Development and Application of a Set of Novel Caregiver Hygiene Behavior Measures Relating to Stunting Open Access

Wodnik, Breanna (Spring 2018)

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Growth stunting affects 165 million children globally and causes serious lifelong and generational effects for the world’s poorest populations. As exposure to environmental pathogens is a determinant of malnutrition, it is hypothesized that caregiver hygiene behaviors such as those surrounding handwashing and food preparation play a critical role in stunting outcomes, though there is limited evidence. Standard metrics to assess these behaviors are warranted in order to provide a means of quantifying the impact these behaviors have on stunting and also for evaluating the success or failure of interventions and programs. This paper documents the development of three novel caregiver hygiene behavior measures: hygienic food preparation and storage, handwashing at key times, and provision of a safe play environment for children under two. We developed these measures using formative qualitative work, survey creation and deployment theoretically underpinned by the COM-B model, and exploratory and confirmatory factor analysis. The final measure for hygienic food preparation and storage had 10 items across two factors; the measure for handwashing at key times had 15 items across three factors; and the final measure for safe play environment had 13 items across three factors. Future researchers may employ these measures to assess caregiver behaviors in other populations, identify specific behavioral dimensions that should be the focus of interventions, and evaluate interventions and programs.

Table of Contents

Chapter I:  Introduction


Chapter II:  Manuscript


1.    Introduction

2.    Methods

2.1 Setting

2.2 Overview of Study Design

2.3 Phase 1: Qualitative Research

2.4 Phase 2: Quantitative Research

2.5 Phase 3: Measurement Finalization

2.6 Ethical Approval

3.   Results

      3.1 Participant Demographics

      3.2 Hygiene Behavior Measure Survey Item Frequencies

      3.3 Exploratory Factor Analysis

      3.4 Confirmatory Factor Analysis

      3.5 Hygiene Behavior Scores

4.   Discussion


Chapter III:  Public Health Significance


Chapter IV:  References



Appendix A. Finalized tool for the three hygiene behavior measures

Appendix B. Responsive feeding and porridge thickness items

Appendix C. COM-B components and TDF domains of all scale questions 

Appendix D. Agree / Disagree scale as used by participants

Appendix E. Frequency of responses for all 61 items

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