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

Covid19 Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04765540
• Other study ID #: 2020091
• Status: Completed
• Phase: N/A
• Start date: January 3, 2021
• Est. completion date: May 6, 2021

Study information

• Verified date: July 2021
• Source: The Behavioural Insights Team
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

Description:

As part of the COVID-19 response, BRAC, an international development organisation based in Bangladesh, has built 1000 public handwashing stations in several hundred villages in Dhaka, Khulna and Mymensingh divisions. 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 of interventions, which do not require ongoing labour (hence termed 'low intensity'), involve the installation of various 'nudges' (e.g. mirrors and signposts) on the station and in the surrounding area; these interventions are designed to attract attention and guide people to the stations. The second set of interventions, which do require ongoing labour ('high intensity'), involve 'promoters' visiting the stations a few times a week for three weeks to hand out free bars of soap to station users, update a community board next to the station with cumulative usage numbers, and to encourage users to place comments or marks on the board as a form of social proof. Stations will be assigned to receive either the low intensity nudges, the high intensity intervention, or no additional intervention beyond BRAC's standard programming using a covariate adaptive randomisation process (with randomisation occurring at the village level to reduce spillover risk).

The Investigators will measure use of the stations for one week prior to the implementation of the behavioural interventions, and then for a further six weeks. Station usage will be measured by a combination of structured observations and tally counters attached to the foot pedals that operate the station.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 855
• Est. completion date: May 6, 2021
• Est. primary completion date: May 6, 2021
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Note: the sample consists of villages that have received at least one public handwashing station from BRAC, rather than human participants, though the investigators are measuring the use of the stations by human participants.

The initial sample of villages has been chosen from a set of 1,899 villages identified by BRAC as being eligible for this project based on criteria related to COVID-19 cases, existing BRAC programs and village characteristics. The villages are spread across 3 of Bangladesh's 8 divisions, 8 of its 64 districts, and 20 of its 492 subdistricts ('upazilas'). While most of the 'villages' are located in rural parts of Bangladesh, roughly 15 percent are better characterised as wards or towns within urban and peri-urban municipalities.

Inclusion Criteria:

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

Exclusion Criteria:

• 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

Related Conditions & MeSH terms

• Covid19
• Hand Washing
• Handwashing

Intervention

Behavioral:
• Low Intensity Nudges
A bundle of 'low-intensity' passive interventions, including: Large Mirrors & hand-shaped sign posts pointing to the station
• High Intensity Activities
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
• BRAC's business-as-usual
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.

Locations

Country	Name	City	State
Bangladesh	BRAC	Dhaka
Bangladesh	BRAC Khulna	Khulna
Bangladesh	BRAC Mymensingh	Mymensingh

Sponsors (6)

Lead Sponsor	Collaborator
The Behavioural Insights Team	Brac, BRAC Institute of Governance and Development, D2 Technologies Ltd, Bangladesh, Foreign, Commonwealth and Development Office, U.K., Unilever U.K. Central Resources Limited

Country where clinical trial is conducted

Bangladesh, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Average number of people nearby handwashing station per hour (subsample of handwashing stations and villages)	Enumerators will count the number of people within a 10 meter radius of handwashing stations in pre-specified periods during the day.	2 weeks post-intervention (exact timing will vary by station)
Other	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)
Other	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)
Other	Proportion of handwashing station users who are repeat users (subsample of handwashing stations and villages)	This will be measured by surveying members of the public who pass by the handwashing stations or are observed to use them. The investigators will record participant's reported past use of the handwashing station as well as their observed use during the survey session.	4 weeks post-intervention (exact timing will vary by station)
Primary	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	Average handwashing station soap pedal presses per day (in weeks 4 to 6)	This outcome will be measured identically to the primary outcome, but measures usage over the slightly longer term (the second three-week period 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 6 weeks post-intervention