TY - JOUR
T1 - Psychosocial Factors Mediating the Effect of the CHoBI7 Intervention on Handwashing With Soap
T2 - A Randomized Controlled Trial
AU - George, Christine Marie
AU - Biswas, Shwapon
AU - Jung, Danielle
AU - Perin, Jamie
AU - Parvin, Tahmina
AU - Monira, Shirajum
AU - Saif-Ur-Rahman, K. M.
AU - Rashid, Mahamud Ur
AU - Bhuyian, Sazzadul Islam
AU - Thomas, Elizabeth D.
AU - Dreibelbis, Robert
AU - Begum, Farzana
AU - Zohura, Fatema
AU - Zhang, Xiaotong
AU - Sack, David A.
AU - Alam, Munirul
AU - Sack, R. Bradley
AU - Leontsini, Elli
AU - Winch, Peter J.
N1 - Funding Information:
We thank the study participants and the following research assistants who conducted the fieldwork for this study: Ismat Minhaz Uddin, Rafiqul Islam, Al-Mamun, Maynul Hasan, Kalpona Akhter, Khandokar Fazilatunnessa, Sadia Afrin Ananya, Akhi Sultana, Sohag Sarker, Jahed Masud, Abul Sikder, Shirin Akter, and Laki Das. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Center for Global Health at Johns Hopkins University and the National Institute of Allergy and Infectious Diseases. icddr,b thanks the governments of Australia, Bangladesh, Canada, Sweden, and United Kingdom for providing core/unrestricted support.
Publisher Copyright:
© 2017, © 2017 Society for Public Health Education.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Inadequate hand hygiene is estimated to result in nearly 300,000 deaths annually, with the majority of deaths being among children younger than 5 years. In an effort to promote handwashing with soap and water treatment behaviors among highly susceptible household members of cholera patients, we recently developed the Cholera-Hospital-Based Intervention-for-7-Days (CHoBI7); chobi means picture in Bengali. This 1-week handwashing with soap and water treatment intervention is delivered by a promoter in the hospital and the home to cholera patients and their household members. In our randomized controlled trial of this intervention, we observed a significant reduction in symptomatic cholera infections during the 1-week intervention period compared to the control arm and sustained high uptake of observed handwashing with soap behaviors up to 12 months postintervention. The aim of the present study was to assess the underlying mechanism of change that led to the high handwashing with soap behavior observed among participants who received the CHoBI7 intervention. Handwashing with soap was measured using 5-hour structured observation, and psychosocial factors were assessed using a structured questionnaire among 170 intervention and 174 control household members enrolled in the CHoBI7 trial. To investigate potential mediators of the CHoBI7 intervention effect, mediation models were performed. Response efficacy was found to mediate the intervention’s effect on habit formation for handwashing with soap at the 1-week follow-up, and disgust, convenience, and cholera awareness were mediators of habit maintenance at the 6- to 12-month follow-up. These results support the use of theory-driven approaches for the development and implementation of handwashing with soap interventions.
AB - Inadequate hand hygiene is estimated to result in nearly 300,000 deaths annually, with the majority of deaths being among children younger than 5 years. In an effort to promote handwashing with soap and water treatment behaviors among highly susceptible household members of cholera patients, we recently developed the Cholera-Hospital-Based Intervention-for-7-Days (CHoBI7); chobi means picture in Bengali. This 1-week handwashing with soap and water treatment intervention is delivered by a promoter in the hospital and the home to cholera patients and their household members. In our randomized controlled trial of this intervention, we observed a significant reduction in symptomatic cholera infections during the 1-week intervention period compared to the control arm and sustained high uptake of observed handwashing with soap behaviors up to 12 months postintervention. The aim of the present study was to assess the underlying mechanism of change that led to the high handwashing with soap behavior observed among participants who received the CHoBI7 intervention. Handwashing with soap was measured using 5-hour structured observation, and psychosocial factors were assessed using a structured questionnaire among 170 intervention and 174 control household members enrolled in the CHoBI7 trial. To investigate potential mediators of the CHoBI7 intervention effect, mediation models were performed. Response efficacy was found to mediate the intervention’s effect on habit formation for handwashing with soap at the 1-week follow-up, and disgust, convenience, and cholera awareness were mediators of habit maintenance at the 6- to 12-month follow-up. These results support the use of theory-driven approaches for the development and implementation of handwashing with soap interventions.
KW - Bangladesh
KW - behavioral interventions
KW - behavioral theories
KW - diarrhea disease
KW - handwashing with soap
KW - mediation analysis
KW - randomized controlled trial
UR - http://www.scopus.com/inward/record.url?scp=85025078749&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85025078749&partnerID=8YFLogxK
U2 - 10.1177/1090198116683141
DO - 10.1177/1090198116683141
M3 - Article
C2 - 28071141
AN - SCOPUS:85025078749
SN - 1090-1981
VL - 44
SP - 613
EP - 625
JO - Health Education and Behavior
JF - Health Education and Behavior
IS - 4
ER -