title: Turkey Handwashing Survey: suggestion for taking the ecological model into better consideration.
abstract: OBJECTIVE
  This study is aimed to find out the handwashing habits and their relations to the socio-economic variables.
  
  
  METHODS
  The sampling is determined regarding the address-based population registration system of the country. The multi-staged stratified cluster sampling method was used. It is conducted by a face to face questionnaire with 6854 persons. 22 questions are asked whether they are washing their hands or not related to different situations, the results are graded and the "Handwashing Habits Score" (HHS) is obtained. The reasons for not handwashing were evaluated by categorizing as individual, environmental and combined reasons.
  
  
  RESULTS
  The HHS is increasing in the older age groups (β = 0.148, p < 0.001), females (β = 0.306, p < 0.001), citizens of urban settlement (β = 0.061, p < 0.001), higher education levels (β = 0.191, p < 0.001). The reasons for not handwashing were found as 53.3 % individual, 39.2 % environmental, 7.5 % combined. The frequency of mentioning not washing hands because of the environmental reasons is getting higher in the older age groups, in the urban side, and in the higher education level (p < 0.001).
  
  
  CONCLUSIONS
  The handwashing habits are shaped by the determinant networks which form a complex structure by intertwining individual, socio-economic and environmental factors in different sub-groups with various weights. This result might contribute to the efforts of conceptualizing the health behaviors with ecological model.
authors.affiliation: Republic of Turkey, Ministry of Health, General Directorate of Health Promotion, Türkiye Halk Sağlığı Kurumu K Blok. Sıhhiye, 06410, Ankara, Turkey, drtuzunh@yahoo.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Tüzün
authors.forename: Kağan
authors.initials: K
authors.lastname: Karakaya
authors.forename: Emine Baran
authors.initials: EB
authors.lastname: Deniz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016000:Cluster Analysis; D005260:Female; D006235:Hand Disinfection; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012959:Socioeconomic Factors; D014421:Turkey; D055815:Young Adult