Determinants to Food Hygiene and Preparation in Western Kenya Open Access

Ogutu, Emily (Spring 2021)

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Diarrhea is a leading cause of child mortality and morbidity worldwide and is linked to stunting of children under two (CU2). Diarrhea causing agents are frequently associated with contaminated food and water sources. Understanding the barriers and facilitators to food hygiene and preparation practices among caregivers is critical to inform interventions to prevent diarrhea and reduce stunting. The aim of this formative research was to explore the determinants to food preparation and hygiene behaviors including handwashing habits, food preparation and cooking practices, and food storage among caregivers in Homa Bay and Migori counties. We used a theory-informed behavior change intervention to address water, sanitation, and hygiene (WASH), and nutrition behaviors.


We conducted 24 focus group discussions with mothers, fathers and grandmothers; 29 key informant interviews with community stakeholders including implementing partners, religious and community leaders and 24 household observations to understand caregiver practices related to food hygiene and preparation. We used the behavioral domains, capability, opportunity and motivation as our theoretical framework to map caregiver behavioral determinants.


Facilitators to food hygiene and preparation practices among caregivers were capability and motivation. Caregivers had the ability and motivation to wash hands at critical times, wash food, cook food, cover food, and clean and dry utensils. Barriers to food hygiene and preparation practices included lack of psychological capability, for instance, lack of handwashing with soap by caregivers and children, lack of perceived importance of washing some foods before eating and not knowing the perceived risks of storing food for more than four hours. Other barriers were opportunity related to lack of resources (soap, water, firewood) and enabling environment. Time constraints due to work, competing priorities, socio cultural norms and religion hindered the practice of food hygiene and preparation behaviors.


Capability and motivation to practice behavior does not necessarily translate to practicing that behavior without opportunity as these components influence each other. Addressing challenges to food hygiene and preparation would require an integrated intervention design to address these barriers and highlighting the facilitators to enable optimal WASH behaviors in this context.

Table of Contents

Introduction. 8

Literature review.. 11

Methods. 18

Study sites. 18

Training of Research Assistants. 19

Data collection. 19

Data Management and Analysis. 21

Results. 23

Capability. 28

Physical capability. 29

Psychological capability. 31

Opportunity. 33

Physical opportunity. 34

Social opportunity. 37

Motivation. 39

Reflective motivation. 39

Automatic motivation. 40


Strengths and Limitations. 46

Conclusion. 47

References. 49

Appendices. 54

Appendix 1. 54

Appendix 2. 60

Appendix 3. 68

Appendix 4. 75

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