Quantifying the relationships between measures of facial and hand cleanliness and household WASH conditions, psychosocial factors, and personal hygiene practices from the Andilaye Trial Pubblico

Abstract

Background: Many water, sanitation, and hygiene (WASH) interventions target improvements in personal hygiene behaviors to reduce the transmission of infectious diseases. Programs implementing WASH interventions confront challenges in addressing behavioral factors that serve as barriers to uptake of improved WASH behaviors. Accurate measurement of behavior change remains a challenge for monitoring and evaluation of WASH programs.

Methods: This analysis was a sub-study of the Andilaye Trial, an impact evaluation of a community-based WASH intervention implemented in Amhara, Ethiopia. The outcomes of interest were facial and hand cleanliness, as measured by the Quantitative Personal Hygiene Assessment Tool (qPHAT), an objective measure of cleanliness based on an 11-point color scale. Multivariable models evaluated the associations between qPHAT measures of facial and hand cleanliness and (1) household WASH conditions, (2) psychosocial factors, and (3) reported personal hygiene practices. Models employed a generalized linear regression framework with generalized estimating equations and robust standard errors to account for clustering at the community level.

Results: Higher perceived water insecurity, a measure of household WASH conditions, was associated with dirtier faces (b=-0.08 95%CI [-0.12,-0.04]). Several psychosocial factors were associated with cleanliness outcomes. Perceptions regarding the cleanliness of others in one’s social group were associated with cleaner faces (b=0.41 95%CI [0.15,0.67]) and reported commitment to washing was associated with dirtier faces (b=-0.61 95%CI [-0.99,-0.13]). The belief that washing takes too much water was associated with both cleaner faces and cleaner hands (b=0.26 95%CI [0.10,0.57] and b=-0.26 95%CI [-0.19,0.43], respectively). Reported hygiene practices were not significantly associated with cleanliness outcomes. The Andilaye intervention did not result in meaningful differences in either facial or hand cleanliness (b=0.12, 95%CI [-0.23,-0.47] and b=0.05, 95%CI [-0.37,0.46], respectively).

Conclusions: This research highlights the role of intermediate behavioral factors, including water insecurity and psychosocial factors, in influencing hygiene practices. Many WASH interventions have identified biases in common proxy indicators of hygiene practices, including reported practices, as was seen in this study. This research highlighted the potential value of the qPHAT metric for future research and impact evaluations of hygiene interventions to provide a nuanced measure of hygiene outcomes that is less prone to bias.

Table of Contents

Introduction……………………………………………………………………………………..……………………………………………………………….1

Methods………………………………………………………………………………………..………………………………………………………………….3

           Study Population……………………………………………………………………………………..………………………………………………….4

           Data Source……………………………………………………………………………………..………………………………………………………...4

           Variables………………………………………………………………………………………..………………………………………………………….5

           Statistical Analyses….…………………………………………………………………………………..……………………………………………...9

Results……………………………………………………………………………………..………………………………………………………………………10

           Descriptive Statistics and Unadjusted Univariable Analyses…………………………………………………………………………………..10

           RQ1 – Associations between quantitative measures of cleanliness and intermediate behavioral factors and outcomes ….…… 11

           RQ2 – Associations between quantitative measures of cleanliness and the Andilaye intervention.………………………………….12

Discussion…..…………………………………………………………………………………..……………………………………………………………….. 19

Conclusion…..…………………………………………………………………………………..………………………………………………………………..22

References……..………………………………………………………………………..………………………………………………………………………...23

Appendices…..………………………………………………………………………..………………………………………………………………………..…28

           Appendix A – Data Flow Diagram…...………………………………………………………………………..………………………………………29

           Appendix B – Psychosocial Factor Variables..………………………………………………………………………..…………………………….30

           Appendix C – Variables for Wealth Index…..………………………………………………………………………..……………………………...31

           Appendix D – Multivariable Model Equations..………………………………………………………………………..…………………………..33

           Appendix E – Multivariable Analysis Detailed Results…..………………………………………………………………………....................34

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Environmental Health
Parola chiave	Behavioral outcomes Behavior change WASH Water, sanitation, and hygiene Personal hygiene
Committee Chair / Thesis Advisor	Matthew Freeman, Emory University
Committee Members	Maryann Delea, Emory University Jedidiah Snyder, Emory University

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