The Effect of Behaviour Change Interventions on Use of Public Handwashing Stations in Bangladesh

NCT04765540 | Completed

• 1 other identifier: 2020091
• Study Type: interventional
• Target: 855
• Locations: 1 country
• Sites: 3

Brief Summary

As part of the COVID-19 response, BRAC has built 1000 public handwashing stations in several hundred villages in 20 sub-districts of Bangladesh. The investigators investigate the effects of two sets of behavioural interventions on use of the handwashing stations, compared to no additional interventions. The first set comprises passive nudges installed on and around the handwashing station, aimed at attracting people to the station. The second set comprises actively delivered higher-intensity interventions, including free soap offered as an incentive for using the handwashing station and a community board used to display social proof. This set of interventions aims to increase motivation to use the station.

Conditions

Hand Washing; Handwashing; Covid19

Keywords

Covid19; Handwashing; Hand Washing; COVID-19 Virus Prevention; COVID-19 Virus Infection; Behavioural Science; Nudges; Incentives; Social proof; Randomised controlled trial; Public handwashing stations

Outcome Measures

Primary Outcomes (1)

• Average handwashing station soap pedal presses per day (in weeks 1 to 3)

  The investigators will use the number of times the soap pedals on the handwashing stations are pressed as a proxy measure of the frequency of use of the handwashing station for handwashing with soap. This data will be collected via mechanical tally counters ('clickers') connected to the soap pedals such that their count increments when the soap pedal is pressed. The clicker counts will be recorded at 4 points each day for 5 days per week. The investigators will use this information to infer the average number of soap pedal presses per day in the three weeks after the T2 and T3 interventions are first installed or delivered. The investigators will also attempt to translate this outcome to an estimate of the number of times the handwashing station was used per day, by correlating soap pedal presses with counts of handwashing station users gathered via structured observations in 3 half-hour periods each day.

  At the end of 3 weeks post-implementation

Secondary Outcomes (1)

• Average handwashing station soap pedal presses per day (in weeks 4 to 6)

  At the end of 6 weeks post-intervention

Other Outcomes (4)

• Average number of people nearby handwashing station per hour (subsample of handwashing stations and villages)

  2 weeks post-intervention (exact timing will vary by station)

• Percent of people nearby handwashing station observed to use handwashing station (subsample of handwashing stations and villages)

  2 weeks post-intervention (exact timing will vary by station)

• Percent of people nearby handwashing station observed to be wearing face masks and coverings (subsample of handwashing stations and villages)

  2 weeks post-intervention (exact timing will vary by station)

Study Arms (3)

T1: Business as Usual (BAU)

ACTIVE COMPARATOR

Handwashing station plus standard BRAC programming, i.e. in-person community WASH (water, sanitation and hygiene) demonstrations conducted in households/communal areas, and sticker signs/posters placed on walls in the 'catchment area' of the handwashing station, alerting people to the stations and roughly pointing the way.

Behavioral: BRAC's business-as-usual

T2: BAU + Low Intensity Nudges

EXPERIMENTAL

T1 plus a bundle of 'low-intensity' passive interventions, including: * Large mirrors installed above handwashing station sinks to attract more people to the station * 7 to 8 large hand-shaped signposts pointing to the station and leading up to the station, placed on the ground in the vicinity of the station, starting from the nearest 'busy spot'

Behavioral: Low Intensity Nudges; Behavioral: BRAC's business-as-usual

T3: BAU + High Intensity Activities

EXPERIMENTAL

T1 plus an additional bundle of 'high-intensity' active interventions delivered for three weeks, including: * Free soap and free facemasks provided to handwashing station users in regular giveaways at key times, along with encouragement to return to the station and to spread the word. * A 'community message board' along with encouragement to make a mark on a "scoreboard" at the top of the board before/after use of the station to increase commitment and as an additional social cue. This will also visually show cumulative number of uses as a persistent cue of the social norm. * General encouragement to use the stations, provided by the intervention delivery team while they are at the station. Intervention team members are equipped with a loudhailer to assist this. * In addition, village handwashing station committees will be encouraged to try out their own ideas for encouraging more people to use the stations.

Behavioral: High Intensity Activities; Behavioral: BRAC's business-as-usual

Interventions

Low Intensity Nudges BEHAVIORAL

A bundle of 'low-intensity' passive interventions, including: Large Mirrors \& hand-shaped sign posts pointing to the station

T2: BAU + Low Intensity Nudges

High Intensity Activities BEHAVIORAL

A bundle of 'high-intensity' active interventions delivered for three weeks, including: Free soap and free facemasks for handwashing station users, a community message board \& general encouragement

T3: BAU + High Intensity Activities

BRAC's business-as-usual BEHAVIORAL

A set of community activities to increase awareness of public handwashing stations and the need to use them. This includes in-person group sessions demonstrating hand hygiene as well as stickers and posters placed in the community to alert people to the handwashing stations.

T1: Business as Usual (BAU); T2: BAU + Low Intensity Nudges; T3: BAU + High Intensity Activities

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Villages identified by BRAC as being eligible for this based on:
• COVID-19 cases
• Existing BRAC programs
• village characteristics
• viable location for a handwashing station (space/water source)
• local community members willing to 'sponsor' and maintain handwashing station

You may not qualify if:

• Lack of viable location for a handwashing station.
• Villages that received handwashing stations as part of the pilot phase
• Villages randomly selected in a related impact evaluation measuring the impact of the stations themselves

Sponsors & Collaborators

• The Behavioural Insights Team: lead
• Brac: collaborator
• BRAC Institute of Governance and Development: collaborator
• Unilever U.K. Central Resources Limited: collaborator
• D2 Technologies Ltd, Bangladesh: collaborator
• Foreign, Commonwealth and Development Office, U.K.: collaborator

Study Sites (3)

BRAC

Dhaka, Dhaka-1212, Bangladesh

Location

BRAC Khulna

Khulna, Bangladesh

Location

BRAC Mymensingh

Mymensingh, Bangladesh

Location

MeSH Terms

Conditions

COVID-19

Condition Hierarchy (Ancestors)

Pneumonia, Viral; Pneumonia; Respiratory Tract Infections; Infections; Virus Diseases; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Lung Diseases; Respiratory Tract Diseases

Study Officials

• Stewart Kettle, PhD

  Behavioural Insights Team

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Primary outcomes will be measured using mechanical tally counters attached to the handwashing station foot pedals. The individuals involved in recording these counters will be exposed to the treatment but will not be aware of the alternative treatments occurring at other handwashing stations.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Co-Head of International Programmes

Model Details: Handwashing stations will be assigned, at the village level, to one of three conditions (including one control condition) using a covariate-adaptive randomisation procedure. The investigators will measure usage of the handwashing stations for one week before the treatments are installed, and then for another six weeks, and compare usage between the conditions. A linear regression model will be used to estimate the effects of the treatments relative to the control condition. Note that residents of a village are free to avoid the stations or use stations outside their village, and primary outcome measurement will be at the handwashing station level, rather than at the individual or household level. Hence the investigators have not 'enrolled' participants into the trial. The number of 'participants' reported below refers to the number of handwashing stations across which treatment will be varied.

Study Record Dates

• First Submitted: January 6, 2021
• First Posted: February 21, 2021
• Study Start: January 3, 2021
• Primary Completion: May 6, 2021
• Study Completion: May 6, 2021
• Last Updated: July 22, 2021

Record last verified: 2021-07

Data Sharing

• IPD Sharing: Will not share

Locations

BA (3)