Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH)

Kristyna R S Hulland, Elli Leontsini, Robert Dreibelbis, Leanne Unicomb, Aasma Afroz, Notan Chandra Dutta, Fosiul Alam Nizame, Stephen P. Luby, Pavani K. Ram, Peter John Winch

Research output: Contribution to journalArticle

Abstract

Background: In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations - a dedicated, convenient location where both soap and water are available for handwashing - are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour. Methods. We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs. Results: Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials. Conclusions: A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

Original languageEnglish (US)
Article number877
JournalBMC Public Health
Volume13
Issue number1
DOIs
StatePublished - 2013

Fingerprint

Hand Disinfection
Sanitation
Bangladesh
Hygiene
Water
Soaps
Technology
Research
Interviews
Psychology

Keywords

  • Acceptability
  • Behaviour change
  • Behavioural model
  • Enabling technology
  • Feasibility
  • formative research
  • Handwashing
  • Handwashing station
  • Handwashing technology
  • Hygiene behaviour
  • Qualitative methods
  • Soapy water
  • Trials of improved practices

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Medicine(all)

Cite this

Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). / Hulland, Kristyna R S; Leontsini, Elli; Dreibelbis, Robert; Unicomb, Leanne; Afroz, Aasma; Dutta, Notan Chandra; Nizame, Fosiul Alam; Luby, Stephen P.; Ram, Pavani K.; Winch, Peter John.

In: BMC Public Health, Vol. 13, No. 1, 877, 2013.

Research output: Contribution to journalArticle

Hulland, Kristyna R S ; Leontsini, Elli ; Dreibelbis, Robert ; Unicomb, Leanne ; Afroz, Aasma ; Dutta, Notan Chandra ; Nizame, Fosiul Alam ; Luby, Stephen P. ; Ram, Pavani K. ; Winch, Peter John. / Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH). In: BMC Public Health. 2013 ; Vol. 13, No. 1.
@article{14cdefcc94a44b89a0020f5d364b8743,
title = "Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH)",
abstract = "Background: In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations - a dedicated, convenient location where both soap and water are available for handwashing - are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour. Methods. We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs. Results: Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials. Conclusions: A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.",
keywords = "Acceptability, Behaviour change, Behavioural model, Enabling technology, Feasibility, formative research, Handwashing, Handwashing station, Handwashing technology, Hygiene behaviour, Qualitative methods, Soapy water, Trials of improved practices",
author = "Hulland, {Kristyna R S} and Elli Leontsini and Robert Dreibelbis and Leanne Unicomb and Aasma Afroz and Dutta, {Notan Chandra} and Nizame, {Fosiul Alam} and Luby, {Stephen P.} and Ram, {Pavani K.} and Winch, {Peter John}",
year = "2013",
doi = "10.1186/1471-2458-13-877",
language = "English (US)",
volume = "13",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH)

AU - Hulland, Kristyna R S

AU - Leontsini, Elli

AU - Dreibelbis, Robert

AU - Unicomb, Leanne

AU - Afroz, Aasma

AU - Dutta, Notan Chandra

AU - Nizame, Fosiul Alam

AU - Luby, Stephen P.

AU - Ram, Pavani K.

AU - Winch, Peter John

PY - 2013

Y1 - 2013

N2 - Background: In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations - a dedicated, convenient location where both soap and water are available for handwashing - are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour. Methods. We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs. Results: Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials. Conclusions: A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

AB - Background: In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations - a dedicated, convenient location where both soap and water are available for handwashing - are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour. Methods. We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs. Results: Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials. Conclusions: A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

KW - Acceptability

KW - Behaviour change

KW - Behavioural model

KW - Enabling technology

KW - Feasibility

KW - formative research

KW - Handwashing

KW - Handwashing station

KW - Handwashing technology

KW - Hygiene behaviour

KW - Qualitative methods

KW - Soapy water

KW - Trials of improved practices

UR - http://www.scopus.com/inward/record.url?scp=84884382591&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884382591&partnerID=8YFLogxK

U2 - 10.1186/1471-2458-13-877

DO - 10.1186/1471-2458-13-877

M3 - Article

VL - 13

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

IS - 1

M1 - 877

ER -