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

Latrine block with hygiene messages in a displaced persons camp in Port-au-Prince, Haiti. Photo Credit: Johanna Braun.

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

Identifying the psychological determinants of handwashing: results from two cross-sectional questionnaire studies in Haiti and Ethiopia

Background: Diarrheal disease kills around 760,000 infants every year. Many of these deaths could have been prevented by handwashing with soap. However, the whole range of psychological factors encouraging handwashing is not yet identified and handwashing campaigns are often limited to awareness-raising and education. The purpose of this article was to identify the psychological determinants of handwashing in Haiti (study 1) and Ethiopia (study 2).
Methods: Data were collected cross-sectionally by administering face-to-face interviews with the primary caregiver in a participating household (NHaiti = 811; NEthiopia = 463). Hierarchical multiple regression analyses were performed on self-reported handwashing.
Results: In both countries, risk factors—meaning awareness and health knowledge—accounted for only 11%-19% of variance in handwashing and were not consistently associated with handwashing. The inclusion of additional factor-groups, namely attitude, norm, ability, and self-regulation factors, led to significant increases in explained variance (P ≤ .01), accounting for 25%-44% of additionally explained variance. The attitude factor 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.
Conclusions: Handwashing campaigns should focus especially on attitudes and norms and not only on risk.
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

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

Aim. In a disaster context, where risk for diarrhoeal disease is elevated, personal hygiene, i.e. handwashing with soap, is especially relevant. However, to date, the promotion of hygiene in an emergency context has not been adequately addressed in the literature. The aim of the present study is to evaluate the effectiveness of hygiene promotions in post-earthquake Haiti.
Subject and Methods. Cross-sectional data was collected by means of structured interviews in camps and neighbourhoods in which three affiliates of a well-known relief organisation had conducted hygiene promotions. Primary caregivers were targeted. A total sample of 811 was obtained. Data was 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 answering listener's questions, material distributions with instructions for use, information from friends or neighbours, hygiene theatres, and community clubs. However, five of the promotional channels were negatively related with handwashing. Respondents who experienced a focus group, stickers, posters and paintings, hygiene songs, special hygiene days and home visits tended to wash their hands less often.
Conclusions. By revealing positive but also negative associations between hygiene promotions and handwashing behaviour, the study underlines the need to apply theory-driven emergency hygiene promotions which are subjected to in-depth evaluation. Only through doing this, is it ensured that effective hygiene promotions are implemented for the most vulnerable people — those affected by a humanitarian disaster.
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, Environmental Health Psychology 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