Nudging Handwashing: a Cluster-randomized Trial in Bangladesh

Not Applicable

Completed

• Conditions: Hand Disinfection
• Interventions: Behavioral: Late handwashing station; Behavioral: Early handwashing station; Behavioral: Nudge; Behavioral: Education

• Registration Number: NCT02703974
• Lead Sponsor: University of Oklahoma

Brief Summary

The study will collect and analyze quantitative data regarding handwashing behaviors among school-aged children to determine the impact of nudges compared to handwashing and hygiene education programs.

Based on the success of the preliminary pilot, we hypothesize nudges leading to higher rates of handwashing than traditional handwashing and hygiene education programs.

Detailed Description

This study will utilize a cluster-randomized trial design to collect quantitative data and analyze the handwashing behaviors of school-aged children.

The primary purpose of this protocol is to assess nudges as a viable method of promoting handwashing among school-aged children.

The specific objectives of this quantitative exploration are to:

1. Determine if nudges can prompt significant behavior change and result in higher rates of handwashing among school-aged children in Bangladesh

2. Determine if behavior change resulting from nudging is sustainable over time

Study Timeline

• Study First Submitted: 2016-02-18
• Study Start: 2016-03
• Study First Submitted QC: 2016-03-03
• Study First Posted: 2016-03-09
• Primary Completion: 2016-08
• Study Completion: 2016-08
• Status Verified: 2016-11
• Last Update Submitted: 2016-11-18
• Last Update Posted: 2016-11-22

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

• schools in Dhunat, Gurudaspur and Boraigram Upazilla (sub districts) of Bogra and Natore districts of Rajshahi Division that that meet the following inclusion criteria:

  1. No hygiene education programs in the last two years
  2. No handwashing stations or facilities on school grounds
  3. Improved sanitation/toilets facilities (latrines)
  4. Water supply on site or within 3-6 meters of the school
  5. A school population between 125-450 students, and
  6. A government primary school (all co-ed)
  7. Willingness of the school principle / head teacher and a representative of the School Management Committee (SMC) to participate in the proposed research

Exclusion Criteria

1. Located outside of Dhunat, Gurudaspur and Boraigram Upazilla (sub districts) of Bogra and Natore districts of Rajshahi Division
2. Have had a hygiene education program in the last two years
3. Already has handwashing stations or facilities on school grounds
4. Does not have improved sanitation/toilets facilities (latrines)
5. Does not have water supply on site or within 3-6 meters of the school
6. Has a school population under 125 or over 450 students
7. Is not a government primary school or is not co-ed
8. School principle / head teacher or representative of the School Management Committee (SMC) is not willing to participate in the proposed research

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Late handwashing station + nudge	Late handwashing station	This arm will include 5 randomly selected schools that will have had handwashing stations and nudges built at the same time, after Phase II data collection.
Late handwashing station + nudge	Nudge	This arm will include 5 randomly selected schools that will have had handwashing stations and nudges built at the same time, after Phase II data collection.
Early handwashing station + education	Early handwashing station	This arm will include 5 randomly selected schools that will have had handwashing stations built after the baseline observation (Phase I), and will receive a Hand hygiene education-based program, after Phase II data collection is complete.
Late handwashing station + education	Education	This arm will include 5 randomly selected schools that will have had handwashing stations built after Phase II data collection is complete, when the Hand hygiene education-based program will commence.
Early handwashing station + nudge	Early handwashing station	This arm will include 5 randomly selected schools that will have had handwashing stations built after the baseline observation (Phase I), and nudges built after Phase II data collection.
Early handwashing station + nudge	Nudge	This arm will include 5 randomly selected schools that will have had handwashing stations built after the baseline observation (Phase I), and nudges built after Phase II data collection.
Late handwashing station + education	Late handwashing station	This arm will include 5 randomly selected schools that will have had handwashing stations built after Phase II data collection is complete, when the Hand hygiene education-based program will commence.
Early handwashing station + education	Education	This arm will include 5 randomly selected schools that will have had handwashing stations built after the baseline observation (Phase I), and will receive a Hand hygiene education-based program, after Phase II data collection is complete.

Primary Outcome Measures

Name	Time	Method
Change in the probability of handwashing with soap after a toileting event among students receiving nudge intervention compared to that of students in hygiene education group	Weeks 6-7, Week 12, Weeks 18-19, Weeks 24-25	Students will be randomized into Nudge intervention or Hygiene Education intervention at the completion of data collection in week 6, and the change in probability, or prevalence ratio, will be assessed over time, with measures at weeks 4-5, weeks 6-7, week 12, weeks 18-19 and weeks 24-25, comparing the probability of handwashing of nudge students post-toileting event to that of hygiene education students post-toileting event, measured using camera observations of the handwashing station outside of the latrine area.

Secondary Outcome Measures

Name	Time	Method
Change in the probability of handwashing with soap after a toileting event among students who received the early handwashing station intervention compared to students who received the late handwashing station intervention	Weeks 2-3, Weeks 4-5	Students will be randomized into early handwashing station intervention (built in weeks 1-2) or late handwashing station intervention (built in weeks 3 and 4), and the change in probability, or prevalence ratio, will be assessed at week 2-3 and week 4-5, comparing the probability of handwashing of the early handwashing station students post-toileting event to that of the late handwashing station students post-toileting event, measured using camera observations of the handwashing station outside of the latrine area.
Change in the probability of handwashing with soap after a toileting event within the nudge intervention group, comparing students in the early handwashing station intervention to students in the late handwashing station intervention	Weeks 4-5, Weeks 6-7, Week 12, Weeks 18-19, Weeks 24-25	In order to assess if the timing of the handwashing station building influences handwashing, the change in probability, or prevalence ratio, will be assessed over time, with observations at weeks 4-5, weeks 6-7, week 12, weeks 18-19 and weeks 24-25 within the Nudge group, comparing the probability of handwashing among students who received the early handwashing station (built in weeks 1 and 2) to the probability of handwashing among those students who received the late handwashing stations (built in weeks 3 and 4), measured using camera observations of the handwashing station outside of the latrine area.
Change in the probability of handwashing with soap after a toileting event within the hygiene education intervention group, comparing students in the early handwashing station intervention to students in the late handwashing station intervention	Weeks 4-5, Weeks 6-7, Week 12, Weeks 18-19, Weeks 24-25	In order to assess if the timing of the handwashing station building influences handwashing, the change in probability, or prevalence ratio, will be assessed over time, with observations at weeks 4-5, weeks 6-7, week 12, weeks 18-19 and weeks 24-25 within the Hygiene Education group, comparing the probability of handwashing among students who received the early handwashing station (built in weeks 1 and 2) to the probability of handwashing among those students who received the late handwashing stations (built in weeks 3 and 4), measured using camera observations of the handwashing station outside of the latrine area.

Trial Locations

Locations (1)

Save the Children; 🇧🇩 Dhaka, Bangladesh