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Study Tests Methods to Measure Handwashing Behavior

Handwashing with soap has proven to be a life-saving habit, dramatically reducing the incidence of diarrheal disease in developing countries. As handwashing promotion is scaled up and adopted by more organizations, the need for field-friendly, affordable, and readily adaptable monitoring and evaluation techniques has increased. A WSP study conducted in rural Bangladesh set out to determine the most effective and appropriate methods for measuring handwashing behaviors in the field. Determining the utility of sensor soap, which uses a novel technology embedded in bars of soap that allows for continuous monitoring of soap-use behavior, was of particular interest to the researchers.
 
Improving Measures of Handwashing Behavior, authored by Pavani K. Ram, Stephen P. Luby, Amal Krishna Halder, M. Sirajul Islam, and Stewart Granger, presents findings and recommendations based on the Bangladesh study, which targeted female caregivers in rural households with at least one child under the age of five.
 
Along with other findings, the study confirmed the utility of sensor soap for measuring handwashing behavior at the household level. In addition, the sensor soap enabled researchers to identify a subset of households in which the presence of an observer for structured observation resulted in substantial reactivity and, thus, increase in soap use. Interestingly, reactivity was associated with socioeconomic and educational factors.
 
Ann Thomas, sanitation and hygiene specialist for UNICEF’s Water, Sanitation, and Hygiene (WASH) program, recognizes the potential of sensor soap as an important tool for large-scale handwashing behavior monitoring. “Sensors provide a simple, straightforward method for collecting behavioral data; I hope sensor soap will become widely available and yield solid data on household usage, which for many countries will be a great starting point in establishing behavioral baselines,” says Thomas.
 
Based on the findings regarding sensor soap, the authors recommend further research to:
  • evaluate the utility and feasibility of sensor soap in large-scale research studies and evaluations of handwashing promotion programs
  • deploy sensor soaps among households participating in structured observation, in order to assess for reactivity
  • confirm that knowledge regarding sensor soap construction, deployment, retrieval, and data download can be transferred speedily and accurately to in-country personnel in various countries
 
Research methods consisted of a cross-sectional survey in 100 households in six randomly selected rural areas in Bangladesh. The handwashing behaviors of households supplied with sensor soap were assessed through structured observations of 90 minutes or five hours over an eight-day period, spot checks, hand microbiology, and questionnaire administration.
The paper is a companion piece to Practical Guidance for Measuring Handwashing Behaviors(March 2010), which discusses the validity, reliability, efficiency, and best use of handwashing behavior measures.
 

For more information about this or other Global Scaling Up Sanitation publications, visit www.wsp.org/scalinguphandwashing or contact Eduardo Perez, wsp@worldbank.org.