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Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh.
BMC Public Health 2018; 18(1):483BP

Abstract

BACKGROUND

To design a maternal handwashing intervention for the newborn period, this qualitative study explored drivers of handwashing among mothers and other caregivers of neonates and infants in two rural areas of Bangladesh.

METHODS

We conducted 40 semi-structured observation sessions to observe handwashing behaviors of primiparous and multiparous mothers of neonates, and to understand the contextual factors that facilitated or hampered those behaviors. We then conducted 64 interviews with mothers of neonates and mothers of infants and 6 group discussions with mothers of infants, other female caregivers and fathers to explore perceptions, beliefs, and practices related to handwashing in the neonatal period. Based on a conceptual model and the Theory of Reasoned Action/Theory of Planned Behavior, we developed a conceptual model a priori, we performed thematic analysis to explain determinants of maternal handwashing behaviors.

RESULTS

We conducted 200 h of observation among mothers of neonates. The age range of participating mothers varied between 17 and 25 years and their maximum education was up to 10th grade of schooling. Mothers, other female caregivers and fathers perceived a need to wash hands with or without soap before eating or before feeding a child by hand to prevent diarrhea. Mothers expressed the importance of washing their hands before holding a baby but were rarely observed doing so. All respondents prioritized using soap for visible dirt or feces; otherwise, water alone was considered sufficient. Lack of family support, social norms of infrequent handwashing, perceptions of frequent contact with water as a health threat and mothers' restricted movement during first 40 days of neonate's life, and childcare and household responsibilities adversely impacted handwashing behavior.

CONCLUSIONS

Addressing emotive drivers of handwashing within existing social norms by engaging family members, ensuring handwashing facilities and clarifying neonatal health threats may improve maternal handwashing behavior in the neonatal period.

Authors+Show Affiliations

Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. shahana@icddrb.org.Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. Infectious Diseases and Geographic Medicine, Stanford University, Y2E2, MC 4205473 Via Ortega, Stanford, CA, 94305, USA.School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Rm. 237 Farber Hall, Buffalo, NY, 14214, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29642885

Citation

Parveen, Shahana, et al. "Barriers to and Motivators of Handwashing Behavior Among Mothers of Neonates in Rural Bangladesh." BMC Public Health, vol. 18, no. 1, 2018, p. 483.
Parveen S, Nasreen S, Allen JV, et al. Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health. 2018;18(1):483.
Parveen, S., Nasreen, S., Allen, J. V., Kamm, K. B., Khan, S., Akter, S., ... Ram, P. K. (2018). Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health, 18(1), p. 483. doi:10.1186/s12889-018-5365-1.
Parveen S, et al. Barriers to and Motivators of Handwashing Behavior Among Mothers of Neonates in Rural Bangladesh. BMC Public Health. 2018 04 11;18(1):483. PubMed PMID: 29642885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. AU - Parveen,Shahana, AU - Nasreen,Sharifa, AU - Allen,Jelena V, AU - Kamm,Kelly B, AU - Khan,Shifat, AU - Akter,Shirina, AU - Lopa,Tajnin Marin, AU - Zaman,K, AU - El Arifeen,Shams, AU - Luby,Stephen P, AU - Ram,Pavani K, Y1 - 2018/04/11/ PY - 2017/08/16/received PY - 2018/03/22/accepted PY - 2018/4/13/entrez PY - 2018/4/13/pubmed PY - 2019/3/20/medline KW - Bangladesh KW - Handwashing KW - Maternal KW - Neonatal SP - 483 EP - 483 JF - BMC public health JO - BMC Public Health VL - 18 IS - 1 N2 - BACKGROUND: To design a maternal handwashing intervention for the newborn period, this qualitative study explored drivers of handwashing among mothers and other caregivers of neonates and infants in two rural areas of Bangladesh. METHODS: We conducted 40 semi-structured observation sessions to observe handwashing behaviors of primiparous and multiparous mothers of neonates, and to understand the contextual factors that facilitated or hampered those behaviors. We then conducted 64 interviews with mothers of neonates and mothers of infants and 6 group discussions with mothers of infants, other female caregivers and fathers to explore perceptions, beliefs, and practices related to handwashing in the neonatal period. Based on a conceptual model and the Theory of Reasoned Action/Theory of Planned Behavior, we developed a conceptual model a priori, we performed thematic analysis to explain determinants of maternal handwashing behaviors. RESULTS: We conducted 200 h of observation among mothers of neonates. The age range of participating mothers varied between 17 and 25 years and their maximum education was up to 10th grade of schooling. Mothers, other female caregivers and fathers perceived a need to wash hands with or without soap before eating or before feeding a child by hand to prevent diarrhea. Mothers expressed the importance of washing their hands before holding a baby but were rarely observed doing so. All respondents prioritized using soap for visible dirt or feces; otherwise, water alone was considered sufficient. Lack of family support, social norms of infrequent handwashing, perceptions of frequent contact with water as a health threat and mothers' restricted movement during first 40 days of neonate's life, and childcare and household responsibilities adversely impacted handwashing behavior. CONCLUSIONS: Addressing emotive drivers of handwashing within existing social norms by engaging family members, ensuring handwashing facilities and clarifying neonatal health threats may improve maternal handwashing behavior in the neonatal period. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/29642885/Barriers_to_and_motivators_of_handwashing_behavior_among_mothers_of_neonates_in_rural_Bangladesh L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5365-1 DB - PRIME DP - Unbound Medicine ER -