Clinical trial NCT04765540: The Effect of Behaviour Change Interventions on Use of Public Handwashing Stations in Bangladesh
Official title: The Effect of Behaviour Change Interventions on Use of Public Handwashing Stations in Bangladesh
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Hand Washing
Handwashing
Covid19
Keywords: Covid19
Handwashing
Hand Washing
COVID-19 Virus Prevention
COVID-19 Virus Infection
Behavioural Science
Nudges
Incentives
Social proof
Randomised controlled trial
Public handwashing stations
Lead sponsor: The Behavioural Insights Team
Sponsor class: OTHER
Collaborators: name: Brac
name: BRAC Institute of Governance and Development
name: Unilever U.K. Central Resources Limited
name: D2 Technologies Ltd, Bangladesh
name: Foreign, Commonwealth and Development Office, U.K.
First posted: 2021-02-21
Enrollment: 855
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Handwashing stations will be assigned, at the village level, to one of three conditions (including one control condition) using a covariate-adaptive randomisation procedure. The investigators will measure usage of the handwashing stations for one week before the treatments are installed, and then for another six weeks, and compare usage between the conditions. A linear regression model will be used to estimate the effects of the treatments relative to the control condition.

Note that residents of a village are free to avoid the stations or use stations outside their village, and primary outcome measurement will be at the handwashing station level, rather than at the individual or household level. Hence the investigators have not 'enrolled' participants into the trial. The number of 'participants' reported below refers to the number of handwashing stations across which treatment will be varied.
Primary purpose: PREVENTION

Brief 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.

Detailed 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.

Eligibility criteria: 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

Primary outcomes:
measure: Average handwashing station soap pedal presses per day (in weeks 1 to 3)
timeFrame: At the end of 3 weeks post-implementation
Secondary outcomes:
measure: Average handwashing station soap pedal presses per day (in weeks 4 to 6)
timeFrame: At the end of 6 weeks post-intervention
Other outcomes:
measure: Average number of people nearby handwashing station per hour (subsample of handwashing stations and villages)
timeFrame: 2 weeks post-intervention (exact timing will vary by station)
measure: Percent of people nearby handwashing station observed to use handwashing station (subsample of handwashing stations and villages)
timeFrame: 2 weeks post-intervention (exact timing will vary by station)
measure: Percent of people nearby handwashing station observed to be wearing face masks and coverings (subsample of handwashing stations and villages)
timeFrame: 2 weeks post-intervention (exact timing will vary by station)
measure: Proportion of handwashing station users who are repeat users (subsample of handwashing stations and villages)
timeFrame: 4 weeks post-intervention (exact timing will vary by station)
Locations:
city: Dhaka
country: Bangladesh
facility: BRAC
city: Khulna
country: Bangladesh
facility: BRAC Khulna
city: Mymensingh
country: Bangladesh
facility: BRAC Mymensingh
Study officials:
affiliation: Behavioural Insights Team
name: Stewart Kettle, PhD
role: PRINCIPAL_INVESTIGATOR
References: