Social Influence on Handwashing with Soap: Results from a Cluster Randomized Controlled Trial in Bangladesh

Elise Grover Department of Civil Engineering and Environmental Science, Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma;
Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, Colorado;

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Mohammed Kamal Hossain Save the Children, Bangladesh, Dhaka, Bangladesh;

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Saker Uddin Save the Children, Bangladesh, Dhaka, Bangladesh;

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Mohini Venkatesh Save the Children, USA, Washington, District of Columbia;

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Pavani K. Ram Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York;

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Robert Dreibelbis Department of Civil Engineering and Environmental Science, Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma;
Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom

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We analyzed data from a cluster-randomized controlled trial conducted among 20 schools in Rajshahi, Bangladesh, to explore the role of social influence on handwashing with soap (HWWS) in a primary school setting. Using data collected through covert video cameras outside of school latrines, we used robust Poisson regression analysis to assess the impact of social influence—defined as the presence of another person near the handwashing location—on HWWS after a toileting event. In adjusted analyses, we found a 30% increase in HWWS when someone was present, as compared with when a child was alone (Prevalence ratio 1.30; 95% confidence interval: 1.14–1.47, P < 0.001). The highest prevalence of HWWS was found when both child(ren) and adult(s) were present or when just children were present (64%). Our study supports the conclusion that the presence of another individual after a toileting event can positively impact HWWS in a primary school setting.

Author Notes

Address correspondence to Robert Dreibelbis, Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Kepple St., London WC1E 7HT, United Kingdom. E-mail: robert.dreibelbis@lshtm.ac.uk

Authors’ addresses: Elise Grover, Department of Civil Engineering and Environmental Science, Center for Applied Social Research, University of Oklahoma, Norman, OK, and Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, CO, E-mail: elise.grover@ucdenver.edu. Mohammed Kamal Hossain and Saker Uddin, Save the Children, Bangladesh, Dhaka, Bangladesh, E-mails: kamal.hossain@savethechildren.org and sakeruddin@gmail.com. Mohini Venkatesh, Save the Children, USA, Washington, DC, E-mail: mvenkatesh@savechildren.org. Pavani K. Ram, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, E-mail: pkram@buffalo.edu. Robert Dreibelbis, Department of Civil Engineering and Environmental Science, Center for Applied Social Research, University of Oklahoma, Norman, OK, and Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: robert.dreibelbis@lshtm.ac.uk.

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