The association between handwashing practices and illness symptoms among college students living in a university dormitory

"I Can Sense When My Hands Need Washing": A Qualitative Study and Thematic Analysis of Factors Affecting Young Adults' Hand Hygiene

Handwashing is one of the most effective and low-cost public health measures. However, it is often not practiced frequently enough or correctly by the public. Young adults in particular have poorer intentions to wash their hands, frequency of handwashing, and sanitizer use compared to other age groups. Therefore, there is a need to identify barriers and facilitators affecting hand hygiene within this group. The objective of this qualitative study was to apply the Theoretical Domains Framework to explore factors which influence hand hygiene among young adults aged 18 to 25 years old. An online questionnaire (n = 37) and thematic analysis were used to generate 3 overarching themes. The main findings indicated internal factors such as knowledge and intentions; interpersonal factors such as social norms; and environmental factors such as reminders, cues, accessibility, and cleanliness of handwashing facilities determined the level of hand hygiene practiced among young adults. The findings suggest that behavior change techniques such as social comparisons and tailored messaging to suit the needs of young adults may be more effective at increasing hand hygiene.

The dynamic theory of reasoned action: evidence for a reverse causal process in the context of WHO handwashing guidelines

OBJECTIVE

This study provided a first empirical test of the Reverse Dynamic Theory of Reasoned Action (RDTRA) developed by Boster et al.

DESIGN

In a longitudinal experiment, 169 participants were exposed to a WHO handwashing-guidelines behavioural induction, followed by an immediate posttest and a follow-up one week later.

MAIN OUTCOME MEASURES

The study measured attitudes and norms about WHO handwashing guidelines, as well as self-reported handwashing behaviour.

RESULTS

The experimental induction produced variance in self-reported handwashing behaviour, allowing a test of the RDTRA using path analysis and structural equation modelling (SEM). Results were consistent with the RDTRA, with a positive effect of behaviour on both the attitude and norm coupled with excellent model fit. Results were inconsistent with behaviour as an outcome of attitudes and norms in this context.

CONCLUSION

For health behaviours, such as the WHO handwashing technique, initial behavioural adoption may promote subsequent shaping of attitudes and perceived norms. Boundary conditions for this effect may include the degree of spontaneity and consent involved in behaviour adoption.

Associations of hand washing frequency with the incidence of illness: a systematic review and meta-analysis

Background

Hand hygiene is one of the ways to prevent the spread of diseases. Our aim was to explore the relationship between hand washing frequency and the impact on disease, and give recommendations on the number of times to wash hands.

Methods

We searched seven electronic databases from their inception to April 11, 2020, and reference lists of related reviews for all studies on hand washing frequency and disease prevention. The Review Manager 5.3. software was used to conduct a meta-analysis. We assessed the risk of bias of included studies, and quality of evidence of the main findings.

Results

A total of eight studies were included. The results of the meta-analysis showed that there was no statistical significance between the effect of disease prevention and washing more than 4 times/day compared to not [odds ratio (OR) =0.61, 95% confidence interval (CI): 0.37 to 1.01]. The results of a case-control study showed that compared with hand washing ≤4 times/day, hand washing 5–10 times/day (OR =0.75, 95% CI: 0.63 to 0.91) and hand washing >10 times/day (OR =0.65, 95% CI 0.53 to 0.80) could reduce the risk of disease infection. There was no statistical significance advantage to hand washing more than 10 times/day compared to 5–10 times/day (OR =0.86, 95% CI: 0.70 to 1.06). Comparing hand washing ≤10 times/day with hand washing >10 times/day, increased hand washing was a protective factor against infection (OR =0.59, 95% CI: 0.36 to 0.97).

Conclusions

The more frequently hands were washed, the lower risk of disease. So far however, there is no high-quality evidence indicating the best range of hand washing frequency for disease prevention.

Variation in the timing of Covid-19 communication across universities in the UK

During the Covid-19 pandemic, universities in the UK used social media to raise awareness and provide guidance and advice about the disease to students and staff. We explain why some universities used social media to communicate with stakeholders sooner than others. To do so, we identified the date of the first Covid-19 related tweet posted by each university in the country and used survival models to estimate the effect of university-specific characteristics on the timing of these messages. In order to confirm our results, we supplemented our analysis with a study of the introduction of coronavirus-related university webpages. We find that universities with large numbers of students are more likely to use social media and the web to speak about the pandemic sooner than institutions with fewer students. Universities with large financial resources are also more likely to tweet sooner, but they do not introduce Covid-19 webpages faster than other universities. We also find evidence of a strong process of emulation, whereby universities are more likely to post a coronavirus-related tweet or webpage if other universities have already done so.

Measuring office workplace interactions and hand hygiene behaviors through electronic sensors: A feasibility study

Office-based workplaces are an important but understudied context for infectious disease transmission. We examined the feasibility of two different sensors (Opos and Bluetooth beacons) for collecting person-to-person contacts and hand hygiene in office-based workplaces. Opo is an interaction sensor that captures sensor-to-sensor interactions through ultrasonic frequencies, which correspond to face-to-face contacts between study participants. Opos were additionally used to measure hand hygiene events by affixing sensors to soap and alcohol-based hand sanitizer dispensers. Bluetooth beacons were used in conjunction with a smartphone application and recorded proximity contacts between study participants. Participants in two office sites were followed for one-week in their workplace in March 2018. Contact patterns varied by time of day and day of the week. Face-to-face contacts were of shorter mean duration than proximity contacts. Supervisors had fewer proximity contacts but more face-to-face contacts than non-supervisors. Self-reported hand hygiene was substantively higher than sensor-collected hand hygiene events and duration of hand washing events was short (median: 9 seconds, range: 2.5-33 seconds). Given that office settings are key environments in which working age populations spend a large proportion of their time and interactions, a better characterization of empirical social networks and hand hygiene behaviors for workplace interactions are needed to mitigate outbreaks and prepare for pandemics. Our study demonstrates that implementing sensor technologies for tracking interactions and behaviors in offices is feasible and can provide new insights into real-world social networks and hygiene practices. We identified key social interactions, variability in hand hygiene, and differences in interactions by workplace roles. High-resolution network data will be essential for identifying the most effective ways to mitigate infectious disease transmission and develop pandemic preparedness plans for the workplace setting.

Predicting Hand Washing and Sleep Hygiene Behaviors among College Students: Test of an Integrated Social-Cognition Model

Objective: Hand washing and sleep hygiene are two important health behaviors. The purpose of the current study was to identify the motivational and volitional antecedents of college students’ hand washing and sleep hygiene behaviors based on an integrated model of behavior that combined social-cognition constructs from the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA). Methods: Using a prospective design, college students (N = 1106) completed a survey assessing the motivational constructs of action self-efficacy, attitudes, subjective norm, perceived behavioral control, intentions, and behaviors of hand washing and sleep hygiene at Time 1. Demographic variables were also collected. One month later, at Time 2, college students (N = 524) self-reported on their volitional factors of maintenance self-efficacy, action planning, coping planning, and behaviors of hand washing and sleep hygiene. A further 2 months later, at Time 3, college students (N = 297) were asked to self-report on their hand washing and sleep hygiene behaviors over the past month. Findings: Data were analyzed using variance-based structural equation modelling. Results showed significant direct effects of attitudes, subjective norm, and perceived behavioral control on intentions; significant direct effects of action self-efficacy on maintenance self-efficacy; and significant direct effects of maintenance self-efficacy on action planning and coping planning. Significant direct effects of intention on action planning (sleep hygiene only), and significant direct effects of intention, maintenance self-efficacy (hand washing only), action and coping planning on behavior were also observed. Action planning also moderated the intention–behavior relationship, but only for hand washing. There were also significant total indirect effects of action self-efficacy on behavior mediated by maintenance self-efficacy, action planning, and coping planning for both behaviors, and significant total indirect effects of subjective norm and perceived behavioral control on behavior mediated by intention for sleep hygiene. When past behavior was included in the integrated model predicting all the psychological variables and behavior, all of the structural relations were attenuated. Discussion: Current findings indicate that college students’ hand washing and sleep hygiene behaviors are a function of both motivational and volitional factors. Findings also indicate that the TPB and HAPA pathways might differ for the two health behaviors. Implications of the current findings for future health interventions aimed at improving college students’ hand washing and sleep hygiene are discussed.

The effects of perceived social norms on handwashing behaviour in students

Handwashing is widely considered the most effective method of preventing the spread of infectious illness. Exploring the determinants of handwashing is vital to the development of interventions to increase this behaviour. A survey based on Social Norms Theory assessed handwashing frequency and perceptions of peer handwashing in 255 university students. Participants reported their own handwashing frequency, and how often they thought their peers washed their hands in particular circumstances, to determine whether misperceptions around handwashing exist, and whether these influence the behaviour of individuals. Gender was found to be a significant determinant of handwashing frequency as females reported washing their hands significantly more often than males. Participants also believed they washed their hands significantly more frequently than their peers. Perceived peer handwashing frequency was significantly correlated with participants' own behaviour. This effect was seen in overall handwashing and in food, waste and illness-related hand washing. These results suggest perceived social norms around hand washing have a clear association with individual behaviour. Future research might test the effectiveness of a social norms intervention in other settings which carry an increased risk of infection spread.

Promoting action control and coping planning to improve hand hygiene

BACKGROUND

We examined a brief educational intervention addressing hand hygiene self-regulatory mechanisms, and evaluated which psychological mechanisms may lead to hand hygiene behaviours.

METHODS

Two hundred forty two students (mean age = 21 years, SD = 3.9) received either an experimental (n = 149) or a control condition on action control and planning (n = 93). Hand hygiene, coping planning, and action control were measured at baseline and six weeks later. By applying repeated measures ANOVA, we compared the experimental condition addressing planning to perform hand hygiene with a control condition. Additionally, working mechanisms were evaluated by means of mediation analysis.

RESULTS

The intervention had an effect on action control, as reflected by a time by treatment interaction. The direct effect of the intervention on behaviour was, however, non-significant. Changes in action control led to changes in coping planning. These social-cognitive changes mediated the effect of intervention on behaviour, after controlling for gender, baseline behaviour, and classroom membership.

DISCUSSION

In spite of the associations between the intervention and self-regulatory strategies, no direct effect was found of the intervention on behaviour. Further research on how to increase hand sanitizing, involving enviromental characteristics, is required.

CONCLUSION

The intervention led only indirectly to an improvement of hand hygiene via changes in self-regulatory factors. Results indicate the importance of promoting action control and coping planning to initiate changes in hand hygienic behaviours.

Evaluating brief motivational and self-regulatory hand hygiene interventions: a cross-over longitudinal design

BACKGROUND

Frequent handwashing can prevent infections, but non-compliance to hand hygiene is pervasive. Few theory- and evidence-based interventions to improve regular handwashing are available. Therefore, two intervention modules, a motivational and a self-regulatory one, were designed and evaluated.

METHODS

In a longitudinal study, 205 young adults, aged 18 to 26 years, were randomized into two intervention groups. The Mot-SelfR group received first a motivational intervention (Mot; risk perception and outcome expectancies) followed by a self-regulatory intervention (SelfR; perceived self-efficacy and planning) 17 days later. The SelfR-Mot group received the same two intervention modules in the opposite order. Follow-up data were assessed 17 and 34 days after the baseline.

RESULTS

Both intervention sequences led to an increase in handwashing frequency, intention, self-efficacy, and planning. Also, overall gains were found for the self-regulatory module (increased planning and self-efficacy levels) and the motivational module (intention). Within groups, the self-regulatory module appeared to be more effective than the motivational module, independent of sequence.

CONCLUSIONS

Self-regulatory interventions can help individuals to exhibit more handwashing. Sequencing may be important as a motivation module (Mot) first helps to set the goal and a self-regulatory module (SelfR) then helps to translate this goal into actual behavior, but further research is needed to evaluate mechanisms.

Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis

Community-based prevention strategies for seasonal and pandemic influenza are essential to minimize their potential threat to public health. Our aim was to evaluate the efficacy of hand hygiene interventions in reducing influenza transmission in the community and to investigate the possible modifying effects of latitude, temperature and humidity on hand hygiene efficacy. We identified 979 articles in the initial search and 10 randomized controlled trials met our inclusion criteria. The combination of hand hygiene with facemasks was found to have statistically significant efficacy against laboratory-confirmed influenza while hand hygiene alone did not. Our meta-regression model did not identify statistically significant effects of latitude, temperature or humidity on the efficacy of hand hygiene. Our findings highlight the potential importance of interventions that protect against multiple modes of influenza transmission, and the modest efficacy of hand hygiene suggests that additional measures besides hand hygiene may also be important to control influenza.

Prediction of socially desirable and discreet hand hygiene behaviors

To investigate hand hygiene in settings with fewer policies regulating hygiene practice, self-reported hand hygiene behavior and personal orientation data were collected from 353 college students. Hypothesizing that in this context some behaviors would show more variability, 2 dimensions of hand hygiene behavior were created. This proved useful because socially desirable practices were predicted by health promotion focus and individual identity, whereas discreet practices were predicted by health prevention focus and collective identity.

"Think the sink:" Preliminary evaluation of a handwashing promotion campaign

Owing to its utility in guiding the planning and evaluation of health promotion campaigns, the Theory of Planned Behavior was used to implement a 1-month campaign aimed at increasing handwashing among college students. Based on observations of bathroom users' handwashing behavior (n = 1,005) and an online survey (n = 188), overall handwashing did not increase as a result of the campaign; however, more students did use soap (58% vs 70%). Future campaigns designed to increase handwashing behavior in students may be advised to target messages according to gender difference-based responsiveness to handwashing norms.

An evaluation of behavioral health compliance and microbial risk factors on student populations within a high-density campus

OBJECTIVE

The aim of this Canadian study was to assess student behavioral response to disease transmission risk, while identifying high microbial deposition/transmission sites.

PARTICIPANTS

A student survey was conducted during October 2009.

METHODS

The methods included a survey of students to assess use of health services, vaccination compliance, and hygiene along with a microbial analysis of potential transmission sites targeting specific residence buildings on campus.

RESULTS

Results indicated that most students maintained that they were worried about H1N1 and reported making changes in hygienic behavior, with the majority not planning to be vaccinated. The microbial analysis indicated contamination of fomites in co-ed residences to be higher than either male or female student residences.

CONCLUSIONS

A consideration of physical space along with behavioral factors is required in order to properly assess risk pathways in the establishment of an evidence-based infection control plan for universities and their contiguous communities.