Identifying behavioral determinants of handwashing with soap after defecation in an urban setting in Bangladesh: Findings from a Barrier Analysis

Open Access

Abstract

Social and Behavioral Change (SBC) has long been considered as core component of hand washing with soap (HWWS) intervention, but identifying barriers and enablers of HWWS from a behavioral perspective is limited. By examining twelve potential behavioral determinants this Barrier Analysis study was conducted to identify the barriers and enablers of HWWS after defecation in urban setting in Bangladesh. We conducted 45 interviews with those who washed their hands with soap after defecation ("Doers") and another 45 interviews with those who did not ("Non-doers"). Data analysis was performed to identify which beliefs were most highly-associated with hand washing with soap. The analysis showed that two of the main barriers of HWWS after defecation were related to perceived self-efficacy and access, especially availability of soap. Non-doers claimed that access to soap was difficult due to lack of money and unavailability at nearby shops. Other important determinants such as difficulty remembering to buy soap (cues for action)), believing that most people did not approve of HWWS (e.g. perceived social norms), low perceived severity of diarrhea, and not believing that HWWS would work to reduce diarrhea (perceived action efficacy) were significantly correlated with adoption of the behavior. Perceived divine will (believing that it is God's will when one gets diarrhea) was also a factor among the Non-doers. Other benefits such as feeling clean and keeping free from illness were reported more often by Doers, while Non-doers were more likely to report increased costs as a barrier to HWWS. The results suggest that an integrated behavior change strategy promoting specific beliefs about HWWS using culturally-inclusive messaging and activities to address the different barriers and leverage the different enablers may lead to better adoption of HWWS.