title: 'If an Eye Is Washed Properly, It Means It Would See Clearly': A Mixed Methods Study of Face Washing Knowledge, Attitudes, and Behaviors in Rural Ethiopia.
abstract: BACKGROUND
  Face cleanliness is a core component of the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy for trachoma control. Understanding knowledge, attitudes, and behaviors related to face washing may be helpful for designing effective interventions for improving facial cleanliness.
  
  
  METHODS
  In April 2014, a mixed methods study including focus groups and a quantitative cross-sectional study was conducted in the East Gojjam zone of the Amhara region of Ethiopia. Participants were asked about face washing practices, motivations for face washing, use of soap (which may reduce bacterial load), and fly control strategies.
  
  
  RESULTS
  Overall, both knowledge and reported practice of face washing was high. Participants reported they knew that washing their own face and their children's faces daily was important for hygiene and infection control. Although participants reported high knowledge of the importance of soap for face washing, quantitative data revealed strong variations by community in the use of soap for face washing, ranging from 4.4% to 82.2% of households reporting using soap for face washing. Cost and forgetfulness were cited as barriers to the use of soap for face washing. Keeping flies from landing on children was a commonly cited motivator for regular face washing, as was trachoma prevention.
  
  
  CONCLUSIONS
  Interventions aiming to improve facial cleanliness for trachoma prevention should focus on habit formation (to address forgetfulness) and address barriers to the use of soap, such as reducing cost. Interventions that focus solely on improving knowledge may not be effective for changing face-washing behaviors.
authors: Francis I. Proctor Foundation, University of California, San Francisco, United States of America.
authors: Kristen
authors: K
authors: Aiemjoy
authors: Francis I. Proctor Foundation, University of California, San Francisco, United States of America.
authors: Nicole E
authors: NE
authors: Stoller
authors: The Carter Center, Addis Ababa, Ethiopia.
authors: Sintayehu
authors: S
authors: Gebresillasie
authors: The Carter Center, Addis Ababa, Ethiopia.
authors: Ayalew
authors: A
authors: Shiferaw
authors: The Carter Center, Addis Ababa, Ethiopia.
authors: Zerihun
authors: Z
authors: Tadesse
authors: The Carter Center, Addis Ababa, Ethiopia.
authors: Tegene
authors: T
authors: Sewnet
authors: The Carter Center, Addis Ababa, Ethiopia.
authors: Bezuayehu
authors: B
authors: Ayele
authors: Regional Health Bureau, Addis Ababa, Ethiopia.
authors: Melsew
authors: M
authors: Chanyalew
authors: The Carter Center, Atlanta, GA, United States of America.
authors: Kelly
authors: K
authors: Callahan
authors: The Carter Center, Atlanta, GA, United States of America.
authors: Aisha
authors: A
authors: Stewart
authors: The Carter Center, Atlanta, GA, United States of America.
authors: Paul M
authors: PM
authors: Emerson
authors: Francis I. Proctor Foundation, University of California, San Francisco, United States of America.|Department of Ophthalmology, University of California, San Francisco, United States of America.|Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America.
authors: Thomas M
authors: TM
authors: Lietman
authors: Francis I. Proctor Foundation, University of California, San Francisco, United States of America.|Department of Ophthalmology, University of California, San Francisco, United States of America.
authors: Jeremy D
authors: JD
authors: Keenan
authors: Francis I. Proctor Foundation, University of California, San Francisco, United States of America.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
authors: Catherine E
authors: http://orcid.org/0000-0002-0763-399X
authors: CE
authors: Oldenburg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001290:Attitude; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005123:Eye / Q000737:chemistry; D005145:Face / Q000502:physiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D006920:Hygiene / Q000592:standards*; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014141:Trachoma / Q000517:prevention & control* / Q000523:psychology*; D055815:Young Adult