Practical Guidance for Measuring Handwashing Behavior

The Water and Sanitation Program is a multi-donor partnership administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. thanks go to them for their constant interest in this topic and their intellectual generosity. Global Scaling Up Handwashing is a Water and Sanitation Program (WSP) project focused on learning how to apply innovative promotional approaches to behavior change to generate widespread and sustained improvements in handwashing with soap at scale among women of reproductive age (ages 15–49) and primary school-aged children (ages 5–9). The project is being implemented by local and national governments with technical support from WSP. For more information, please visit www.wsp.org/scalinguphandwashing. This Working Paper is one in a series of knowledge products designed to showcase project findings, assessments, and lessons learned in the Global Scaling Up Handwashing Project. This paper is conceived as a work in progress to encourage the exchange of ideas about development issues. For more information please email Pavani Ram at [email protected] or visit our website at www.wsp.org. WSP is a multi-donor partnership created in 1978 and administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. States, and the World Bank. WSP reports are published to communicate the results of WSP's work to the development community. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of the World Bank Group concerning the legal status of any territory or the endorsement or acceptance of such boundaries. iii Executive Summary Accurate measures of handwashing behavior are critical to understanding households' health environment. But it can be challenging to measure handwashing reliably. This document discusses a set of handwashing indicators and recommendations that was prepared to support the Water and Sanitation Program's six-country scaling-up of handwash-ing promotion and community-led total sanitation. Descriptions of these measures, and the recommendations for their use (Table 1), should be of interest to a broad audience. The following handwashing measures are assessed based on their validity, reliability, and efficiency: Self-reports are the easiest way to measure handwashing. But they are invalid as measures of handwashing behavior because individuals often report better handwashing behavior than they display during observation. This exaggeration of true behavior may result from a perceived high social desirability of handwashing. However, self-reports remain …