Over-Reporting in Handwashing Self-Reports: Potential Explanatory Factors and Alternative Measurements

Práticas de medicações injetáveis: conduta referida de profissionais de enfermagem

RESUMO Objetivo: Identificar a conduta referida de profissionais da enfermagem, do estado de São Paulo, sobre Práticas de Medicações Injetáveis. Método: Estudo tipo survey que identificou a frequência referida sobre Práticas de Medicações Injetáveis mediante resposta de questionário eletrônico, validado, entre setembro e dezembro de 2017. Resultados: Considerando as 1.295 respostas computadas, foram identificadas inconformidades como compartilhamento de frascos multidoses para dois ou mais pacientes (10,8%), reutilização de insumos de uso único, como seringas para salinização de pacientes diferentes (1,2%) e reencape de agulhas após uso (4,9%). Foram referidas maior adesão ao uso de luvas para administração de injeções endovenosas (80,5%) e falta de treinamento para manipulação de dispositivos de segurança (13%). Dados correlacionais apontaram que, quanto maior a idade, melhor era a conduta referida na prática de injetáveis. Conclusão: Embora a maioria das condutas configure-se dentro das Boas Práticas de Medicações Injetáveis, há relatos de práticas de risco, como compartilhamento de insumos de uso único. O treinamento para uso de dispositivos de segurança ainda não é uma realidade para todos os profissionais, visto que muitos o referiram como raro.

Refining hand washing interventions by identifying active ingredients: A cluster-randomized controlled trial in rural Zimbabwe

RATIONALE

Consistent hand washing with soap can reduce the risk of diarrhea, but changing hand-washing behavior is difficult. Systematic behavior change approaches promise to enhance hand washing with soap effectively, and allow the identification of active intervention ingredients using mediation analysis. This knowledge can then be used to derive hypotheses for systematically refining the intervention.

OBJECTIVE

We demonstrate this at the example of a behavior change intervention to promote hand washing with soap based on the RANAS approach (risk, attitudes, norms, ability, and self-regulation).

METHODS

Sixteen wards of Masvingo province in Zimbabwe were randomly allocated to the RANAS-based intervention or a wait-list control group. Hand washing at baseline and follow-up was observed for 224 randomly selected caregivers of young children. They additionally participated in quantitative face-to-face interviews assessing psychosocial factors.

RESULTS

At baseline, hand washing with soap was <3% on average, and did not differ between groups (p = .526). At follow-up, intervention participants washed hands with soap more frequently than controls (in 29.4% vs. 8.2% of all stool- and food-related situations, B = 1.88, SE = 0.32, OR = 6.6, p < .001). Mediation analyses revealed that the intervention enhanced several of the targeted psychosocial factors; return, descriptive and injunctive norms, action knowledge, action self-efficacy, maintenance self-efficacy, action planning, and remembering. The intervention effect was mediated through increased remembering.

CONCLUSION

This study supports the efficacy of a systematic approach to behavior change to promote hand washing with soap. The analyses of the mechanisms revealed important insights into the active ingredients of the intervention, which will facilitate its future refinement.

The 3 Cs of Content, Context, and Concepts: A Practical Approach to Recording Unstructured Field Observations

Most primary care researchers lack a practical approach for including field observations in their studies, even though observations can offer important qualitative insights and provide a mechanism for documenting behaviors, events, and unexpected occurrences. We present an overview of unstructured field observations as a qualitative research method for analyzing material surroundings and social interactions. We then detail a practical approach to collecting and recording observational data through a "3 Cs" template of content, context, and concepts. To demonstrate how this method works in practice, we provide an example of a completed template and discuss the analytical approach used during a study on informed consent for research participation in the primary care setting of Qatar.

Hand washing practice at critical times and its associated factors among mothers of under five children in Debark town, northwest Ethiopia, 2018

BACKGROUND

The burden of communicable diseases within developing countries is mainly influenced by poor personal hygiene practices. Hand washing is considered as most cost effective intervention for reducing health problems such as diarrhoea and acute respiratory tract infections. This study aimed to assess hand washing practice at critical times and identify associated factors among mothers of under five children in Debark town.

METHOD

A community based cross-sectional study design was carried out from May 1-20, 2018 in Debark town. After selection of participants using simple random sampling, face to face interview was performed by using semi-structured pre-tested questionnaire. Data were entered into EPI Info 7 and exported into SPSS 21 for further analysis. Results were presented by simple frequency, percentage and mean for descriptive variables. Binary logistic regression analysis was used to test the association of dependent and independent factors. Variables with 95% confidence interval and p ≤ 0.2 during the univariable binary logistic regression analysis were included in the multivariate logistic regression analysis. At the final model variables with p ≤ 0.05 were treated as significantly associated factors of hand washing practice at critical times.

RESULTS

Good hand washing practice at critical times was reported in 52.2% (95% CI: 47.5, 57.2%) of study participants. Desirable attitude [AOR = 3.37, 95% CI (2.03, 5.58)], presence of water for washing hands [AOR = 4.86, 95% CI (1.26, 18.69)] and a good knowledge [AOR = 2.98, 95% CI (1.92, 4.60)] were significantly associated factors with hand washing practice at critical times.

CONCLUSION

The hand washing practice at critical times of study participants was found to be low. A significant proportion of mothers of under five children have a poor hand washing practice at critical times. It is necessary to increase the access to water and to improve knowledge and attitude of mothers to improve their hand washing practice at critical times.

On the Role of Habit in Self-Reported and Observed Hand Hygiene Behavior

BACKGROUND

The present contribution tests the main ideas that (a) hand hygiene behavior is associated with habit, and (b) this association is robust when deliberative constructs (i.e. knowledge and intention) are controlled for, indicating an automatic component in hand hygiene behavior.

METHODS

Two correlational studies using different operationalisations of hand hygiene behavior are reported. In Study 1, hand hygiene was assessed in the context of food preparation; data were measured using the Day Reconstruction Method in a sample of the general population. Study 2 considered hand hygiene compliance of healthcare workers applying video observation by body cameras and additionally self-reported behavior. In both studies, habit was assessed using the Self-Report Behavioral Automaticity Index.

RESULTS

Both studies found the expected positive association between habit and hand hygiene (0.271 < r < 0.570). Habit was further analyzed in combination with knowledge and intention (Study 2), and emerged as a significant predictor of observed hand hygiene, while knowledge and intention were marginally significant. No significant interactions were found.

CONCLUSIONS

The present work provides evidence that hand hygiene behavior is reliably related to habit. The findings speak to the notion that addressing the automatic route to hand hygiene behavior when designing interventions can be fruitful.

Food safety knowledge and self-reported practices among adolescents in rural secondary schools in Nigeria

BACKGROUND

Severe foodborne disease outbreaks have occurred in different continents of the globe in recent decades, particularly due to ineffective food laws, regulatory systems and inadequate food handling knowledge among food handlers and consumers. The purpose of the present study was to assess the food safety knowledge and practices among secondary school students in rural parts of Kogi State, Nigeria.

METHODS

A cross-sectional study using self-administered questionnaires was carried out between October and December, 2017. The study was carried out in two public secondary schools located in a rural area in Kogi State, North-central Nigeria. All consenting students in both schools were recruited for the study. Descriptive analysis and chi-square (χ²) tests were carried out using Statistical Package for Service Solutions v.20.

RESULTS

A total of 259 out of 300 survey questionnaires were completed and returned (86.33%). The mean age of the study participants was 15.9 ± 2.5 years. There were more males than females (55.2%, n = 143). The mean percent knowledge score was 75.79%. The mean percent practice score was 82.48%. More than half (n = 143, 55.2%) respondents had a good knowledge level, and 54.4% (n = 141) had a good practice level. A significant association was found only between food hygiene knowledge and mothers' education (χ² = 9.49, p = 0.023).

CONCLUSION

The overall food safety knowledge and practice among the secondary school students surveyed was good. Targeted educational interventions on food safety can be made to improve knowledge and practice of food hygiene among students.

Evaluating the effectiveness of the "Germ-Free Hands" intervention for improving the hand hygiene practices of public health students

PURPOSE

This quasi-experimental study sought to assess the effectiveness of a multidisciplinary intervention called "Germ-Free Hands" to improve the hand hygiene practices of students attending Thailand's Sirindhorn College of Public Health (SCPH).

METHODS

The intervention was developed and implemented at SCPH and incorporated education, training, a workshop, and performance feedback. The intervention targeted behavioral antecedents specified by the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Handwashing determinants (knowledge, beliefs, attitudes, subjective norms, perceived behavioral control, and intentions) and hand hygiene behaviors were assessed at baseline, immediately post-intervention, and 3 months post-intervention for the intervention group at (n=60) at the Suphanburi campus of SCPH and a matched control group (n=60) of students at the Ubonratchathani campus. Data analysis included descriptive statistics, independent samples t-tests, two-way measures of analysis of variance, and a generalized estimating equation to compare handwashing practices by self-reports between two groups.

RESULTS

The "Germ-Free Hands" intervention produced significant improvements in the intervention group's handwashing knowledge, behavioral and control beliefs, subjective norm scores, intentions, and behaviors, as compared to the control group. However, the intervention had no significant impact on normative beliefs, attitudes, or perceived behavioral control. Reported improvements also decreased 3 months post-intervention, and the number of bacterial colonies on students' hands increased over the course of the study.

CONCLUSION

This study adds to the evidence that multidisciplinary interventions can be effective at improving handwashing rates. However, education and training must be continuous, rather than delivered as a one-time program, in order to have sustained results. Participants may also require more in-depth instruction in correct handwashing and drying techniques to remove bacteria effectively and prevent recolonization.

The Impact of Various Promotional Activities on Ebola Prevention Behaviors and Psychosocial Factors Predicting Ebola Prevention Behaviors in the Gambia Evaluation of Ebola Prevention Promotions

The outbreak of the Ebola virus disease (EVD) from 2014 to 2016 is over. However, several outbreaks of contagious diseases have already arisen and will recur. This paper aims to evaluate the effectiveness of EVD prevention promotions in the Gambia and to assess the psychosocial factors that steer three behaviors: handwashing with soap, calling the Ebola Hotline, and not touching a person who might be suffering from EVD. In 2015, data were gathered from 498 primary care providers. The questionnaire was based on psychosocial factors from the risks, attitudes, norms, abilities, and self-regulation (RANAS) model. Three promotional activities were significantly associated with psychosocial factors of handwashing and, thus, with increased handwashing behavior: the home visit, posters, and info sheets. Norm factors, especially the perception of what other people do, had a great impact on handwashing with soap and on calling the Ebola Hotline. The perceived certainty that a behavior will prevent a disease was a predictor for all three protection behaviors. Commitment to the behavior emerged as especially relevant for the intention to call the Ebola Hotline and for not touching a person who might be suffering from EVD. Health behavior change programs should rely on evidence to target the right psychosocial factors and to maximize their effects on prevention behaviors, especially in emergency contexts.

Could the Supertowel be used as an alternative hand cleaning product for emergencies? An acceptability and feasibility study in a refugee camp in Ethiopia

BACKGROUND

Diarrhoeal diseases are a major contributor to morbidity and mortality in humanitarian crises. Handwashing with soap may reduce diarrhoea by up to 47%, however, the circumstances associated with displacement make it challenging for crisis-affected populations to be able to wash their hands with soap. The Supertowel is an alternative hand-cleaning product, proven to be as efficacious as handwashing with soap. The Supertowel is a micro-fibre towel with an anti-microbial treatment. When dipped in water it is capable of removing and killing pathogens from hands. This study aims to assess whether the Supertowel could be an acceptable and feasible product for crisis-affected populations.

METHODS

The study took place in an Eritrean refugee camp located in Tigray state in Ethiopia. We used a mix of qualitative methods to understand use and acceptability, including baseline observations (n = 13), behaviour trials involving interviews at three time points (n = 19) and focus group discussions (n = 3). We thematically analysed data from interviews and discussions.

RESULTS

Participants indicated that the Supertowel was convenient, easy to use and saved them water and money. All households participating in the behaviour trials had at least one Supertowel in use at the end of the trials (follow-up visit two). In discussions participants reported that the Supertowel was more desirable than comparable hand cleaning products. In interviews, trial participants explained that the product enabled them to clean their hands at times when they might not normally bother. The research also identified some issues with the smell of the Supertowel and its intuitive use.

CONCLUSIONS

The Supertowel was found to be an acceptable and useful hand-cleaning product that could complement soap use in crisis contexts. This pilot study also identified areas of future research including the need to compare different distribution models for the Supertowel (distribution in hygiene kits compared to distribution with an accompanying communication package) and to evaluate its use at scale over a longer time period.

The Most Important Recommended Times of Hand Washing with Soap and Water in Preventing the Occurrence of Acute Diarrhea Among Children Under Five Years of Age in Slums of Addis Ababa, Ethiopia

Adequate hand washing with soap at five recommended times is particularly important in urban slums in developing countries, but which of the recommended times are the most important in the prevention of diarrhea among children under five years of age living in these areas remains unclear. To address this gap, a community-based cross-sectional study was undertaken in the slums of Addis Ababa, Ethiopia between September and November 2014. Data were collected using a pre-tested structured questionnaire and an observational checklist. Multivariable logistic regression with 95% confidence interval (CI) was used for data analysis. Only 4.4% of the households had hand washing facilities within or near a latrine with soap and water access. The average prevalence of hand washing with soap at the five recommended times was 19.8%. One quarter (24.8%) of caregivers washed their hands with soap before feeding a child, 23.8% before preparing food, and 17.1% after defecation. The most important recommended times in preventing acute diarrhea were before preparing food [adjusted odds ratio (AOR) 0.2; 95% CI 0.1-0.7] and after defecation (AOR 0.3; 95% CI 0.1-0.9). Household size of six or more persons (AOR 2.3; 95% CI 1.4-3.9) and low monthly household income (AOR 2.4; 95% CI 1.4-4.0) were significantly associated with acute diarrhea. Promoting hand washing with soap and advocacy programs at the five recommended times, especially before preparing food and after defecation, and implementation of socioeconomic development programs targeting poor households are essential for increasing the prevalence of hand washing with soap and preventing acute diarrhea in the slums of Addis Ababa.

Typhoid fever outbreak in the Democratic Republic of Congo: Case control and ecological study

During 2011 a large outbreak of typhoid fever affected an estimated 1430 people in Kikwit, Democratic Republic of Congo. The outbreak started in military camps in the city but then spread to the general population. This paper reports the results of an ecological analysis and a case-control study undertaken to examine water and other possible transmission pathways. Attack rates were determined for health areas and risk ratios were estimated with respect to spatial exposures. Approximately 15 months after the outbreak, demographic, environmental and exposure data were collected for 320 cases and 640 controls residing in the worst affected areas, using a structured interview questionnaire. Unadjusted and adjusted odds ratios were estimated. Complete data were available for 956 respondents. Residents of areas with water supplied via gravity on the mains network were at much greater risk of disease acquisition (risk ratio = 6.20, 95%CI 3.39–11.35) than residents of areas not supplied by this mains network. In the case control study, typhoid was found to be associated with ever using tap water from the municipal supply (OR = 4.29, 95% CI 2.20–8.38). Visible urine or faeces in the latrine was also associated with increased risk of typhoid and having chosen a water source because it is protected was negatively associated. Knowledge that washing hands can prevent typhoid fever, and stated habit of handwashing habits before cooking or after toileting was associated with increased risk of disease. However, observed associations between handwashing or plate-sharing with disease risk could very likely be due to recall bias. This outbreak of typhoid fever was strongly associated with drinking water from the municipal drinking water supply, based on the descriptive and analytic epidemiology and the finding of high levels of faecal contamination of drinking water. Future outbreaks of potentially waterborne disease need an integrated response that includes epidemiology and environmental microbiology during early stages of the outbreak.

There was a large outbreak of typhoid fever in Kikwit, DRC, in late 2011. The outbreak started in military camps in the city but then spread to the general population. Multiple investigations were undertaken to understand how the disease spread. The worst affected areas of the city were mapped and compared to the water network. In early 2013, demographic and exposure data were collected for 320 cases and 640 controls residing in the worst affected areas, using a structured interview questionnaire to try to better understand individual risk factors. Residents of areas with water supplied via a gravity fed network were about six times more likely to have been ill with typhoid fever than residents of areas not supplied by the mains network. The most important individual risk factor was ever using tap water. Visible urine or faeces increased risk of getting typhoid but having chosen a water source because it is protected was linked to lower risk. Not handwashing and regularly sharing plates of food were also linked to less illness, but these findings may be especially subject to recall bias. The water network was also found to be heavily contaminated, including with faecal bacteria of human origin in multiple microbiological studies. Spatial, microbiological and case-control studies all implicate the water supplies in Kikwit to be unsafe and linked to spread of typhoid fever in 2011. Improvements to the mains water network in Kikwit are urgently needed to prevent future typhoid fever outbreaks.

Shadow Puppets and Neglected Diseases: Evaluating a Health Promotion Performance in Rural Indonesia

'Rama and the Worm' is a shadow puppet production targeting neglected diseases in Central Java. It is an entertainment-based intervention study to promote health by reducing the impact of parasitic diseases such as soil-transmitted helminths (STH). The study uses traditional Javanese shadow puppetry (wayang kulit) as a vehicle in village communities to disseminate health messages and promote behaviour change to prevent diseases caused, primarily, by inadequate sanitation and poor hygiene. The health education messages contained in the play, although using traditional characters and themes, required the creation of a completely new narrative script, using characters and plot lines familiar to the wayang kulit repertoire, but placing them in new situations that relate specifically to health promotion objectives. The intervention was piloted in a village in Central Java, Indonesia using a pre/post design with both qualitative and quantitative analysis. A total of 96 male and female villagers, aged between 7 and 87 years, provided both baseline and follow up data. Participant knowledge and behaviours related to gastrointestinal and helminth-related disease were assessed before and after the intervention through a questionnaire administered by interview. Results revealed statistically significant improvements in both knowledge (48.6% pre-intervention score vs. 62.8% post-intervention score, p < 0.001) and behaviour (77.4% vs. 80.6%, p = 0.004) related to gastrointestinal and helminth disease. Findings of the study indicate the wayang kulit performance is an effective health education tool. The results provide proof of concept with scaling up the next step forward. The wayang kulit production provides a significant additional component for an integrated, comprehensive approach to reduction and elimination of STH infection.

Practice of hand hygiene and use of protective gloves: Differences in the perception between patients and medical staff

This study investigated differences in perceptions of hand hygiene and protective glove use among patients and health care workers (HCWs) in Poland. We conducted a survey using an original questionnaire among 462 respondents, including 173 (37.4%) patients and 289 (62.6%) HCWs; HCWs demonstrated poor familiarity with the My 5 Moments for Hand Hygiene. The role of protective gloves in preventing health care-associated infection was overestimated by both patients and HCWs.

Biases Inherent in Studies of Coffee Consumption in Early Pregnancy and the Risks of Subsequent Events

Consumption of coffee by women early in their pregnancy has been viewed as potentially increasing the risk of miscarriage, low birth weight, and childhood leukemias. Many of these reports of epidemiologic studies have not acknowledged the potential biases inherent in studying the relationship between early-pregnancy-coffee consumption and subsequent events. I discuss five of these biases, recall bias, misclassification, residual confounding, reverse causation, and publication bias. Each might account for claims that attribute adversities to early-pregnancy-coffee consumption. To what extent these biases can be avoided remains to be determined. As a minimum, these biases need to be acknowledged wherever they might account for what is reported.

Effects of a behavior change campaign on household drinking water disinfection in the Lake Chad basin using the RANAS approach

Worldwide, an estimated 700 million people rely on unimproved drinking water sources; even more consume water that is not safe to drink. Inadequate drinking water quality constitutes a major risk factor for cholera and other diarrheal diseases around the globe, especially for young children in developing countries. Household water treatment and safe storage systems represent an intermediate solution for settings that lack infrastructure supplying safe drinking water. However, the correct and consistent usage of such treatment technologies rely almost exclusively on the consumer's behavior. This study targeted at evaluating effects of a behavior change campaign promoting the uptake of household drinking water chlorination in communities along the Chari and Logone rivers in Chad. The campaign was based on formative research using health psychological theory and targeted several behavioral factors identified as relevant. A total of 220 primary caregivers were interviewed concerning their household water treatment practices and mindset related to water treatment six months after the campaign. The Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model was used to structure the interviews as the RANAS approach had been used for designing the campaign. Results show significantly higher self-reported drinking water chlorination among participants of the intervention. Significant differences from a control group were identified regarding several behavioral factors. Mediation analysis revealed that the intervention positively affected participants' individual risk estimation for diarrheal disease, health knowledge, perceived efforts and benefits of water treatment, social support strategies, knowledge of how to perform chlorination, and perceived ability to do so. The campaign's effect on water treatment was mainly mediated through differences in health knowledge, changes in norms, and self-efficacy convictions. The findings imply that water treatment behavior can be successfully promoted using health psychological theory. However, they also indicate opportunities for improvement in the campaign design and implementation.

From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India

Women face greater challenges than men in accessing water, sanitation, and hygiene (WASH) resources to address their daily needs, and may respond to these challenges by adopting unsafe practices that increase the risk of reproductive tract infections (RTIs). WASH practices may change as women transition through socially-defined life stage experiences, like marriage and pregnancy. Thus, the relationship between WASH practices and RTIs might vary across female reproductive life stages. This cross-sectional study assessed the relationship between WASH exposures and self-reported RTI symptoms in 3,952 girls and women from two rural districts in India, and tested whether social exposures represented by reproductive life stage was an effect modifier of associations. In fully adjusted models, RTI symptoms were less common in women using a latrine without water for defecation versus open defecation (Odds Ratio (OR) = 0.69; Confidence Interval (CI) = 0.48, 0.98) and those walking shorter distances to a bathing location (OR = 0.79, CI = 0.63, 0.99), but there was no association between using a latrine with a water source and RTIs versus open defecation (OR = 1.09; CI = 0.69, 1.72). Unexpectedly, RTI symptoms were more common for women bathing daily with soap (OR = 6.55, CI = 3.60, 11.94) and for women washing their hands after defecation with soap (OR = 10.27; CI = 5.53, 19.08) or ash/soil/mud (OR = 6.02; CI = 3.07, 11.77) versus water only or no hand washing. WASH practices of girls and women varied across reproductive life stages, but the associations between WASH practices and RTI symptoms were not moderated by or confounded by life stage status. This study provides new evidence that WASH access and practices are associated with self-reported reproductive tract infection symptoms in rural Indian girls and women from different reproductive life stages. However, the counterintuitive directions of effect for soap use highlights that causality and mechanisms of effect cannot be inferred from this study design. Future research is needed to understand whether improvements in water and sanitation access could improve the practice of safe hygiene behaviors and reduce the global burden of RTIs in women.

Improved latrine cleanliness through behaviour change and changes in quality of latrine construction: a longitudinal intervention study in rural Burundi

Latrine cleanliness increased in the intervention group compared to the control group (increase from 21 to 31 % of latrines classified as clean in intervention [N = 198] and decrease from 37 to 27 % in control [N = 91]). Improved habitual latrine cleaning lead to latrines being 3.5 times more likely to improve in observed latrine cleanliness (χ² = 16.36, p < .001) and so did improvements in quality of latrine construction, eg households that had installed a lid were 7.39 times more likely to have a cleaner latrine (χ² = 4.46, p < .05). Changes in psychosocial factors, namely forgetting, personal norm, satisfaction with cleanliness, explained much of the change in habitual latrine cleaning (adj. r² = .46). Behaviour change interventions targeting psychosocial factors and quality of latrine construction seem promising to ensure clean and hygienic latrines.

Estimating the prevalence of food risk increasing behaviours in UK kitchens

Foodborne disease poses a serious threat to public health. In the UK, half a million cases are linked to known pathogens and more than half of all outbreaks are associated with catering establishments. The UK Food Standards Agency (FSA) has initiated the UK Food Hygiene Rating Scheme in which commercial food establishments are inspected and scored with the results made public. In this study we investigate the prevalence of food risk increasing behaviours among chefs, catering students and the public. Given the incentive for respondents to misreport when asked about illegal or illicit behaviours we employed a Randomised Response Technique designed to elicit more accurate prevalence rates of such behaviours. We found 14% of the public not always hand-washing immediately after handling raw meat, poultry or fish; 32% of chefs and catering students had worked within 48 hours of suffering from diarrhoea or vomiting. 22% of the public admitted having served meat "on the turn" and 33% of chefs and catering students admitted working in kitchens where such meat was served; 12% of the public and 16% of chefs and catering students admitted having served chicken at a barbeque when not totally sure it was fully cooked. Chefs in fine-dining establishment were less likely to wash their hands after handling meat and fish and those who worked in award winning restaurants were more likely to have returned to work within 48 hours of suffering from diarrhoea and vomiting. We found no correlation between the price of a meal in an establishment, nor its Food Hygiene Rating Score, and the likelihood of any of the food malpractices occurring.

Water and Sanitation Hygiene Practices for Under-Five Children among Households of Sugali Tribe of Chittoor District, Andhra Pradesh, India

Background

Increased mortality is associated with poor household water, sanitation, and hygiene (WaSH) practices. The objective was to study the WaSH practices for under-five children among households of Sugali Tribe, Chittoor district, Andhra Pradesh, India.

Methods

A community-based cross-sectional study was conducted in four mandals in 2012. A total of 500 households with under-five children were identified. Data was collected from mothers/caregivers. A summary WaSH score was generated from four specific indices, water, sanitation, hygiene, and hand washing practices, and determinants were identified.

Results

Of the total households, 69% reported doing nothing at home to make the water safe for drinking. Over 90% of the households reported storing water in a utensil covered with a lid and retrieving water by dipping glass in the vessels. Open defecation was a commonly reported practice (84.8%). About three-fifths of the study's households reported using water and soap for cleaning dirty hands and one-third (37.4%) reported using water and soap after defecation. The median WaSH score was 15. In the hierarchical stepwise multiple linear regression, only socioeconomic variables were significantly associated with WaSH score.

Conclusion

WaSH related practices were generally poor in people of the Sugali Tribe in Andhra Pradesh, India.

Construct validity-Current issues and recommendations for future hand hygiene research

Health care-associated infection is a leading cause of morbidity and mortality. Hand hygiene is widely regarded as an effective prevention strategy. Often, hand hygiene research is designed and conducted by health care practitioners who may lack formal training in research methods, particularly in the area of social science. In a research context, a construct is a concept that can be measured or observed in some way. A construct can be directly or indirectly measured. For example, height can be directly measured by centimeters, whereas depression can be indirectly measured by a scale of 20 items. Every construct needs to be operationalized by measure(s) to make it a variable. Hence, construct validity refers to the degree of fit between the construct of interest and its operational measure. However, issues with construct validity often weaken the translation from construct to measure(s). This article will (1) describe the common threats to construct validity pertaining to hand hygiene research, (2) identify practical limitations in current research design, and (3) provide recommendations to improve construct validity in future hand hygiene research. By understanding how construct validity may affect hand hygiene research design, there is great potential to improve the validity of future hand hygiene research findings.

Behaviour Centred Design: towards an applied science of behaviour change

Behaviour change has become a hot topic. We describe a new approach, Behaviour Centred Design (BCD), which encompasses a theory of change, a suite of behavioural determinants and a programme design process. The theory of change is generic, assuming that successful interventions must create a cascade of effects via environments, through brains, to behaviour and hence to the desired impact, such as improved health. Changes in behaviour are viewed as the consequence of a reinforcement learning process involving the targeting of evolved motives and changes to behaviour settings, and are produced by three types of behavioural control mechanism (automatic, motivated and executive). The implications are that interventions must create surprise, revalue behaviour and disrupt performance in target behaviour settings. We then describe a sequence of five steps required to design an intervention to change specific behaviours: Assess, Build, Create, Deliver and Evaluate. The BCD approach has been shown to change hygiene, nutrition and exercise-related behaviours and has the advantages of being applicable to product, service or institutional design, as well as being able to incorporate future developments in behaviour science. We therefore argue that BCD can become the foundation for an applied science of behaviour change.