Cousens S, Kanki B, Toure S, Diallo I, Curtis V
Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, UK.
Soc Sci Med. 1996 Nov;43(9):1299-308. doi: 10.1016/0277-9536(95)00380-0.
If interventions promoting improved hygiene behaviour to prevent childhood diarrhoea are to be implemented and evaluated, valid methods for measuring this behaviour will be required. This paper presents findings from a study to investigate the use of structured observations to measure hygiene behaviour in Burkina Faso. Two hundred mothers with young children (2-36 months) were observed on several occasions, with particular attention focused on events/behaviour surrounding defaecation. Child defaecation occurred most often in a potty (67% of occasions). Stools were most often disposed of into a latrine (79%). Following defaecation the child's bottom was usually rinsed using water alone with a bare hand (76%). Subsequent hand washing by the mother/caretaker was much rarer (29%). None of these behaviours appeared "reactive" to the presence of the observer. Less common behaviors showed some evidence of reactivity. The frequency of child defaecation in the yard increased over the course of three observations (5% to 16%; P = 0.01) and the proportion of occasions on which the child was observed to be cleaned after defaecation declined (95% to 85%; P = 0.01). Mothers usually took with them to the latrine a water recipient (91%). Hand washing after leaving the latrine was observed on 30% of occasions. This proportion declined from 36% to 22% over three observations (P = 0.05). Defaecation by older siblings (aged 3-5 years) was usually into a potty (48%) or directly in a latrine (30%). There was no evidence that this behaviour was reactive. The repeatability of behaviours at the individual level was generally low. The site of index child defaecation (kappa = 0.27), how the child's bottom was cleaned (kappa = -0.01) and whether the caretaker washed her hands afterwards (kappa = 0.26) all showed low repeatability. The method of stool disposal was more repeatable (kappa = 0.73). Hand washing by mothers after using the latrine showed moderate repeatability (kappa = 0.40). Older sibling's defaecation behavior had excellent repeatability (kappa = 0.90). Our findings suggest that, in studies which aim to measure behaviour at the population level, structured observations may provide a useful tool. Studies which investigate links between hygiene behaviour and diarrhoea incidence at the individual level will require repeated observations of mothers and children since measuring behaviour during a single observation will lead to misclassification of exposure status, resulting in bias which could mask any underlying association. This is likely to be very costly.
如果要实施和评估旨在促进改善卫生行为以预防儿童腹泻的干预措施，将需要有效的方法来衡量这种行为。本文介绍了一项研究的结果，该研究旨在调查在布基纳法索使用结构化观察来衡量卫生行为的情况。对200名有幼儿（2至36个月）的母亲进行了多次观察，特别关注排便前后的事件/行为。儿童排便最常发生在便盆中（67%的情况）。粪便大多被倒入厕所（79%）。排便后，孩子的屁股通常只用清水徒手冲洗（76%）。随后母亲/照顾者洗手的情况则少见得多（29%）。这些行为似乎都不会因观察者的在场而“产生反应”。不太常见的行为显示出一些反应性的迹象。在三次观察过程中，孩子在院子里排便的频率有所增加（从5%增至16%；P = 0.01），且观察到孩子排便后被清洁的比例下降（从95%降至85%；P = 0.01）。母亲们通常会带着一个盛水容器去厕所（91%）。30%的情况下观察到离开厕所后洗手。在三次观察中，这个比例从36%降至22%（P = 0.05）。年长的兄弟姐妹（3至5岁）排便通常是在便盆中（48%）或直接在厕所里（30%）。没有证据表明这种行为有反应性。个体层面行为的可重复性总体较低。指标儿童排便的地点（kappa = 0.27）、孩子屁股的清洁方式（kappa = -0.01）以及照顾者之后是否洗手（kappa = 0.26）都显示出低可重复性。粪便处理方式的可重复性更高（kappa = 0.73）。母亲使用厕所后洗手显示出中等可重复性（kappa = 0.40）。年长兄弟姐妹的排便行为具有出色的可重复性（kappa = 0.90）。我们的研究结果表明，在旨在衡量人群层面行为的研究中，结构化观察可能是一种有用的工具。在个体层面研究卫生行为与腹泻发病率之间联系的研究将需要对母亲和孩子进行反复观察，因为在单次观察期间衡量行为会导致暴露状态的错误分类，从而产生偏差，可能掩盖任何潜在的关联。这可能成本非常高。
