Search

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. [ABSTRACT FROM AUTHOR]

Social scientists often employ direct observation to study human behavior, but a health researcher who proposes it may face considerable skepticism from colleagues. Concerns about reactivity lead many to question the validity of observational data. Because few studies have measured reactivity, evidence to evaluate this concern is limited. The authors report results from their systematic measurement of reactivity during a Peruvian malaria prevention study. In sixty observations over nine months, observers recorded all behavior they perceived as potentially reactive. The authors then assessed reactivity using iterative coding and analysis. Although they documented 339 reactivity episodes, only two involved behaviors related to study objectives. These findings are consistent with prior research and provide additional evidence that reactivity, though common, need not bias study results. The authors suggest strategies for assessing reactivity that can help reassure skeptics and reinforce the validity of observational data. [ABSTRACT FROM AUTHOR]