Reactivity in Rapidly Collected Hygiene and Toilet Spot Check Measurements: A Cautionary Note for Longitudinal Studies

Benjamin F. Arnold Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Ranjiv S. Khush Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Padmavathi Ramaswamy Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Paramasivan Rajkumar Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Natesan Durairaj Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Prabhakar Ramaprabha Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Kalpana Balakrishnan Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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John M. Colford Jr. Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

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Discreet collection of spot check observations to measure household hygiene conditions is a common measurement technique in epidemiologic studies of hygiene in low-income countries. The objective of this study was to determine whether the collection of spot check observations in longitudinal studies could itself induce reactivity (i.e., change participant behavior). We analyzed data from a 12-month prospective cohort study in rural Tamil Nadu, India that was conducted in the absence of any hygiene or toilet promotion activities. Our data included hygiene and toilet spot checks from 10,427 household visits. We found substantial evidence of participant reactivity to spot check observations of hygiene practices that were easy to modify on short notice. For example, soap observed at the household's primary handwashing location increased from 49% at enrollment to 81% by the fourth visit and remained at or above 77% for the remainder of the study.

Author Notes

* Address correspondence to Benjamin F. Arnold, 101 Haviland Hall, MC 7358, Berkeley, CA 94720. E-mail: benarnold@berkeley.edu

Financial support: This study was funded by the Open Square Foundation.

Authors' addresses: Benjamin F. Arnold and John M. Colford Jr., Division of Epidemiology, University of California, Berkeley, CA, E-mails: benarnold@berkeley.edu and jcolford@berkeley.edu. Ranjiv S. Khush, Aquaya Institute, San Francisco, CA, E-mail: ranjiv@aquaya.org. Padmavathi Ramaswamy and Prabhakar Ramaprabha, Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, E-mails: drpadmavathi@yahoo.com and abyrr@yahoo.com. Paramasivan Rajkumar, Natesan Durairaj, and Kalpana Balakrishnan, Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, E-mails: rkpk16@yahoo.co, n_durai2008@yahoo.com, and kalpanasrmc@gmail.com.

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