Hygiene (Handwashing) BehaviorsEffect of Handwashing on Diarrhea Risk - Curtis and Cairncross (2003)Slide 3Positive Associationd of HW with Other WASH FactorsHygiene Behavior Studies - Curtis Et. al, 2009 Planned, motivated and habitual hygiene behaviour: an eleven country review Health Educ Res. 2009 Mar 13. [Epub ahead of print]Conceptual Model of the Causes of BehaviorEnvironmentEnvironmental factors influencing HWWSSlide 9Slide 10Behavior - BrainHabit Learnt automated behaviors produced by cues, often as part of a routineMotivation Tendency to do work to put oneself into a state that was good for the survival and reproduction of our ancestors (includes drives and emotions)Motivation - ResultsSlide 15Planning The pursuit of long-term objectivesBelief/knowledge that linked HW to long-term beneficial outcomesKey FindingsSlide 19SummarySlide 21Hygiene (Handwashing) BehaviorsMark D. SobseyENVR 890-2Spring, 2009Effect of Handwashing on Diarrhea Risk - Curtis and Cairncross (2003)Effect of Handwashing on Diarrhea Risk - Curtis and Cairncross (2003)Positive Associationd of HW with Other WASH FactorsHygiene Behavior Studies - Curtis Et. al, 2009Planned, motivated and habitual hygiene behaviour: an eleven country reviewHealth Educ Res. 2009 Mar 13. [Epub ahead of print]•Results of a series of formative research (FR) studies•Used the perspectives and methods of medical and biological anthropology, as well as of consumer science•Helped elucidate a range of factors associated with risky hygiene behavior•Aimed to provide insights needed to develop strategies for changing handwashing behaviorConceptual Model of the Causes of Behavior•Environment•Environmental factors influencing behavior were divided into 3 components:• ‘social’–The individuals, groups and institutions (e.g. local norms, national regulations and religion) that influence the behavior of the target individual•‘physical’–The geographic, climatic, material and artefactual factors affecting behaviour (e.g. water and sanitation availability and house design)• ‘biological’–Other life forms and their products (e.g. foodstuffs, domestic animals and disease agents) that influence behavior• Assumed that salient changes in the environment lead to changes in the brain which can lead to changes in behaviorEnvironmental factors influencing HWWSEnvironmental factors influencing HWWSEnvironmental factors influencing HWWSBehavior - Brain•Assigned behavior to 3 types of discrete but interacting causes –Cognitive or executive control which produces ‘planned’ behavior, –the reward system which produces ‘motivated’ behavior–Automatic or reflexive control which is responsible for ‘habitual’ behavior•Based on recent thinking in social and evolutionary psychology and neuroscienceHabit Learnt automated behaviors produced by cues, often as part of a routine•The most primitive psychological system involved in handwashing behavior is ‘habit•Learnt, automated behavior that can be regularly triggered by a particular cue •Mothers often ascribed handwashing (HW) habits to what they were taught when they were young •The habit of washing with plain water was much more frequent than HWWS–It sometimes occurred as a part of religious ritual, a special form of habitMotivationTendency to do work to put oneself into a state that was good for the survival and reproduction of our ancestors (includes drives and emotions)Motivations concerning HWWS•Disgust–Tendency to avoid objects & situations carrying disease risk•Status–Tendency to seek to optimize social rank•Affiliation–Tendency to seek to conform so as to reap the benefits of social living•Attraction –Tendency to be attracted to, & want to attract, high-value mates•Nurture–Tendency to want to care for offspring•Comfort–Tendency to place one’s body in optimal physical, chemical conditions•Fear–Tendency to avoid objects & situations carrying risk of injury or deathMotivation - Results•‘Disgust’ emerged as a motivator of HW in all the studies• Hands had to be washed when they became contaminated with organic material that was dirty, foul or smelly. •Most commonly mentioned contaminants:–Feces, fish, urine, bodily fluids, rotten or dead items•Feces were found to be particularly repulsive. –Some, the smell or sight of feces alone was enough to motivate HW–Others: hands that had not obviously contacted fecal material during toileting did not need washing.PlanningThe pursuit of long-term objectives •Looked for ways in which caretakers constructed plans to use HW to help achieve some form of long-term end or objective. •Planned behavior is distinct from –motivated behavior, which aims at short-term reward, or –habitual behavior which is automatic and cue-based1. HW could help to provide a platform of good health for all the family.2. HW was sometimes carried out for the sake of beneficial supernatural objectives, e.g., being in a state of religious purity or of having ‘good luck’. 3. Caretakers made plans to teach children HW to socialize them correctly•There was a chain of logically connected representations which linked HW to some form of long-term beneficial objective. •But for some, HW gets in the way of achieving long-term plans•Health as a long-term objective is often described as being instrumental in meeting other objectives, such as being beautiful, or saving money.Belief/knowledge that linked HW to long-term beneficial outcomes•Flaws we found flaws in the chain of belief/knowledge that linked HW to long-term beneficial outcomes. •Knowledge of germ theory of disease was widespread, but..•Germs remained essentially abstract; they are invisible and undetectable.•Mothers have learnt that poor hygiene causes ‘diarrhea’ in children•Yet mothers often did not recognize this condition as a disease•Diarrhea is just a symptom, either of normal child development (e.g. teething) or of another underlying disease. •Diarrhea was not seen as life-threatening or as relevant to one’s own children•It was thought to be mild and self-limiting, hence unlikely to lead to other adverse outcomes. •Thus, the chain of associations that would make it worthwhile to go to the trouble of washing hands with soap is probably too tenuous to cause mothers to make conscious plans to always carry it out–Benefits associated with preventing child diarrhea, and hence the possible
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