Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Food for the Hungry, Washington, DC, USA.
Int J Hyg Environ Health. 2021 Sep;238:113850. doi: 10.1016/j.ijheh.2021.113850. Epub 2021 Oct 18.
Diarrheal disease remains a leading cause of child mortality, globally. In the Democratic Republic of the Congo (DRC), each year there are an estimated 45 million episodes of diarrhea in children under five years of age. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to develop theory-driven, evidence-based approaches to reduce diarrheal diseases among young children. The REDUCE prospective cohort study in Walungu Territory in Eastern DRC took guidance from the risks, attitudes, norms, abilities, and self-regulation model, the integrated behavioral model for water, sanitation, and hygiene (WASH), and other behavior change theories to identify psychosocial factors associated with WASH behaviors. Psychosocial factors were measured among 417 caregivers at baseline and caregiver responses to child mouthing of dirty fomites and handwashing with soap was assessed by 5-hour structured observation at the 6-month follow-up. Caregivers who agreed that their child could become sick if they put dirt in their mouth (perceived susceptibility) and caregivers that agreed they could prevent their child from playing with dirty things outside (self-efficacy) were significantly more likely to stop their child from mouthing a dirty fomite. Higher perceived susceptibility, self-efficacy, and disgust, and lower dirty reactivity, were associated with higher handwashing with soap behaviors. This study took a theory-driven and evidence-based approach to identify psychosocial factors to target for intervention development. The findings from this study informed the development of the REDUCE Baby WASH Modules that have been delivered to over 1 million people in eastern DRC.
腹泻病仍然是全球儿童死亡的主要原因。在刚果民主共和国（DRC），估计每年有 4500 万例 5 岁以下儿童腹泻。减少肠病、腹泻、营养不良和环境中的污染（REDUCE）项目旨在制定基于理论、基于证据的方法，以减少幼儿腹泻病。在刚果民主共和国东部瓦隆古地区进行的 REDUCE 前瞻性队列研究从风险、态度、规范、能力和自我调节模型、水卫生和环境卫生综合行为模型（WASH）以及其他行为改变理论中获得指导，以确定与 WASH 行为相关的社会心理因素。在基线时对 417 名照顾者进行了社会心理因素测量，并在 6 个月的随访时通过 5 小时的结构化观察评估了照顾者对儿童口含脏污物品和用肥皂洗手的反应。认为孩子如果把脏东西放进嘴里会生病（感知易感性），并且认为可以防止孩子在外玩脏东西的照顾者（自我效能感）更有可能阻止孩子口含脏污物品。更高的感知易感性、自我效能感和厌恶感，以及更低的脏污反应性，与更高的用肥皂洗手行为相关。本研究采用基于理论和循证的方法来确定社会心理因素作为干预措施的目标。本研究的结果为 REDUCE 婴儿 WASH 模块的开发提供了信息，该模块已在刚果民主共和国东部地区的 100 多万人中使用。
