What is it about?

Handwashing is a complex behavior made up of several steps. CDC recommends five steps as part of the handwashing process; WHO and UNICEF recommend 10-11 steps. Researchers evaluating the effects of handwashing interventions have also used various levels of complexity in the steps for the promotion of handwashing at the community level. The complexity of instructions can impact adherence to recommended health behaviors. No study has been conducted to assess the impact of handwashing instruction complexity for handwashing procedure replication on the behavior at the community level.

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Why is it important?

Several studies have investigated the effects of different regimens of handwashing complexity on microbial hand contamination but no data are available on how the complexity of regimens affects on the handwashing procedures in a community setting.


This was a really difficult paper to write with many psychological aspects of handwashing. I hope the readers, especially who work on hand hygiene will get benefit from this paper.

Nuhu Amin
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)

Read the Original

This page is a summary of: Effects of complexity of handwashing instructions on handwashing procedure replication in low-income urban slums in Bangladesh: a randomized non-inferiority field trial, Journal of Water Sanitation and Hygiene for Development, June 2019, IWA Publishing,
DOI: 10.2166/washdev.2019.131.
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