Department of Civil Engineering and Environmental Science/Center for Applied Social Research, University of Oklahoma, Norman, OK, USA.
Save the Children, Bangladesh, Dhaka, Bangladesh.
Trop Med Int Health. 2018 Jan;23(1):10-25. doi: 10.1111/tmi.12999. Epub 2017 Dec 1.
To determine the impact of environmental nudges on handwashing behaviours among primary school children as compared to a high-intensity hygiene education intervention.
In a cluster-randomised trial (CRT), we compared the rates of handwashing with soap (HWWS) after a toileting event among primary school students in rural Bangladesh. Eligible schools (government run, on-site sanitation and water, no hygiene interventions in last year, fewer than 450 students) were identified, and 20 schools were randomly selected and allocated without blinding to one of four interventions, five schools per group: simultaneous handwashing infrastructure and nudge construction, sequential infrastructure then nudge construction, simultaneous infrastructure and high-intensity hygiene education (HE) and sequential handwashing infrastructure and HE. The primary outcome, incidence of HWWS after a toileting event, was compared between the intervention groups at different data collection points with robust-Poisson regression analysis with generalised estimating equations, adjusting for school-level clustering of outcomes.
The nudge intervention and the HE intervention were found to be equally effective at sustained impact over 5 months post-intervention (adjusted IRR 0.81, 95% CI 0.61-1.09). When comparing intervention delivery timing, the simultaneous delivery of the HE intervention significantly outperformed the sequential HE delivery (adjusted IRR 1.58 CI 1.20-2.08), whereas no significant difference was observed between sequential and simultaneous nudge intervention delivery (adjusted IRR 0.75, 95% CI 0.48-1.17).
Our trial demonstrates sustained improved handwashing behaviour 5 months after the nudge intervention. The nudge intervention's comparable performance to a high-intensity hygiene education intervention is encouraging.
与高强度卫生教育干预相比，确定环境提示对小学生洗手行为的影响。
在一项整群随机试验（CRT）中，我们比较了孟加拉国农村地区小学生在如厕后用肥皂洗手（HWWS）的比率。确定了符合条件的学校（政府运营、现场卫生和供水、去年没有卫生干预措施、学生少于 450 人），随机选择了 20 所学校，不设盲法分为四组干预措施，每组五所学校：同时进行洗手基础设施和提示建设、先进行基础设施建设再进行提示建设、同时进行基础设施建设和高强度卫生教育（HE）以及先进行基础设施建设再进行 HE。主要结局是在不同的数据收集点比较干预组在如厕后 HWWS 的发生率，使用广义估计方程的稳健泊松回归分析进行比较，调整了学校层面结局的聚类。
在干预后 5 个月，提示干预和 HE 干预都具有持续的效果（调整后的 IRR 为 0.81，95%CI 为 0.61-1.09）。当比较干预措施的实施时间时，HE 干预的同步实施明显优于 HE 干预的序贯实施（调整后的 IRR 为 1.58，95%CI 为 1.20-2.08），而序贯和同步提示干预实施之间没有观察到显著差异（调整后的 IRR 为 0.75，95%CI 为 0.48-1.17）。
我们的试验表明，在提示干预后 5 个月，洗手行为持续改善。提示干预与高强度卫生教育干预的相当性能令人鼓舞。
