Nongovernmental Organization Practitioners’ Perspectives on the Challenges and Solutions to Changing Handwashing Behavior in Older Children: A Qualitative Study

We explore the challenges to handwashing interventions targeting older children and recommended solutions from nongovernmental organization practitioners’ perspectives involved in the design, coordination, implementation, or evaluation of child-targeted HWWS interventions. Key Findings Improving handwashing with soap (HWWS) practice among older children can reduce disease transmission, but funding for these interventions targeting older children is insufficient and inconsistent. Practitioners report that most HWWS interventions targeting older children are resource-heavy, unengaging, and implemented within non-enabling physical environments, with little evidence of success. Lack of coordination within and between sectors creates major challenges to implementing HWWS interventions targeting children. Key Implications The nongovernmental organization (NGO) sector should prioritize improving older children’s handwashing and support programs accordingly. NGO practitioners should balance resource needs against using evidence-based, engaging approaches that address the drivers of handwashing among older children. NGOs should foster better intra- and intersectoral coordination to overcome challenges related to the integration of HWWS promotion within existing educational institutions, the standardization of implementation tools, and the sustainability of interventions. ABSTRACT Background: Increasing handwashing with soap (HWWS) among older children (aged 5–14 years) can achieve a substantial public health impact. However, HWWS interventions targeting older children have had mixed success. Recent research has attempted to quantitatively identify effective intervention techniques; however, success is likely also influenced by the wider context of implementation. We explore nongovernmental organization (NGO) practitioners’ perspectives on the challenges and solutions to HWWS interventions targeting older children to enhance understanding of what is required, beyond intervention content, for them to be effective. Methods: We conducted in-depth, semistructured interviews in April–November 2020 with 25 practitioners employed across 11 NGOs and involved in HWWS interventions targeting older children in development and humanitarian settings. We used purposive and snowball sampling to recruit participants in roles at the global, national/regional, and local levels. Interviews were audio-recorded, transcribed, and thematically analyzed to identify challenges and solutions to HWWS interventions targeting older children. Results were organized according to program development cycle stages. Results: Twelve themes relating to perceived challenges emerged: (1) lack of prioritization, (2) funding inconsistency, (3) insufficient formative research, (4) demand on resources, (5) unengaging intervention content, (6) non-enabling physical environments, (7) availability of skilled implementers, (8) reaching out-of-school children, (9) community mistrust, (10) lack of coordination, (11) lack of evaluation rigor, and (12) failure to assign older children’s HWWS as a primary outcome in evaluations of hygiene interventions. Recommended solutions were at the intervention, organization, and sector levels. Conclusion: Intervention design and delivery are important for the success of HWWS interventions for older children, but contextual factors, such as the availability of human and material resources and the level of coordination within and beyond the NGO sector, should also be considered. NGOs need to prioritize HWWS promotion among older children and support programs accordingly.