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- Title
Psychosocial Factors Mediating the Effect of the CHoBI7 Mobile Health Program on Handwashing With Soap and Household Stored Water Quality: A Randomized Controlled Trial.
- Authors
George, Christine Marie; Bhuyian, Md. Sazzadul Islam; Thomas, Elizabeth D.; Parvin, Tahmina; Monira, Shirajum; Zohura, Fatema; Hasan, M. Tasdik; Tahmina, Sanya; Munmun, Farzana; Sack, David A.; Perin, Jamie; Alam, Munirul
- Abstract
Household members of diarrhea patients are at higher risk of developing diarrheal diseases (>100 times for cholera) than the general population during the 7 days after the diarrhea patient is admitted at a health facility. There is growing evidence demonstrating that theory-driven water, sanitation, and hygiene (WASH) interventions are likely to yield greater behavior change than those based on health education alone. The Cholera Hospital-Based Intervention for 7-Days (CHoBI7) mobile health (mHealth) program is a theory-driven WASH intervention initially delivered to a diarrhea patient by a health promoter during a health facility visit and reinforced through weekly voice and text messages. In the recent randomized controlled trial (RCT) of the CHoBI7-mHealth program in Bangladesh, this intervention significantly reduced diarrheal disease and stunting, and increased handwashing with soap and stored drinking water quality over the 12-month program period. The aim of this study was to assess the underlying mechanism of change of this intervention. Handwashing with soap was measured by 5-hour structured observation. Stored drinking water quality was assessed by the presence of Escherichia coli during unannounced spot checks. Psychosocial factors were measured among 1,468 participants in the CHoBI7-mHealth RCT. Perceived susceptibility, response efficacy, self-efficacy, dirt reactivity, and diarrhea knowledge were mediators of the CHoBI7-mHealth program's effect on stored drinking water quality at the 1-week follow-up. Self-efficacy, response efficacy, and diarrhea knowledge were mediators of the intervention's effect on handwashing with soap habit maintenance and stored drinking water quality at the 12-month follow-up. This study demonstrates how theory-driven approaches for intervention design can facilitate WASH behavior change.
- Subjects
BANGLADESH; PREVENTION of infectious disease transmission; DIARRHEA prevention; HEALTH education; ESCHERICHIA coli; HOUSEHOLD supplies; PATIENT aftercare; EVALUATION of human services programs; SANITATION; HYGIENE; HEALTH outcome assessment; REGRESSION analysis; AQUATIC microbiology; PATIENT psychology; HUMAN services programs; RANDOMIZED controlled trials; SELF-efficacy; HEALTH literacy; PEARSON correlation (Statistics); QUALITY assurance; DISEASE susceptibility; INTERPERSONAL relations; COMMUNICATION; FACTOR analysis; QUESTIONNAIRES; RESEARCH funding; HAND washing; STATISTICAL sampling; CLUSTER analysis (Statistics); LOGISTIC regression analysis; DATA analysis software; TELEMEDICINE; INDUSTRIAL research
- Publication
Health Education & Behavior, 2022, Vol 49, Issue 2, p326
- ISSN
1090-1981
- Publication type
Article
- DOI
10.1177/1090198120987134