Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma)

A cluster-randomised trial

Dados Bibliográficos

ID23348142
AutoresAdam Biran (0009-0002-0702-2109, London School of Hygiene & Tropical Medicine, autor correspondente), Wolf‐peter Schmidt (0000-0001-7449-4152, London School of Hygiene & Tropical Medicine), Wolf-Peter Schmidt, Kiruba Sankar Varadharajan (St. John's National Academy of Health Sciences), Divya Rajaraman (St. John's National Academy of Health Sciences), Raja Kumar (0000-0001-8843-1478, St. John's National Academy of Health Sciences), Katie Greenland (0000-0002-3331-0377, London School of Hygiene & Tropical Medicine), Balaji Gopalan, Robert Aunger (0000-0001-8136-9376, London School of Hygiene & Tropical Medicine), Val Curtis (0000-0001-8994-2878, London School of Hygiene & Tropical Medicine)
Ano2014
Volume2
Fascículo3
Páginase145-e154
Data de publicação2014-03-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoThe Lancet Global Health (JOURNAL)
Identificadores do periódicoISSN: 2214-109X • E-ISSN: 2572-116X
EditoraElsevier BV (PUBLISHER)
DOI10.1016/s2214-109x(13)70160-8
PMID25102847
OpenAlexW2170019583
IdiomaEN
Citações recebidas61
Referências citadas27

BACKGROUND: Diarrhoea and respiratory infections are the two biggest causes of child death globally. Handwashing with soap could substantially reduce diarrhoea and respiratory infections, but prevalence of adequate handwashing is low. We tested whether a scalable village-level intervention based on emotional drivers of behaviour, rather than knowledge, could improve handwashing behaviour in rural India. METHODS: The study was done in Chittoor district in southern Andhra Pradesh, India, between May 24, 2011, and Sept 10, 2012. Eligible villages had a population of 700-2000 people, a state-run primary school for children aged 8-13 years, and a preschool for children younger than 5 years. 14 villages (clusters) were selected, stratified by population size ( 1200), and randomly assigned in a 1:1 ratio to intervention or control (no intervention). Clusters were enrolled by the study manager. Random allocation was done by the study statistician using a random number generator. The intervention included community and school-based events incorporating an animated film, skits, and public pledging ceremonies. Outcomes were measured by direct observation in 20-25 households per village at baseline and at three follow-up visits (6 weeks, 6 months, and 12 months after the intervention). Observers had no connection with the intervention and observers and participant households were told that the study was about domestic water use to reduce the risk of bias. No other masking was possible. The primary outcome was the proportion of handwashing with soap at key events (after defecation, after cleaning a child's bottom, before food preparation, and before eating) at all follow-up visits. The control villages received a shortened version of the intervention before the final follow-up round. Outcome data are presented as village-level means. FINDINGS: Handwashing with soap at key events was rare at baseline in both the intervention and control groups (1% [SD 1] vs 2% [1]). At 6 weeks' follow-up, handwashing with soap at key events was more common in the intervention group than in the control group (19% [SD 21] vs 4% [2]; difference 15%, p=0·005). At the 6-month follow-up visit, the proportion handwashing with soap was 37% (SD 7) in the intervention group versus 6% (3) in the control group (difference 31%; p=0·02). At the 12-month follow-up visit, after the control villages had received the shortened intervention, the proportion handwashing with soap was 29% (SD 9) in the intervention group and 29% (13) in the control group. INTERPRETATION: This study shows that substantial increases in handwashing with soap can be achieved using a scalable intervention based on emotional drivers. FUNDING: Wellcome Trust, SHARE.

Cluster (spacecraft) · Cluster randomised controlled trial · Environmental health · Intervention (counseling) · Population · Randomized controlled trial · Child Nutrition and Water Access · Food Safety and Hygiene · Medicine · Nursing · Pediatric health and respiratory diseases · Surgery