Evaluating the Individual and Combined Effects of Hand Hygiene Promotion and Hardware Provision on Handwashing With Soap in Lusaka, Zambia

NCT06865495 | Active Not Recruiting

• 1 other identifier: 31387
• Study Type: interventional
• Target: 1,800
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this study is to assess the individual and combined effects of hand hygiene behavioural promotion and handwashing hardware and supply provision on handwashing with soap behaviour at handwashing opportunities in households in peri-urban communities in Lusaka, Zambia. Households will be randomly allocated to one of the four groups: AB) Hand hygiene behavioural promotion + handwashing hardware and supply provision, A) handwashing hardware and supply provision only, B) hand hygiene behavioural promotion only or C) No intervention. Researchers will compare handwashing behaviour between the four groups to see which is most effective.

Conditions

Handwashing Behaviour

Keywords

handwashing; hygiene; urban

Outcome Measures

Primary Outcomes (1)

• Handwashing with soap (HWWS) at all handwashing opportunities

  The probability of HWWS within three minutes of any handwashing opportunity (before cooking, before eating, before feeding a child, before breastfeeding, after toilet use, after handling child/adult faeces or cleaning a child's bottom, after contact with animals and after coughing/sneezing) in the correct sequence (e.g., before or after the relevant opportunity); measured through direct observation of individual behaviour over a a three-hour observation period.

  Measured at baseline and endline (6-months after intervention delivery begins)

Secondary Outcomes (4)

• Handwashing with soap (HWWS) at each specific handwashing opportunity.

  Measured at baseline and endline (6-months after intervention delivery begins)

• Hand-rinsing measured as a three-level outcome: no action, hand-rinsing or handwashing with soap at all handwashing opportunities.

  Measured at baseline and endline (6-months after intervention delivery begins)

• Handwashing Facility Presence

  Measured at baseline and endline (6-months after intervention delivery begins)

• Handwashing knowledge and reported practice.

  Measured at baseline and endline (6-months after intervention delivery begins)

Other Outcomes (2)

• Diarrhoeal Illness

  Measured at baseline and endline (6-months after intervention delivery begins)

• Respiratory Illness

  Measured at baseline and endline (6-months after intervention delivery begins)

Study Arms (4)

Handwashing Hardware and Supply Provision

EXPERIMENTAL

Households in this arm will receive a locally available handwashing facility called the Kalingalinga bucket and be given supplies to make soapy water. They will receive a 3-month visit to check the facility is functioning.

Other: Handwashing Hardware and Supply Provision

Hand Hygiene Behavioural Promotion

EXPERIMENTAL

Households in this arm will receive five bi-weekly educational visits, with a sixth follow-up visit four weeks later (6 visits in total).

Behavioral: Hand Hygiene Behavioural Promotion

Handwashing Hardware and Supply Provision + Hand Hygiene Behavioural Promotion

EXPERIMENTAL

Households in this arm will receive both the hardware and supply provision and hand hygiene behavioural promotion interventions.

Other: Handwashing Hardware and Supply Provision; Behavioral: Hand Hygiene Behavioural Promotion

Control

NO INTERVENTION

Households in this arm will receive no intervention during the study period. They will receive the most effective intervention combination after the study is complete.

Interventions

Handwashing Hardware and Supply Provision OTHER

Households will be given a locally available handwashing facility called the Kalingalinga bucket. Intervention delivery workers will set-up the handwashing facility, and demonstrate how it works, including where to place soap on the stand. Households will also be given supplies and materials to make their own liquid soap from locally available soap products (soapy water). Discussions will also be held on HWF maintenance. This component of the intervention should take no longer than 30 minutes. Intervention delivery workers will return to households after three months (one visit) to ensure there are no issues with the handwashing station (e.g., broken stand or tap), to bring more liquid soap and to remind households how to make soapy water.

Handwashing Hardware and Supply Provision; Handwashing Hardware and Supply Provision + Hand Hygiene Behavioural Promotion

Hand Hygiene Behavioural Promotion BEHAVIORAL

The hand hygiene behavioural promotion intervention employs interactive storytelling and visual aids to promote handwashing with soap. Intervention delivery workers will act as storytellers, narrating stories about three characters with different handwashing habits. The intervention progresses through five bi-weekly visits, with a final sixth visit 4 weeks after the fifth visit. The 30-minute visits progress through different stages: (1) identifying behaviours, (2) understanding disease risks, (3) encouraging practical solutions and (4) promoting practice. The penultimate stage of the intervention focuses on reflection and commitment, encouraging participants to assess their behaviours and pledge to adopt improved hygiene practices. The final visit allows participants to reflect on the whole intervention and covers information participants would like to revisit.

Hand Hygiene Behavioural Promotion; Handwashing Hardware and Supply Provision + Hand Hygiene Behavioural Promotion

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• At least one adult (aged 18 or older) who can consent to the study on behalf of all members of the household.
• At least one child under the age of 5.

You may not qualify if:

• Already own a similar handwashing facility (e.g., sink, handwashing station).
• Not permanent residents of the selected community and/or plans to leave the community within the next 3-6 months.

Sponsors & Collaborators

• London School of Hygiene and Tropical Medicine: lead
• Centre for Infectious Disease Research in Zambia: collaborator

Study Sites (1)

Centre for Infectious Disease Research in Zambia (CIDRZ)

Lusaka, Zambia

Location

Study Officials

• Robert Dreibelbis, PhD

  London School of Hygiene and Tropical Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 24, 2025
• First Posted: March 7, 2025
• Study Start: March 14, 2025
• Primary Completion: November 1, 2025
• Study Completion: November 1, 2025
• Last Updated: September 16, 2025

Record last verified: 2025-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
• Time Frame: Data will be made available within 2 years of endline data collection.
• Access Criteria: To be determined.

Locations

ZA (1)