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ABSTRACT
Handwashing with soap at critical times helps prevent diarrhoeal diseases. Changing handwashing practices through behaviour change communication remains a challenge. This study designed and tested a scalable intervention to promote handwashing with soap. A cluster-randomised, controlled trial compared our intervention against standard practice. Subjects were men, women and children in 14 villages in Cross-River state, Nigeria. The primary outcome was the proportion of observed key events on which hands were washed with soap. Binomial regression analysis calculated prevalence differences between study arms. The intervention had minimal effect on the primary outcome (+2.4%, p = 0.096). The intervention was associated with increased frequency of handwashes without soap before food contact (+13%, p = 0.017). The intervention failed to produce significant changes in handwashing with soap at key times. The low dose delivered (two contact points) may have increased scalability at the cost of effectiveness, particularly in the challenging context of inconvenient water access.
Acknowledgments
The intervention and intervention materials were developed in collaboration with StepJump Marketing, London. The film used in the intervention (The Parable) was produced and directed by Femi Odugbemi of DVWorx Studios (now Zuri24 Media), Lagos. Formative research to inform the intervention was carried out in collaboration with Nic Long of African Grey, London. Data collection during formative research and outcome evaluation was carried out by Marketing Support Services Ltd (MSSL), Lagos, led by Anthony Adedoyin and Titilayo Oluyemi. Initial facilitator training and pilot testing of the intervention were carried out in collaboration with Chris Parkes Marketing Solutions (CPMS), Lagos.