title: Impact of duration of structured observations on measurement of handwashing behavior at critical times.
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.
authors.affiliation: International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. amalk@icddrb.org.
authors.forename: Amal K
authors.initials: AK
authors.lastname: Halder
authors.forename: John W
authors.initials: JW
authors.lastname: Molyneaux
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: Pavani K
authors.initials: PK
authors.lastname: Ram
mesh_terms: D001459:Bangladesh; D003296:Cooking; D003672:Defecation; D004435:Eating; D005191:Family Characteristics; D005243:Feces; D006235:Hand Disinfection; D015438:Health Behavior; D006801:Humans; D007223:Infant; D019370:Observation; D012424:Rural Population; D012915:Soaps
chemical_list: D012915:Soaps
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