Promoting handwashing and sanitation behaviour change in low- and middle-income countries
No promotional approaches for handwashing and sanitation behaviour change are better than others, yet several promotional elements look promising.
This systematic review examined the effectiveness and implementation of approaches to promote handwashing and sanitation behaviour change in low- and middle income countries. In total, 42 studies on effectiveness of promotional programs were identified. No promotional approach could be identified that was better than all others, yet several promotional elements seemed promising: involving the community in the context of sanitation programs, social marketing elements in the context of combined handwashing and sanitation programs, adding elements derived from psychosocial theory to the promotional approach in the context of a handwashing intervention, and use of interpersonal communication, as part of the communication strategy of the promotion program. An additional 28 studies investigated which implementation factors were associated with the success or failure of these promotional approaches. A number of facilitators were relevant across different promotional approaches, including frequent visits by the implementers, short communication messages, and kindness, respect and accessibility of the implementer, among others.
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