR) to assess the association between exposure to the intervention and the outcomes. The intervention increased the availability of water and soap at handwashing place from 2% to 42% (PR = 117.00, 95% CI = 16.08, 851.30), and prevalence of observed handwashing with water and soap from 0% (none) to 26% (PR incalculable). (Abstract shortened by ProQuest.)
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| Subject
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Epidemiology
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Public health education
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Social psychology
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