title: Three kinds of psychological determinants for hand-washing behaviour in Kenya.
abstract: Washing hands with soap at the right times - primarily after contact with faeces, but also before handling food or feeding an infant - can significantly reduce the incidence of childhood infectious disease. Here, we present empirical results which substantiate a recent claim that washing hands can be the consequence of different kinds of psychological causes. Such causes can be divided into three kinds of control over behaviour: automatic or habitual responses, motivated or goal-driven behaviour to satisfy needs, and cognitive causes which reflect conscious concerns. Empirical results are based on 3-h-long structured observations of hand-washing behaviour in 802 nationally representative Kenyan households with children under five, and structured interviews with the primary female caretaker in these households, collected in March 2007. Factor analysis of questionnaire responses identified three psychological factors which are also significant predictors of observed hand-washing behaviour: having the habit of hand-washing at particular junctures during the day, the motivated need for personal or household cleanliness, and a lack of cognitive concern about the cost of soap use. These factors each represent a different kind of psychological cause. A perceived link between clean hands and sexual attractiveness also appeared in the factor analysis, but was not a determinant of actual behaviour. We also report evidence that those who express concern about the cost of soap use are those with relatively few economic resources. We suggest that those developing hygiene promotion programmes should consider the possible existence of multiple types of strategies for increasing hand-washing behaviour.
authors.affiliation: London School of Hygiene and Tropical Medicine, ITD, Keppel Street, London, United Kingdom. Electronic address: robert.aunger@lshtm.ac.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: Aunger
authors.affiliation: London School of Hygiene and Tropical Medicine, ITD, Keppel Street, London, United Kingdom.
authors.forename: Wolf-Peter
authors.initials: WP
authors.lastname: Schmidt
authors.affiliation: Institute for Cognitive Neuroscience, University College London, United Kingdom.
authors.forename: Ashish
authors.initials: A
authors.lastname: Ranpura
authors.affiliation: Water and Sanitation Program, World Bank, Nairobi, Kenya.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Coombes
authors.affiliation: Steadman International Kenya, Kenya.
authors.forename: Peninnah Mukiri
authors.initials: PM
authors.lastname: Maina
authors.affiliation: Steadman International Kenya, Kenya.
authors.forename: Carol Nkatha
authors.initials: CN
authors.lastname: Matiko
authors.affiliation: London School of Hygiene and Tropical Medicine, ITD, Keppel Street, London, United Kingdom.
authors.forename: Valerie
authors.initials: V
authors.lastname: Curtis
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006184:Habits; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D009042:Motivation; D019370:Observation; D019529:Sexuality; D012915:Soaps / Q000191:economics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D012915:Soaps