Ram P, 2013. Practical Guidance for Measuring Handwashing Behavior: 2013 Update. World Bank Water and Sanitation Program. Available at: www.wsp.org/sites/wsp.org/files/publications/WSP-Practical-Guidance-Measuring-Handwashing-Behavior-2013-Update.pdf. Accessed October 3, 2014.
Ram PK, Halder AK, Granger SP, Jones T, Hall P, Hitchcock D, Wright R, Nygren B, Islam MS, Molyneaux JW, Luby SP, 2010. Is structured observation a valid technique to measure handwashing behavior? Use of acceleration sensors embedded in soap to assess reactivity to structured observation. Am J Trop Med Hyg 83: 1070–1076.
Clasen T, Fabini D, Boisson S, Taneja J, Song J, Aichinger E, Bui A, Dadashi S, Schmidt WP, Burt Z, Nelson KL, 2012. Making sanitation count: developing and testing a device for assessing latrine use in low-income settings. Environ Sci Technol 46: 3295–3303.
Zwane AP, Zinman J, Van Dusen E, Pariente W, Null C, Miguel E, Kremer M, Karlan DS, Hornbeck R, Giné X, Duflo E, Devoto F, Crepon B, Banerjee A, 2011. Being surveyed can change later behavior and related parameter estimates. Proc Natl Acad Sci U S A 108: 1821–1826.
Arnold BF, Khush RS, Ramaswamy P, London AG, Rajkumar P, Ramaprabha P, Durairaj N, Hubbard AE, Balakrishnan K, Colford JM Jr, 2010. Causal inference methods to study nonrandomized, preexisting development interventions. Proc Natl Acad Sci U S A 107: 22605–22610.
Khush RS, Arnold BF, Srikanth P, Sudharsanam S, Ramaswamy P, Durairaj N, London AG, Ramaprabha P, Rajkumar P, Balakrishnan K, Colford JM Jr, 2013. H2S as an indicator of water supply vulnerability and health risk in low-resource settings: a prospective cohort study. Am J Trop Med Hyg 89: 251–259.
Adair JG, 1984. The Hawthorne effect: a reconsideration of the methodological artifact. J Appl Psychol 69: 334–345.
Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB, 2011. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 8: e1001052.
Rabie T, Curtis VA, 2006. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 11: 258–267.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||345||131||1|
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.
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: email@example.com and firstname.lastname@example.org. Ranjiv S. Khush, Aquaya Institute, San Francisco, CA, E-mail: email@example.com. Padmavathi Ramaswamy and Prabhakar Ramaprabha, Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, E-mails: firstname.lastname@example.org and email@example.com. Paramasivan Rajkumar, Natesan Durairaj, and Kalpana Balakrishnan, Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org.