The determinants of handwashing during the COVID-19 pandemic: A multi-country analysis of data from the Wash’Em process for hygiene programme design

Abstract

AbstractBackground The Wash’Em process was developed to improve the design of handwashing behaviour change programmes in outbreaks and fragile humanitarian settings, ensuring that programmes are able to be designed rapidly while still being contextualised and evidence-based. The approach was widely used during the COVID-19 pandemic to inform prevention programmes. This study aims to compare data emerging from the use of the Wash’Em process during the pandemic, to understand whether commonalities in programming constraints or the determinants of handwashing behaviour existed across countries. Methods We conducted a secondary data analysis of summary data entered into the Wash’Em Programme Designer Software. This summary data was drawn from the use of the Wash’Em Rapid Assessment Tools in 38 settings during the pandemic. Data was verified prior to inclusion; descriptively summarised and then statistical summaries of homogeneity were derived. Results Wash’Em was implemented as intended during the pandemic, typically taking a small number of humanitarian staff less than a week to complete. Most humanitarian actors reported using the programmatic recommendations suggested by the process but did so within relatively short-term and poorly financed prevention programmes. Homogeneity in the responses to the Rapid Assessment Tools was low indicating that the determinants of handwashing behaviour during the pandemic were predominantly shaped by pre-existing factors within the context rather than the nature of the health threat. Conclusion Hygiene programmes during outbreaks should avoid ‘copying and pasting’ interventions from one setting to another and instead make time to holistically understand the behavioural determinants in a specific context and develop programme activities that are designed to address these. Particular attention should be given to factors in the physical and social environment which may enable or constrain handwashing behaviour, pre-existing disease vulnerabilities, and the secondary and non-health impacts of outbreaks. Wash’Em provides one feasible way of contextualising handwashing interventions in outbreak or fragile humanitarians settings.