Background

Hygiene promotion interventions are likely to be more effective if they target the determinants of handwashing behaviour. Synthesis of the evidence on the determinants of handwashing behaviour is needed to enable practitioners to use evidence in hygiene promotion programming.

Purpose

To identify, define and categorise the determinants of handwashing behaviour in domestic settings and to appraise the quality of this evidence.

Methods

We conducted an integrative review, searching three databases for terms related to handwashing and behaviour change determinants. Studies were summarised and their quality assessed against a pre-defined set of criteria for qualitative, quantitative and mixed-method studies. Data on determinants were extracted and classified according to a predefined theoretical taxonomy. The effect of each association between a determinant and handwashing behaviour was summarised and weighted based on the quality of evidence provided. Determinants that were reported more than three times were combined into a meta-association and included in the main analysis. Sub-analyses were done for studies conducted during outbreaks or humanitarian crises.

Results

Seventy-eight studies met the criteria. Of these, 18% were graded as ‘good quality’ and 497 associations between determinants and handwashing behaviour were extracted. We found that 21% of these associations did not clearly define the determinant and 70% did not use a valid or reliable method for assessing determinants and/or behaviour. Fifty meta-associations were included in the main analysis. The determinants of handwashing that were most commonly reported were knowledge, risk, psychological trade-offs or discounts, characteristic traits (like gender, wealth and education), and infrastructure. There was insufficient data to draw conclusions about the determinants of behaviour in outbreaks or crises.

Conclusions

This review demonstrates that our understanding of behavioural determinants remains sub-optimal. We found that there are limitations in the way behavioural determinants are conceptualised and measured and that research is biased towards exploring a narrow range of behavioural determinants. Hygiene promotion programmes are likely to be most successful if they use multi-modal approaches, combining infrastructural improvement with ‘soft’ hygiene promotion which addresses a range of determinants rather than just education about disease transmission.

中文翻译：

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家庭环境中洗手行为的决定因素：全面的系统评价。

背景

卫生促进干预措施如果针对洗手行为的决定因素，可能会更有效。需要综合有关洗手行为决定因素的证据，以使从业人员能够在卫生促进计划中使用证据。

目的

对家庭环境中洗手行为的决定因素进行识别，定义和分类，并评估该证据的质量。

方法

我们进行了一次综合审查，在三个数据库中搜索了与洗手和行为改变决定因素有关的术语。根据定性，定量和混合方法研究的预定标准，对研究进行了总结并评估了其质量。根据预定的理论分类法提取行列式数据并进行分类。决定因素和洗手行为之间的每种关联的影响都根据提供的证据质量进行了总结和加权。报告次数超过三次的行列式被合并到一个元关联中，并包括在主要分析中。对爆发或人道主义危机期间进行的研究进行了子分析。

结果

78项研究符合标准。其中，有18％被评为“良好质量”，并且提取了497个决定因素与洗手行为之间的关联。我们发现，这些关联中有21％并未明确定义行列式，而70％并未使用有效或可靠的方法来评估行列式和/或行为。主要分析中包括五十个元关联。最常报告的洗手决定因素是知识，风险，心理权衡或折扣，特征（例如性别，财富和教育）和基础设施。没有足够的数据得出关于爆发或危机中行为决定因素的结论。

结论

这项审查表明，我们对行为决定因素的理解仍然不是最理想的。我们发现，行为决定因素的概念化和度量方式存在局限性，并且研究偏向于探索范围狭窄的行为决定因素。如果卫生促进计划采用多模式方法，将基础设施改善与“软”卫生促进相结合，则可能会最成功，而“软”卫生促进不仅要解决疾病传播方面的教育问题，还要解决一系列决定因素。