title: The effect of a soap promotion and hygiene education campaign on handwashing behaviour in rural India: a cluster randomised trial.
abstract: OBJECTIVE
  To investigate the effectiveness of a hygiene promotion intervention based on germ awareness in increasing handwashing with soap on key occasions (after faecal contact and before eating) in rural Indian households.
  
  
  METHODS
  Cluster randomised trial of a hygiene promotion intervention in five intervention and five control villages. Handwashing was assessed through structured observation in a random sample of 30 households per village. Additionally, soap use was monitored in a sub-sample of 10 households per village using electronic motion detectors embedded in soap bars.
  
  
  RESULTS
  The intervention reached 40% of the target population. Germ awareness increased as well as reported handwashing (a possible indicator of perceived social norms). Observed handwashing with soap on key occasions was rare (6%), especially after faecal contact (2%). Observed handwashing with soap on key occasions did not change 4 weeks after the intervention in either the intervention arm (-1%, 95% CI -2%/+0.3%), or the control arm (+0.4%, 95% CI -1%/+2%). Data from motion detectors indicated a significant but small increase in overall soap use in the intervention arm. We cannot confidently identify the nature of this increase except to say that there was no change in a key measure of handwashing after defecation.
  
  
  CONCLUSIONS
  The intervention proved scalable and effective in raising hygiene awareness. There was some evidence of an impact on soap use but not on the primary outcome of handwashing at key times. However, the results do not exclude that changes in knowledge and social norms may lay the foundations for behaviour change in the longer term.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK. adam.biran@lshtm.ac.uk
authors.forename: Adam
authors.initials: A
authors.lastname: Biran
authors.forename: Wolf-Peter
authors.initials: WP
authors.lastname: Schmidt
authors.forename: Richard
authors.initials: R
authors.lastname: Wright
authors.forename: Therese
authors.initials: T
authors.lastname: Jones
authors.forename: M
authors.initials: M
authors.lastname: Seshadri
authors.forename: Pradeep
authors.initials: P
authors.lastname: Isaac
authors.forename: N A
authors.initials: NA
authors.lastname: Nathan
authors.forename: Peter
authors.initials: P
authors.lastname: Hall
authors.forename: Joeleen
authors.initials: J
authors.lastname: McKenna
authors.forename: Stewart
authors.initials: S
authors.lastname: Granger
authors.forename: Pat
authors.initials: P
authors.lastname: Bidinger
authors.forename: Val
authors.initials: V
authors.lastname: Curtis
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016000:Cluster Analysis; D005191:Family Characteristics; D005243:Feces; D005260:Female; D006235:Hand Disinfection / Q000592:standards; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene / Q000193:education* / Q000592:standards; D008297:Male; D012307:Risk Factors; D012915:Soaps; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D012915:Soaps