Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH)
Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH)
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DOI：
10.1186/1471-2458-13-877
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发表时间：
2013-09-23
影响因子：
4.5
通讯作者：
Winch, Peter J.
中科院分区：
文献类型：
--
作者：
Hulland, Kristyna R. S.;Leontsini, Elli;Winch, Peter J.
背景：在孟加拉国，腹泻病和呼吸道感染是发病率和死亡率的重要因素。用肥皂洗手降低了感染的风险；然而，在基础设施受限的环境中，洗手率仍然很低。洗手站--一个专用的、方便的地方，肥皂和水都可以用来洗手--与改进的洗手做法有关。我们的目标是找出一个在当地可行和可接受的洗手站，以便为随后的两个随机试验测试这种行为对健康的影响而频繁洗手。方法：我们以家庭试验的形式在孟加拉国的城市和农村进行了改进的实践。在两个迭代阶段中，九到十个家庭分别测试了七种候选洗手技术。我们在介绍性访问期间对参与者进行了访谈，并根据阶段的不同在两到六周内进行了两到五次后续访问。我们使用水、卫生和卫生综合行为模型(IBM-WASH)来指导候选洗手站的选择和数据分析。结果：影响候选设计选择的因素是市场上是否有低成本、耐用的材料，这些材料在基础设施受限和共享的环境中易于更换或补充。储水量、使用和维护的便利性以及材料的质量决定了具体洗手站设计的可接受性和可行性。在考察了技术、心理社会和环境因素之后，我们选择了两种不同储水量的洗手系统，每个系统都有水龙头、支架、脸盆、肥皂水瓶和洗衣粉进行初步测试，为随后的随机试验做准备。结论：从习惯到社会，许多环境、心理和技术因素在五个总体水平上影响洗手站的使用。在需要洗手站以便于经常用肥皂洗手的干预措施中，技术要素，如容量、耐用性和家庭内的位置(S)，是高可行性和可接受性的关键。每户可能需要一个以上的洗手站。IBM-WASH帮助指导了研究，而研究反过来又帮助验证了该框架。
Background: In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations - a dedicated, convenient location where both soap and water are available for handwashing - are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour.Methods: We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs.Results: Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials.Conclusions: A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.