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Social-cognitive factors mediating intervention effects on handwashing: a longitudinal study

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Abstract

Handwashing with soap effectively prevents diarrhoea, a leading cause of death in infants. Theory-based interventions are expected to promote handwashing more successfully than standard approaches. The present article investigates the underlying change processes of theory-based handwashing interventions. A nonrandomised field study compared a standard approach to two theory-based interventions that were tailored to the target population, the inhabitants of four villages in southern Ethiopia (N = 408). Data were collected before and after interventions by structured interviews and analysed by mediation analysis. In comparison to the standard approach (i.e., education only), education with public commitment and reminder was slightly more effective in changing social-cognitive factors and handwashing. Education with an infrastructure promotion and reminder was most effective in promoting handwashing through enhancing social-cognitive factors. The results confirm the relevance of testing interventions’ underlying change processes.

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Notes

  1. For the interventions’ main effects, which are not reported in the present article, please refer to Contzen et al. (2015).

  2. Testing the processes that underlay behaviour change (Michie & Abraham, 2004) is a vital contribution that could not have been integrated into the article by Contzen et al. (2015).

  3. Information on the socio-economic and socio-demographic characteristics of the excluded kebeles and thus on differences between excluded and included kebeles is not available.

  4. During the interview respondents were informed by the interviewer that handwashing before handling food means handwashing before preparing food, eating, feeding or breastfeeding a child or handling drinking water, and that handwashing after contact with stool means handwashing after defecation, wiping a child’s bottom and other contact with stool.

  5. That the scarf would serve as a reminder was assumed to be an additional effect.

  6. Handwashing stations.

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Acknowledgments

A special thank is due to Hans-Joachim Mosler for his continuous support and valued input. Myra Foster, Oxfam America, is thanked for initiating and supporting the project. Gratefully acknowledged are the local NGO for implementing the interventions and Iara Meili for her support and hard work. A thank is due to Sarah Zgraggen, Chaka Yohannes Chaka, Wario Dima Godana, and the kebele leaders for their assistance and to all the data collectors and the community members who participated in the study.

Funding

This study was funded by Oxfam America [ETH 029/11].

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Authors and Affiliations

  1. Environmental and Health Psychology Group, Department of Environmental Social Sciences, Eawag: Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, 8600, Dübendorf, Switzerland

    Nadja Contzen

  2. Chair of Applied Social Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland

    Jennifer Inauen

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  1. Nadja Contzen
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  2. Jennifer Inauen
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Correspondence to Nadja Contzen.

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Conflict of interest

Nadja Contzen and Jennifer Inauen declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

The study was in strict accordance with the ethical principles of the American Psychological Association (APA) and the 1964 Declaration of Helsinki and its later amendments. It received ethical approval from the Ethiopian National Research Ethics Review committee and the Faculty of Arts of the University of Zurich. Informed consent was obtained from all individual participants included in the study prior to interviews and interventions.

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Contzen, N., Inauen, J. Social-cognitive factors mediating intervention effects on handwashing: a longitudinal study. J Behav Med 38, 956–969 (2015). https://doi.org/10.1007/s10865-015-9661-2

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