Journal of Behavioral Medicine

, Volume 38, Issue 6, pp 956–969 | Cite as

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

  • Nadja ContzenEmail author
  • Jennifer Inauen


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.


Handwashing interventions Diarrhoea Social-cognitive factors Behaviour change Mediation analysis RANAS approach 



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.


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

Compliance with ethical standards

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.

Supplementary material

10865_2015_9661_MOESM1_ESM.pdf (42 kb)
Supplementary material 1 (PDF 42 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Environmental and Health Psychology Group, Department of Environmental Social SciencesEawag: Swiss Federal Institute of Aquatic Science and TechnologyDübendorfSwitzerland
  2. 2.Chair of Applied Social Psychology, Department of PsychologyUniversity of ZurichZurichSwitzerland

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