2012年-世界发展银行全球_Behavioral_Determinants_of_Handwashing_with_Soap_Among_Mothers_and_Caretakers___Emergent_Learning_from_Senegal_and_Peru_8页_1mb

Global Scaling Up Handwashing Project Summary

Core Content

The Global Scaling Up Handwashing Project, supported by the Water and Sanitation Program (WSP) and funded by the Bill & Melinda Gates Foundation, aimed to identify key behavioral determinants that influence handwashing with soap among mothers and caretakers in Peru and Senegal. The project used the FOAM framework (Focus, Opportunity, Ability, Motivation) to guide its formative research, interventions, and monitoring. It concluded that while knowledge is necessary for behavior change, it is not sufficient, and that the effectiveness of interventions depends on understanding the specific determinants linked to different handwashing practices.

Main Findings

• Beliefs were found to be a significant correlate of handwashing with soap in both countries. In Peru, higher belief scores were associated with the presence of a handwashing station with soap and water at or near sanitation or kitchen facilities. In Senegal, beliefs were also correlated with the presence of such stations near kitchen facilities.
• Access to soap and water was a key determinant. In Peru, higher access scores were associated with the presence of a handwashing station near kitchen facilities or both facilities. In Senegal, access was more strongly linked to the presence of a station near the kitchen.
• Social norms were explored in Senegal and were found to be a good predictor of the presence of a designated handwashing station near the kitchen. However, they were not a significant predictor for stations near the toilet.
• Knowledge was measured in Peru and was found to be a correlate of handwashing station presence, though not as strong as beliefs or access.
• Threat was only explored in Senegal and showed a counterintuitive result: higher threat scores were associated with lower likelihood of having a handwashing station, suggesting either a misinterpretation of the scale or a complex relationship between perceived risk and behavior.
• Habit was not a formal determinant in the FOAM framework but was explored in Senegal. It showed a positive association with the presence of a handwashing station near the kitchen.

Key Behavioral Determinants

• Beliefs: Influenced handwashing behavior in both countries. Mothers and caretakers with stronger beliefs about the necessity of soap were more likely to have designated handwashing stations.
• Access: Important for ensuring that soap and water are available when needed. In Peru, access was more predictive of kitchen station presence, while in Senegal, it was more predictive of kitchen station presence than toilet station presence.
• Social Norms: Played a role in promoting handwashing stations near the kitchen in Senegal.
• Knowledge: Slightly correlated with behavior, but not a major determinant.
• Threat: Had an unexpected negative correlation with handwashing station presence in Senegal.
• Habit: Positively associated with the presence of a handwashing station near the kitchen in Senegal.

Methodology

• The project used segmentation analysis to identify behavioral determinants by comparing those who practiced handwashing with soap (doers) with those who did not (non-doers).
• Logistic regression was used to analyze the relationship between determinants and proxy measures of handwashing behavior.
• Odds ratios (OR) were used to quantify the strength of these associations, with values above 1 indicating a positive correlation and values below 1 indicating a negative correlation.

Implications for Program Managers

• Program managers must clearly define the exact behavior they wish to improve (e.g., specific times or junctures for handwashing).
• The choice of proxy measures affects the identification of behavioral determinants.
• Monitoring and evaluation systems (MIS) are essential for tracking key indicators such as diarrhea incidence and handwashing behavior.
• The FOAM framework provides a structured approach to understanding and influencing behavior change.

Limitations and Future Work

• The project did not explore all behavioral determinants due to limitations in questionnaire length.
• Some determinants, such as threat and locus of control, were not successfully measured.
• Future research should consider qualitative assessments and other methods to explore these determinants further.

Conclusion

The project highlighted the importance of identifying and targeting the right behavioral determinants based on the specific context and proxy measures used. It emphasized the need for a nuanced understanding of how beliefs, access, and social norms influence handwashing behavior and the importance of defining clear behavioral goals to guide effective interventions.

References

• The findings are based on the Peru Impact Evaluation Baseline Study and the Senegal "doer/non-doer" study.
• The FOAM framework was used to structure the analysis.
• Logistic regression and odds ratios were used to quantify the relationship between determinants and handwashing behavior.

Appendix: Key Proxy Measures

Authors

• Jacqueline Devine
• Jonathan Karver
• Yolande Coombes
• Claire Chase
• Orlando Hernandez

Related Reading

• [Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Peru](www.wsp.org/wsp/sites/wsp.org/files/publications/WSP PeruBaselineStudy_HWWS.pdf)
• Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Senegal

Acknowledgements

• Bertha Briceno, WSP Senior Monitoring & Evaluation Specialist, provided thoughtful review of the document.

About the Project

The Global Scaling Up Handwashing Project is managed by the Water and Sanitation Program (WSP), a multi-donor partnership administered by the World Bank. The project focuses on applying innovative promotional approaches to improve handwashing with soap at scale.