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Impact of duration of structured observations on measurement of handwashing behavior at critical times.

Halder AK, Molyneaux JW, Luby SP, Ram PK - BMC Public Health (2013)

Bottom Line: However, the mean number observed was higher than the expected for food preparation, food serving, and child feeding events.Decreasing the duration of handwashing significantly reduced the observation of critical events of interest to evaluators of handwashing programs.Future research should develop and evaluate novel models to reduce reactivity to observation and improve the measurement of handwashing behavior.

View Article: PubMed Central - HTML - PubMed

Affiliation: International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. amalk@icddrb.org.

ABSTRACT

Background: Structured observation is frequently used to measure handwashing at critical events, such as after fecal contact and before eating, but it is time-consuming. We aimed to assess the impact of reducing the duration of structured observation on the number and type of critical events observed.

Methods: The study recruited 100 randomly selected households, 50 for short 90-minute observations and 50 for long 5-hour observations, in six rural Bangladeshi villages. Based on the first 90 minutes in the long observation households, we estimated the number of critical events for handwashing expected, and compared the expected number to the number of events actually observed in the short observation households. In long observation households, we compared soap use at critical events observed during the first 90 minutes to soap use at events observed during the latter 210 minutes of the 5-hour duration.

Results: In short 90-minute observation households, the mean number of events observed was lower than the number of events expected: before eating (observed 0.25, expected 0.45, p<0.05) and after defecation (observed 0.0, expected 0.03, p=0.06). However, the mean number observed was higher than the expected for food preparation, food serving, and child feeding events. In long 5-hour observation households, soap was used more frequently at critical events observed in the first 90 minutes than in the remaining 210 minutes, but this difference was not significant (p=0.29).

Conclusions: Decreasing the duration of handwashing significantly reduced the observation of critical events of interest to evaluators of handwashing programs. Researchers seeking to measure observed handwashing behavior should continue with prolonged duration of structured observation. Future research should develop and evaluate novel models to reduce reactivity to observation and improve the measurement of handwashing behavior.

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Comparisons of short and long observation groups with respect to observation of critical times, and handwashing behavior at critical times, Bangladesh, 2007.
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Figure 1: Comparisons of short and long observation groups with respect to observation of critical times, and handwashing behavior at critical times, Bangladesh, 2007.

Mentions: Our analysis consisted of three principal comparisons– 1) proportion of caregivers in the short versus long observation groups who had at least one event of each type observed (Figure 1), 2) overall number of events observed in the short observation group versus number of events expected, based on the events observed in the average 90 minutes of the long observation group (Figure 2) and, 3) handwashing events observed in the first 90 minutes in the long observation group versus handwashing events observed in the subsequent 210 minutes within the same group (Figure 2). Each of the following events were identified as an opportunity to wash hands: preparing food, serving food, feeding a child, eating, defecation, and cleaning a child who had defecated.


Impact of duration of structured observations on measurement of handwashing behavior at critical times.

Halder AK, Molyneaux JW, Luby SP, Ram PK - BMC Public Health (2013)

Comparisons of short and long observation groups with respect to observation of critical times, and handwashing behavior at critical times, Bangladesh, 2007.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750651&req=5

Figure 1: Comparisons of short and long observation groups with respect to observation of critical times, and handwashing behavior at critical times, Bangladesh, 2007.
Mentions: Our analysis consisted of three principal comparisons– 1) proportion of caregivers in the short versus long observation groups who had at least one event of each type observed (Figure 1), 2) overall number of events observed in the short observation group versus number of events expected, based on the events observed in the average 90 minutes of the long observation group (Figure 2) and, 3) handwashing events observed in the first 90 minutes in the long observation group versus handwashing events observed in the subsequent 210 minutes within the same group (Figure 2). Each of the following events were identified as an opportunity to wash hands: preparing food, serving food, feeding a child, eating, defecation, and cleaning a child who had defecated.

Bottom Line: However, the mean number observed was higher than the expected for food preparation, food serving, and child feeding events.Decreasing the duration of handwashing significantly reduced the observation of critical events of interest to evaluators of handwashing programs.Future research should develop and evaluate novel models to reduce reactivity to observation and improve the measurement of handwashing behavior.

View Article: PubMed Central - HTML - PubMed

Affiliation: International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. amalk@icddrb.org.

ABSTRACT

Background: Structured observation is frequently used to measure handwashing at critical events, such as after fecal contact and before eating, but it is time-consuming. We aimed to assess the impact of reducing the duration of structured observation on the number and type of critical events observed.

Methods: The study recruited 100 randomly selected households, 50 for short 90-minute observations and 50 for long 5-hour observations, in six rural Bangladeshi villages. Based on the first 90 minutes in the long observation households, we estimated the number of critical events for handwashing expected, and compared the expected number to the number of events actually observed in the short observation households. In long observation households, we compared soap use at critical events observed during the first 90 minutes to soap use at events observed during the latter 210 minutes of the 5-hour duration.

Results: In short 90-minute observation households, the mean number of events observed was lower than the number of events expected: before eating (observed 0.25, expected 0.45, p<0.05) and after defecation (observed 0.0, expected 0.03, p=0.06). However, the mean number observed was higher than the expected for food preparation, food serving, and child feeding events. In long 5-hour observation households, soap was used more frequently at critical events observed in the first 90 minutes than in the remaining 210 minutes, but this difference was not significant (p=0.29).

Conclusions: Decreasing the duration of handwashing significantly reduced the observation of critical events of interest to evaluators of handwashing programs. Researchers seeking to measure observed handwashing behavior should continue with prolonged duration of structured observation. Future research should develop and evaluate novel models to reduce reactivity to observation and improve the measurement of handwashing behavior.

Show MeSH