Glycerin Soap and Good Manners: A Mixed-Methods Study about Soap and Handwashing in Barahona, Dominican Republic Open Access

Brennan, Emily (2015)

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Background: Handwashing with soap (HWWS) is a low-cost and effective method of disease prevention, but the prevalence of HWWS globally, especially in low-income countries is low. Literature about soap preferences and influences to HWWS from Latin American countries and about men around the world are sparse. This study aims to understand both soap use and purchasing preferences and influences to HWWS among adults in Barahona, Dominican Republic.

Methods: We conducted surveys and focus group discussions in each of three focus communities: a batey, a rural community, and the city in Barahona Province, Dominican Republic in order to collect quantitative data about soap use and purchasing preferences and qualitative data about motivators and barriers to HWWS.

Results: Most survey participants preferred glycerin soap for handwashing, because of its high quality for multiple household uses. Glycerin soap was also the least expensive and most common type of soap in all communities. Motivators to HWWS included having the habit since childhood and wanting to demonstrate good upbringing, having visibly dirty or potentially contaminated hands, being afraid of illness, wanting to maintain good health, and as a part of cleaning the whole body during bathing. Barriers to HWWS included physical and economic inaccessibility to soap and water for HWWS, most serious in the batey community, and circumstances like being in a hurry or being hungry, most common among young men. A framework for predicting barriers to HWWS was developed through grounded theory analysis; it categorizes individuals into levels of intention to HWWS and predicts the barriers to HWWS to which they are vulnerable based on the intention categories.

Conclusions: Our results suggest that education to increase HWWS in Barahona, Dominican Republic should aim to overcome both community and individual-level barriers, especially among the most vulnerable groups: batey residents and young men. Practitioners can use the framework for predicting barriers to HWWS to tailor educational activities based on individuals' personal and community characteristics.

Table of Contents

Chapter 1: Introduction 1

Chapter 2: Comprehensive Review of the Literature 5

Chapter 3: Methodology 17

Chapter 4: Results 25

Chapter 5: Discussion, Conclusion, and Recommendations

Discussion 50

Conclusion 57

Recommendations 59

References 62

Tables and Figures

Figure 1: Map of Dominican Republic 18

Figure 2: Map of Barahona Province of Dominican Republic 18

Table 1: Study Community Characteristics 19

Figure 3: Diagram of Focus Group Composition 22

Table 2: Household Survey Participant Demographic Information 26

Table 3: Participation in Focus Groups 26

Table 4: Preferred Handwashing Soap Brand 27

Table 5: Other Uses for Preferred Handwashing Soap 28

Figure 4: Average Preferred Soap Price and Soap Price Limit for

Glycerin Soap by Community 29

Figure 5: Soap Price Acceptability by Community 30

Table 6: Soap Purchasing Location and Frequency 30

Table 7: Reasons for Originally Choosing and Continuing to Buy Glycerin Soap 31

Table 8: Reasons for Originally Choosing and Continuing to Buy Non-glycerin Soap Brands 32

Figure 6: Influences to Determination of HWWS Behavior 33

Figure 7: The Role of Upbringing in the Formation of HWWS Habits 36

Figure 8: Framework for Determining Intention to HWWS and

Maintenance of HWWS Behavior 46

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