Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial
Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial
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DOI：
10.1016/s2214-109x(13)70160-8
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发表时间：
2014-03-01
影响因子：
34.3
通讯作者：
Curtis, Val
中科院分区：
文献类型：
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作者：
Biran, Adam;Schmidt, Wolf-Peter;Curtis, Val
背景 腹泻和呼吸道感染是全球儿童死亡的两个最大原因。用肥皂洗手可以大大减少腹泻和呼吸道感染，但充分洗手的普及率很低。我们测试了基于行为情感驱动因素而不是知识的可扩展村庄一级干预措施是否可以改善印度农村地区的洗手行为。 方法 这项研究于 2011 年 5 月 24 日至 2012 年 9 月 10 日在印度安得拉邦南部的 Chittoor 地区进行。符合条件的村庄人口为 700-2000 人，有一所面向 8-13 岁儿童的公立小学， 5岁以下儿童的学前班。选择14个村（组），按人口规模（1200人）分层，并按1：1的比例随机分配为干预组或对照组（不干预）。集群由研究经理登记。随机分配是由研究统计学家使用随机数生成器完成的。干预措施包括社区和学校活动，包括动画电影、短剧和公开宣誓仪式。结果通过在基线和 3 次随访（干预后 6 周、6 个月和 12 个月）时对每个村庄 20-25 个家庭进行直接观察来衡量。观察员与干预无关，观察员和参与者家庭被告知该研究是关于生活用水的，以减少偏见风险。没有其他掩蔽是可能的。主要结果是在所有随访中的关键事件（排便后、清洁儿童臀部后、准备食物前和进食前）用肥皂洗手的比例。对照村在最后一轮后续行动之前接受了缩短版的干预措施。结果数据以村级平均值表示。结果 在干预组和对照组中，基线时在关键事件中用肥皂洗手的情况很少见（1% [SD 1] vs 2% [1]）。在 6 周的随访中，干预组在关键事件中用肥皂洗手比对照组更常见（19% [SD 21] vs 4% [2]；差异 15%，p=0.005）。在 6 个月的随访中，干预组用肥皂洗手的比例为 37% (SD 7)，而对照组为 6% (3)（差异 31%；p=0.02）。在 12 个月的随访中，对照村庄接受缩短的干预后，干预组中用肥皂洗手的比例为 29% (SD 9)，对照组为 29% (13)。 解释 这项研究表明，使用基于情绪驱动因素的可扩展干预措施可以大幅增加用肥皂洗手的比例。 资助 Wellcome Trust、SHARE。版权所有 (C) Biran 等人。开放获取文章根据 CC BY 条款分发。
Background Diarrhoea and respiratory infections are the two biggest causes of child death globally. Handwashing with soap could substantially reduce diarrhoea and respiratory infections, but prevalence of adequate handwashing is low. We tested whether a scalable village-level intervention based on emotional drivers of behaviour, rather than knowledge, could improve handwashing behaviour in rural India.Methods The study was done in Chittoor district in southern Andhra Pradesh, India, between May 24, 2011, and Sept 10, 2012. Eligible villages had a population of 700-2000 people, a state-run primary school for children aged 8-13 years, and a preschool for children younger than 5 years. 14 villages (clusters) were selected, stratified by population size (1200), and randomly assigned in a 1: 1 ratio to intervention or control (no intervention). Clusters were enrolled by the study manager. Random allocation was done by the study statistician using a random number generator. The intervention included community and school-based events incorporating an animated film, skits, and public pledging ceremonies. Outcomes were measured by direct observation in 20-25 households per village at baseline and at three follow-up visits (6 weeks, 6 months, and 12 months after the intervention). Observers had no connection with the intervention and observers and participant households were told that the study was about domestic water use to reduce the risk of bias. No other masking was possible. The primary outcome was the proportion of handwashing with soap at key events (after defecation, after cleaning a child's bottom, before food preparation, and before eating) at all follow-up visits. The control villages received a shortened version of the intervention before the final follow-up round. Outcome data are presented as village-level means.Findings Handwashing with soap at key events was rare at baseline in both the intervention and control groups (1% [SD 1] vs 2% [1]). At 6 weeks' follow-up, handwashing with soap at key events was more common in the intervention group than in the control group (19% [SD 21] vs 4% [2]; difference 15%, p=0.005). At the 6-month follow-up visit, the proportion handwashing with soap was 37% (SD 7) in the intervention group versus 6% (3) in the control group (difference 31%; p=0.02). At the 12-month follow-up visit, after the control villages had received the shortened intervention, the proportion handwashing with soap was 29% (SD 9) in the intervention group and 29% (13) in the control group.Interpretation This study shows that substantial increases in handwashing with soap can be achieved using a scalable intervention based on emotional drivers.Funding Wellcome Trust, SHARE.Copyright (C) Biran et al. Open Access article distributed under the terms of CC BY.