Trial of a Novel Intervention to Improve Multiple Food Hygiene Behaviors in Nepal
Trial of a Novel Intervention to Improve Multiple Food Hygiene Behaviors in Nepal
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DOI：
10.4269/ajtmh.16-0526
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Curtis, Valerie
中科院分区：
文献类型：
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作者：
Gautam, Om Prasad;Schmidt, Wolf-Peter;Curtis, Valerie
在这项研究中，我们报告了一项干预试验的结果，以改善尼泊尔农村幼儿母亲的五种食品卫生行为。这项新的干预措施针对五种行为：清洁餐具，喂食前用肥皂洗手，正确储存熟食，彻底重新加热和水处理。基于形成性研究和创造性的过程中使用的行为为中心的设计方法，一个创新的干预包的设计和交付超过3个月。干预活动包括当地集会、游戏、奖励、讲故事、戏剧、与行为的情感驱动因素相关的比赛，以及破坏行为设置的“厨房改造”。通过在四个村庄进行的分组随机前后研究，评估了包装对行为的影响，其中四个村庄作为对照。主要结果是直接观察到的实行所有五种食品卫生行为的母亲的平均聚类水平比例的差异。五种目标食品卫生行为在基线时很少见（干预组所有五种行为的综合表现为1% [标准差（SD）= 2%]，对照组为2% [SD = 2%]）。干预后6周，随访期间干预组的目标行为比对照组更常见（43% [SD = 14%] vs 2% [SD = 2%]，P = 0.02）。干预似乎在改善所有干预组中的所有五种行为方面同样有效。这项研究表明，一个理论驱动的，系统的方法，采用情感激励和修改行为设置能够大大改善多种食品卫生行为在尼泊尔。
In this study, we report on the results of a trial of an intervention to improve five food hygiene behaviors among mothers of young children in rural Nepal. This novel intervention targeted five behaviors; cleanliness of serving utensils, handwashing with soap before feeding, proper storage of cooked food, and thorough reheating and water treatment. Based on formative research and a creative process using the Behavior-Centered Design approach, an innovative intervention package was designed and delivered over a period of 3 months. The intervention activities included local rallies, games, rewards, storytelling, drama, competitions linking with emotional drivers of behavior, and "kitchen makeovers" to disrupt behavior settings. The effect of the package on behavior was evaluated via a cluster-randomized before-after study in four villages with four villages serving as controls. The primary outcome was the difference in the mean cluster level proportions of mothers directly observed practicing all five food hygiene behaviors. The five targeted food hygiene behaviors were rare at baseline (composite performance of all five behaviors in intervention 1% [standard deviation (SD) = 2%] and in control groups 2% [SD = 2%]). Six weeks after the intervention, the target behaviors were more common in the intervention than in the control group (43% [SD = 14%] versus 2% [SD = 2%], P = 0.02) during follow-up. The intervention appeared to be equally effective in improving all five behaviors in all intervention clusters. This study shows that a theory-driven, systematic approach employing emotional motivators and modifying behavior settings was capable of substantially improving multiple food hygiene behaviors in Nepal.