Why don’t they do it? Handwashing barriers and influencer study in Faridabad district,India

Abstract

Background:

Handwashing has been widely accepted as the simplest protection against communicable diseases. However, despite proven effectiveness and cost-efficiency, adoption of regular handwashing is still poor in developing countries. As children in school-going age are vulnerable and continue to suffer from preventable illnesses, this study aims to spot barriers to handwashing among children while simultaneously recognizing the influencing factors to aid the solutions narrative for effective water, sanitation and hygiene (WASH) strategies.

Methods:

A school-based cross-sectional, mixed-method study was conducted in Ballabhgarh block, Faridabad district, India. A predesigned, pretested, structured questionnaire was administered to 106 class V students in five randomly selected rural government primary schools. Due permissions, consent and ethical clearances were taken.

Results:

The majority (>91%) of children were found to have low illness threat perception. The inability to visually see germs came out as one of the biggest barriers (46%) that were preventing children from practicing regular handwashing. Family, teachers and peers were found to be the most important sources of information for children and not any particular media channel. In fact, role of peers was found to be critical as 72% children said that they would wash hands if their friends were also washing hands.

Conclusion:

This study suggests children’s need for visible proof of germs and associated casual attitude toward illness threat as a hitherto unexplored potential barrier to practicing regular handwashing. In addition, the human channel of communication seems to be the most relevant regarding public health messaging in rural heartlands. Despite 100% penetration of mobile phones and commonplace presence of television, it is the community ecosystem that is still the most trusted sources of information and influence. The unique role of peers found in this study could have strategic implications for future behaviour change interventions making a case for peer-to-peer behaviour modeling.

Keywords

handwashing primary school children India behaviour change barriers

Get full access to this article

View all access options for this article.

References

Available online at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public (last accessed 28 October 2020)

Curtis

Ddanquah

Aunger

. Planned, motivated and habitual hygiene behavior: an eleven country review. Health Educ Res 2009;24(4):655–73.

Rabie

Curtis

. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 2006;11(3):258–67.

Richmond

Kotelchuck

. Personal health maintenance for children. West J Med 1984;141(6):816–23.

UNICEF. Water, sanitation and hygiene. Available online at: https://www.unicef.org/wash/index_43107.html (2016, last accessed 28 July 2020).

Gupta

Anand

. Role of cause marketing in behavior change: critical review of India’s most celebrated hygiene campaigns. Int J Appl Soc Sci 2019;6(5):1173–83.

International Vaccine Access Center (IVAC), John Hopkins Bloomberg School of Public Health. Pneumonia and diarrhea progress report 2018. Available online at: https://stoppneumonia.org/wp-content/uploads/2018/11/Pneumonia-and-Diarrhea-Progress-Report-2018.pdf

Lakshminarayanan

Jayalakshmy

. Diarrheal diseases among children in India: current scenario and future perspectives. J Nat Sci Biol Med 2015;6(1):24–8.

UNICEF. Drinking water, sanitation and hygiene in schools: global baseline report 2018. Available online at: https://data.unicef.org/resources/wash-in-schools/

10.

Scott

Curtis

Rabie

, et al Health in our hands, but not in our heads: understanding hygiene motivation in Ghana. Health Pol Plan 2007;22(4):225–33.

11.

Rogers

Deckner

. Effects of fear appeals and physiological arousal upon emotion, attitudes, and cigarette smoking. J Pers Soc Psychol 1975;32(2):222–30.

12.

Witte

Meyer

Martell

. Effective health risk messages: a step-by-step guide. Thousand Oaks, CA: Sage; 2001.

13.

Peters

Ruiter

Kok

. Threatening communication: a qualitative study of fear appeal effectiveness beliefs among intervention developers, policymakers, politicians, scientists, and advertising professionals. Int J Psychol 2014;49(2):71–9.

14.

Kok

Bartholomew

Parcel

, et al Finding theory- and evidence-based alternatives to fear appeals: intervention mapping. Int J Psychol 2014;49(2):98–107.

15.

Rogers

. A protection motivation theory of fear appeals and attitude change. J Psychol 1975;91(1):93–114.

16.

Ort

Fahr

. Using efficacy cues in persuasive health communication is more effective than employing threats – an experimental study of a vaccination intervention against Ebola. Br J Health Psychol 2018;23(3):665–84.

17.

Lopez-Quintero

Freeman

Neumark

. Hand washing among school children in Bogota, Colombia. Am J Pub Health 2009;99(1):94–101.

18.

Schunk

. Peer models and children’s behavioral change. Rev Educ Res 1987;57(2):149–74.

19.

Parker

Rubin

Erath

, et al Peer relationships, child development, and adjustment: a developmental psychopathology perspective. In: Cicchetti

Cohen

(eds). Developmental psychopathology. 2nd edn. Hoboken, NJ: Wiley; 2006. pp. 419–93.

20.

Artino

Jr . Bandura, Ross, and Ross: observational learning and the Bobo Doll. Online Submission 1 January 2007. Available online at: https://eric.ed.gov/?id=ED499095

21.

Singh

. Ministry of Human Resource Development, Department of School Education and Literacy, Government of India. Available online at: http://mdm.nic.in/mdm_website/Files/OrderCirculars/HandWash-21-july-12.pdf (2012, last accessed 18 June 2020)

22.

Master

Hess Longe

Dickson

. Scheduled hand washing in an elementary school population. Fam Med 1997;29(5):336–9.

23.

Scholz

Nagy

Gohner

, et al Changes in self-regulatory cognitions as predictors of changes in smoking and nutrition behavior. Psychol Health 2009;24(5):545–61.

24.

Conner

Kirk

Cade

, et al Why do women use dietary supplements? The use of the theory of planned behavior to explore beliefs about their use. Soc Sci Med 2001;52(4):621–33.

25.

Rhodes

Plotnikoff

Courneya

. Predicting the physical activity intention – behavior profiles of adopters and maintainers using three social cognition models. Ann Behav Med 2008;36(3):244–52.

26.

Scott

Lawson

Curtis

. Hard to handle: understanding mothers’ handwashing behavior in Ghana. Health Policy and Planning 2007;22(4):216–24.

27.

Seimetz

Slekiene

Friedrich

, et al Identifying behavioral determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe. BMC Res Notes 2017;10(1):280.

28.

Setyautami

Sermsri

Chompikul

. Proper hand washing practices among elementary school students in Selat sub-district, Indonesia; 2012. Available online at: https://www.semanticscholar.org/paper/Proper-hand-washing-practices-among-elementary-in-Setyautamii-Sermsri/265d741ecff82c91be3deeae2349e1029391439e

29.

Blum

Yemweni

Trinies

, et al Programmatic implications for promotion of handwashing behavior in an internally displaced persons camp in North Kivu, Democratic Republic of Congo. Confl Health 2019;13:54.