Department Environmental Social Sciences

Impact of different promotional channels on handwashing behavior in an emergency context: Haiti post-earthquake public health promotions and cholera response

Regular handwashing is especially vital during disasters, when the risk of diarrheal disease is elevated. This project in post-earthquake Haiti aimed to evaluate the impact of public health promotions and cholera response on handwashing rates. The impact of the applied promotional channels proved to be divergent: some were positively associated, some were not associated and others were even negatively associated with handwashing rates.

Project details

Context

During disasters, when the risk of diarrheal disease is elevated, proper hand hygiene is especially relevant and its promotion a key activity of relief organizations. To date, the effectiveness of handwashing promotions in an emergency context has not been adequately addressed.

 

Objectives
The main goal of this project was to evaluate the effectiveness of public health promotions and cholera response in post-earthquake Haiti. Specific objectives were:

  • To assess the current handwashing practices and the behavioral factors determining the handwashing practices.
  • To assess the impact of different promotional channels on the behavioral determinants of handwashing.
  • To assess the impact of different promotional channels on handwashing behavior.

 

Activities
Assess the impact of promotional channels on behavioral determinants and on handwashing practice.

  • A survey was conducted in May 2011 in 811 households measuring the following:
    • Handwashing practices
    • Behavioral determinants of handwashing
    • Experienced promotion activities
  • By means of data analyses the following was specified:
    • The key determinants of handwashing
    • The impact of promotional channels on behavioral determinants and on handwashing practices


Findings

  • The key determinants of handwashing were attitudinal factors (e.g. return of handwashing or disgust), descriptive and injunctive norms, self-efficacy, and coping planning.
  • Of the applied 16 promotional channels all were associated with at least one of these determinants. However, some behavioral determinants (e.g. return of handwashing) were not affected by any of the promotional channels.
  • Six promotional channels were positively associated with handwashing: for example respondents who had experienced hygiene radio spots or material distributions with instructions for use stated higher handwashing rates than those not experiencing these promotional channels.   
  • Five promotional channels were negatively associated with handwashing: for example respondents who experienced a focus group or special hygiene days stated lower handwashing rates than those not experiencing these promotional channels.  
  • Five promotional channels were not associated with handwashing: for example respondents who experienced information spread by megaphone or hygiene trainings stated the same handwashing rates as those not experiencing these promotional channels.

      
Conclusions

  • Standard approaches to promote hygiene during disasters might not only be ineffective but even counter-effective.
  • Rigorous evaluations of hygiene promotions are inevitable to eliminate unwanted effects such as behavior impairment.

Related publications

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   0 => Snowflake\Publications\Domain\Model\Publicationprototypepersistent entity (uid=8153, pid=124)
      originalId => protected8153 (integer)
      authors => protected'Contzen, N.; Mosler, H.-J.' (36 chars)
      title => protected'Identifying the psychological determinants of handwashing: results from two 
         cross-sectional questionnaire studies in Haiti and Ethiopia
' (135 chars) journal => protected'American Journal of Infection Control' (37 chars) year => protected2015 (integer) volume => protected43 (integer) issue => protected'8' (1 chars) startpage => protected'826' (3 chars) otherpage => protected'832' (3 chars) categories => protected'diarrheal disease; cholera; psychological predictors; regression analysis' (73 chars) description => protected'<em>Background:</em> Diarrheal disease kills around 760,000 infants every ye
         ar. Many of these deaths could have been prevented by handwashing with soap.
          However, the whole range of psychological factors encouraging handwashing i
         s not yet identified and handwashing campaigns are often limited to awarenes
         s-raising and education. The purpose of this article was to identify the psy
         chological determinants of handwashing in Haiti (study 1) and Ethiopia (stud
         y 2).<br /><em>Methods:</em> Data were collected cross-sectionally by admini
         stering face-to-face interviews with the primary caregiver in a participatin
         g household (N<sub>Haiti</sub> = 811; N<sub>Ethiopia</sub> = 463). Hiera
         rchical multiple regression analyses were performed on self-reported handwas
         hing.<br /><em>Results:</em> In both countries, risk factors—meaning aware
         ness and health knowledge—accounted for only 11%-19% of variance in handwa
         shing and were not consistently associated with handwashing. The inclusion o
         f additional factor-groups, namely attitude, norm, ability, and self-regulat
         ion factors, led to significant increases in explained variance (P ≤ .01),
          accounting for 25%-44% of additionally explained variance. The attitude fac
         tor disgust, the norm factor, the ability factors motivational self-efficacy
          and perceived impediments, and the self-regulation factors coping planning
         and commitment emerged as especially relevant.<br /><em>Conclusions:</em> Ha
         ndwashing campaigns should focus especially on attitudes and norms and not o
         nly on risk.
' (1532 chars) serialnumber => protected'0196-6553' (9 chars) doi => protected'10.1016/j.ajic.2015.04.186' (26 chars) uid => protected8153 (integer) _localizedUid => protected8153 (integer)modified _languageUid => protectedNULL _versionedUid => protected8153 (integer)modified pid => protected124 (integer)
1 => Snowflake\Publications\Domain\Model\Publicationprototypepersistent entity (uid=7306, pid=124) originalId => protected7306 (integer) authors => protected'Contzen,&nbsp;N.; Mosler,&nbsp;H.-J.' (36 chars) title => protected'Impact of different promotional channels on handwashing behaviour in an emer
         gency context: Haiti post-earthquake public health promotions and cholera re
         sponse
' (158 chars) journal => protected'Journal of Public Health (Berlin, Heidelberg)' (45 chars) year => protected2013 (integer) volume => protected21 (integer) issue => protected'6' (1 chars) startpage => protected'559' (3 chars) otherpage => protected'573' (3 chars) categories => protected'handwashing with soap; diarrhoea; hygiene promotion; communication channels;
          emergency; Haiti
' (93 chars) description => protected'<I>Aim</I>. In a disaster context, where risk for diarrhoeal disease is elev
         ated, personal hygiene, i.e. handwashing with soap, is especially relevant.
         However, to date, the promotion of hygiene in an emergency context has not b
         een adequately addressed in the literature. The aim of the present study is
         to evaluate the effectiveness of hygiene promotions in post-earthquake Haiti
         .<BR/> <I>Subject and Methods</I>. Cross-sectional data was collected by mea
         ns of structured interviews in camps and neighbourhoods in which three affil
         iates of a well-known relief organisation had conducted hygiene promotions.
         Primary caregivers were targeted. A total sample of 811 was obtained. Data w
         as analysed using multiple linear regression and mediation analysis. Results
         . Analysis revealed six promotional channels with positive associations with
          handwashing behaviour: hygiene radio spots, radio programs with experts ans
         wering listener's questions, material distributions with instructions for us
         e, information from friends or neighbours, hygiene theatres, and community c
         lubs. However, five of the promotional channels were negatively related with
          handwashing. Respondents who experienced a focus group, stickers, posters a
         nd paintings, hygiene songs, special hygiene days and home visits tended to
         wash their hands less often.<BR/> <I>Conclusions</I>. By revealing positive
         but also negative associations between hygiene promotions and handwashing be
         haviour, the study underlines the need to apply theory-driven emergency hygi
         ene promotions which are subjected to in-depth evaluation. Only through doin
         g this, is it ensured that effective hygiene promotions are implemented for
         the most vulnerable people — those affected by a humanitarian disaster.
' (1745 chars) serialnumber => protected'2198-1833' (9 chars) doi => protected'10.1007/s10389-013-0577-4' (25 chars) uid => protected7306 (integer) _localizedUid => protected7306 (integer)modified _languageUid => protectedNULL _versionedUid => protected7306 (integer)modified pid => protected124 (integer)
Contzen, N.; Mosler, H.-J. (2015) Identifying the psychological determinants of handwashing: results from two cross-sectional questionnaire studies in Haiti and Ethiopia, American Journal of Infection Control, 43(8), 826-832, doi:10.1016/j.ajic.2015.04.186, Institutional Repository
Contzen, N.; Mosler, H.-J. (2013) Impact of different promotional channels on handwashing behaviour in an emergency context: Haiti post-earthquake public health promotions and cholera response, Journal of Public Health (Berlin, Heidelberg), 21(6), 559-573, doi:10.1007/s10389-013-0577-4, Institutional Repository

Contact

Dr. Nadja Contzen Group leader, Group: EHP Tel. +41 58 765 6892 Send Mail

Project data

Duration: February to November 2011

Project partners: 

  • Oxfam America
  • Oxfam Great Britain
  • Oxfam Québec
  • Intermón Oxfam


Funding: Oxfam America