Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Department of Health Sciences, University of York, York, UK.
Lancet Glob Health. 2021 Dec;9(12):e1707-e1718. doi: 10.1016/S2214-109X(21)00387-9.
Diarrhoeal diseases are an important cause of mortality in children younger than 5 years in sub-Saharan Africa. We aimed to evaluate the effect of three handwashing interventions on handwashing with soap (HWWS) after toilet use.
In this cluster randomised trial in Abidjan, Côte d'Ivoire, we randomly assigned communal housing compounds (1:1:1) to receive one of three interventions: a theory of normative social behaviour (TNSB) intervention, including provision of handwashing stations; handwashing stations only; and no intervention. The TNSB intervention was designed to shift the outcome expectation associated with HWWS from health to riddance of faeces-related disgust, and to increase the perceived descriptive norm and perceived handwashing publicness. Participants and fieldworkers were masked to the study objectives. The primary outcome was HWWS after toilet use, assessed at 1 month and 5 months follow-ups. Analysis was by intention to treat. This trial is registered at the Pan African Clinical Trial Registry, PACTR201501000892239.
Between April 10 and May 22, 2014, we identified 92 eligible compounds, of which 75 compounds were included. Follow-up data on HWWS were available for 23 compounds for the TNSB group, 25 compounds for the handwashing station-only group, and 25 compounds for the control group. The study ended in April, 2017. Compared with a frequency of 5% (29 of 604 occasions) in the control group, HWWS after toilet use increased to 9% (49 of 557 occasions; adjusted risk ratio 1·89, 95% CI 1·16-3·08) in the handwashing station-only group, and 24% (143 of 588 occasions; 4·82, 3·06-7·59) in the TNSB group, at the 1-month follow-up. The intervention effect was only sustained in the TNSB group (98 [22%] of 450 compounds; 2·68, 1·65-4·34).
A social norm-based handwashing intervention combined with disgust-inducing messages, with provision of handwashing stations, was effective at increasing HWWS after toilet use. The provision of handwashing stations alone had little effect. Future studies should investigate whether the same approach, when delivered via mass media, can have a similar effect to the face-to-face delivery used in this study.
None.
在撒哈拉以南非洲，腹泻病是 5 岁以下儿童死亡的一个重要原因。我们旨在评估三种洗手干预措施对使用厕所后用肥皂洗手（HWWS）的影响。
在科特迪瓦阿比让的这项整群随机试验中，我们将公共住房区（1:1:1）随机分配接受以下三种干预措施之一：规范性社会行为理论（TNSB）干预，包括提供洗手站；仅提供洗手站；不干预。TNSB 干预旨在将与 HWWS 相关的结果预期从健康转变为摆脱与粪便相关的厌恶，并增加感知描述性规范和感知公共洗手。参与者和现场工作人员对研究目标不知情。主要结局是使用厕所后进行 HWWS，在 1 个月和 5 个月随访时进行评估。分析采用意向治疗。这项试验在泛非临床试验注册处（PACTRO201501000892239）注册。
在 2014 年 4 月 10 日至 5 月 22 日期间，我们确定了 92 个符合条件的住房区，其中 75 个住房区被纳入研究。TNSB 组有 23 个住房区、洗手站组有 25 个住房区和对照组有 25 个住房区提供了关于使用厕所后进行 HWWS 的随访数据。研究于 2017 年 4 月结束。与对照组的频率为 5%（604 次中有 29 次）相比，在洗手站组，HWWS 增加到 9%（557 次中有 49 次；调整后的风险比 1.89，95%CI 1.16-3.08），而在 TNSB 组增加到 24%（588 次中有 143 次；4.82，3.06-7.59），在 1 个月随访时。干预效果仅在 TNSB 组持续存在（450 个住房区中有 98 个[22%]；2.68，1.65-4.34）。
基于社会规范的洗手干预措施结合引起厌恶的信息，并提供洗手站，可有效增加使用厕所后的 HWWS。单独提供洗手站的效果很小。未来的研究应探讨通过大众媒体传递的类似方法是否能产生与本研究中面对面传递相同的效果。
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