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What causes sustainable changes in hygiene behaviour? A cross-sectional study from Kerala, India

Cairncross, Sandy, Shordt, Kathleen, Zacharia, Suma, Govindan, Beena Kumari·2005·Social Science & Medicine
DOI 10.1016/j.socscimed.2005.04.019
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Abstract

This study was designed and the field work carried out by a non-governmental organisation (NGO) responsible for implementing hygiene promotion. The sustainability of changed hygiene behaviour was studied at various periods up to nine years after the conclusion of a multifaceted hygiene promotion intervention in Kerala, India. Various methods including a questionnaire to assess knowledge, spot observation, demonstration of skills on request, and household pocket voting were used and compared for the measurement of the hygiene outcome. Pocket voting gave the lowest prevalence of good practice, which we infer to be the more accurate. Good handwashing practice was reported by more than half the adults in intervention areas, but < 10% in a control area. Handwashing prevalence showed no association with the elapsed time since the interventions, indicating that behaviour change had occurred and persisted. Recall of participation in health education classes was significantly associated with good hygiene as indicated by women's handwashing practice (OR 2.04, CI 1.05-3.96) and by several other outcomes, suggesting that the classes were an effective component of the intervention. The evidence for a specific impact on behaviour from home visits and an awareness campaign is less strong, although the home visits had influenced knowledge. The finding of an association between interventions and male handwashing, in ecological analysis (comparing administrative areas i.e. panchayats) but not at individual level, suggests that the effect of the interventions on men may have been indirect, via women or neighbours, underlining the need to direct interventions at men as well as women. The finding that hygiene behaviour persisted for years implies that hygiene promotion is a more cost-effective health intervention than previously supposed.

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  • Providing mothers with soap reduced diarrhea by 90% in children, as well as respiratory tract infections in school-children, and improved long-term hand hygienic practices.

    “Providing mothers with soap reduced diarrhea by 90% in children, as well as respiratory tract infections in school-children (Alzaher et al., 2018), and improved longterm hand hygienic practices (Wilson and Chandler, 1993;Cairncross et al., 2005).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Cairncross et al., 2005

  • Evidence that women were better than men at learning sustainable WASH practices through educational interventions has been reported.

    “Evidence that women were better than men at learning sustainable WASH practices through educational interventions has also been reported (Cairncross et al., 2005;Williams et al., 2015).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Cairncross et al., 2005

  • Women had greater levels of WASH knowledge and were better at retaining WASH-related education.

    “To this end, some reports indicated that women had greater levels of WASH knowledge and were better at retaining WASH-related education (Cairncross et al., 2005;Williams et al., 2015).”

    From A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health (2020) · cites this paper as Cairncross et al., 2005

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Authors
Cairncross, S., Shordt, K., Zacharia, S., & Govindan, B. K.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • IRC International Water and Sanitation Centre (NL)
Corresponding author
Cairncross, Sandy
ORCID
Cairncross, Sandy
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2005-11
Volume
61
Issue
10
Pages
2212-2220
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2005.04.019
OpenAlex
W2110421898
Cited by
108
References
30
Citations by year
2026: 2 · 2025: 3 · 2024: 7 · 2023: 3 · 2022: 5 · 2021: 5 · 2020: 8 · 2019: 1 · 2018: 4 · 2017: 7 · 2016: 6 · 2015: 7 · 2014: 6 · 2013: 10 · 2012: 8
FWCI
3.35
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
  • Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
Keywords
hygiene behaviour change, hand washing, hygiene promotion, health education classes, home visits, public awareness campaigns, ecological analysis, Kerala
MeSH terms
Adult, Child, Cross-Sectional Studies, Female, Hand Disinfection, Health Education, Health Promotion, Humans, Hygiene, India, Male, Sex Factors, Socioeconomic Factors

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