Reactivity in rapidly collected hygiene and toilet spot check measurements: a cautionary note for longitudinal studies.
Discreet collection of spot check observations to measure household hygiene conditions is a common measurement technique in epidemiologic studies of hygiene in low-income countries. The objective of this study was to determine whether the collection of spot check observations in longitudinal studies could itself induce reactivity (i.e., change participant behavior). We analyzed data from a 12-month prospective cohort study in rural Tamil Nadu, India that was conducted in the absence of any hygiene or toilet promotion activities. Our data included hygiene and toilet spot checks from 10,427 household visits. We found substantial evidence of participant reactivity to spot check observations of hygiene practices that were easy to modify on short notice. For example, soap observed at the household's primary handwashing location increased from 49% at enrollment to 81% by the fourth visit and remained at or above 77% for the remainder of the study.
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India benarnold@berkeley.edu.
Benjamin F
BF
Arnold
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Ranjiv S
RS
Khush
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Padmavathi
P
Ramaswamy
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Paramasivan
P
Rajkumar
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Natesan
N
Durairaj
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Prabhakar
P
Ramaprabha
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Kalpana
K
Balakrishnan
Division of Epidemiology, University of California, Berkeley, California; Aquaya Institute, San Francisco, California; Physiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India; Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
John M
JM
Colford
D003906:Developing Countries; D006801:Humans; D006920:Hygiene; D008137:Longitudinal Studies