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. 2018 Apr 11;18(1):483.
doi: 10.1186/s12889-018-5365-1.

Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh

Shahana Parveen  1 , Sharifa Nasreen  2 , Jelena V Allen  3 , Kelly B Kamm  3 , Shifat Khan  2 , Shirina Akter  2 , Tajnin Marin Lopa  2 , K Zaman  3 , Shams El Arifeen  3 , Stephen P Luby  2   4 , Pavani K Ram  5
Affiliations

Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh

Shahana Parveen et al. BMC Public Health. .

Abstract

Background: To design a maternal handwashing intervention for the newborn period, this qualitative study explored drivers of handwashing among mothers and other caregivers of neonates and infants in two rural areas of Bangladesh.

Methods: We conducted 40 semi-structured observation sessions to observe handwashing behaviors of primiparous and multiparous mothers of neonates, and to understand the contextual factors that facilitated or hampered those behaviors. We then conducted 64 interviews with mothers of neonates and mothers of infants and 6 group discussions with mothers of infants, other female caregivers and fathers to explore perceptions, beliefs, and practices related to handwashing in the neonatal period. Based on a conceptual model and the Theory of Reasoned Action/Theory of Planned Behavior, we developed a conceptual model a priori, we performed thematic analysis to explain determinants of maternal handwashing behaviors.

Results: We conducted 200 h of observation among mothers of neonates. The age range of participating mothers varied between 17 and 25 years and their maximum education was up to 10th grade of schooling. Mothers, other female caregivers and fathers perceived a need to wash hands with or without soap before eating or before feeding a child by hand to prevent diarrhea. Mothers expressed the importance of washing their hands before holding a baby but were rarely observed doing so. All respondents prioritized using soap for visible dirt or feces; otherwise, water alone was considered sufficient. Lack of family support, social norms of infrequent handwashing, perceptions of frequent contact with water as a health threat and mothers' restricted movement during first 40 days of neonate's life, and childcare and household responsibilities adversely impacted handwashing behavior.

Conclusions: Addressing emotive drivers of handwashing within existing social norms by engaging family members, ensuring handwashing facilities and clarifying neonatal health threats may improve maternal handwashing behavior in the neonatal period.

Keywords: Bangladesh; Handwashing; Maternal; Neonatal.

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Conflict of interest statement

Authors’ information

SP is working as Assistant Scientist at Programme for Emerging Infections under Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh. She served as qualitative researcher and led several qualitative and mixed method studies including interventions related to hand hygiene and infection control.

Ethics approval and consent to participate

The interviewers read aloud the consent form to potential respondents, explained their voluntary participation in the study, then sought for and obtained written consent (signature or thumb print) when one agreed to take part. The study protocols for Matlab and Habigonj were reviewed and approved by the Ethical Review Committee of icddr,b. The protocol for Habigonj data collection was also approved by the Institutional Review Board of Social and Behavioral Sciences at the University at Buffalo.

Consent for publication

Not applicable.

Competing interests

The authors declare that there is no competing interest regarding the publication of this paper.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Conceptual model to explain motivations of maternal handwashing behavior in the neonatal period
Fig. 2
Fig. 2
Performed handwashing within observed opportunities at critical times related to childcare (those observed > 10 times) among mothers of neonates/other caregivers in Matlab, Bangladesh, 2010–2011
Fig. 3
Fig. 3
Performed handwashing within observed opportunities at critical times related to childcare (those observed > 10 times) among mothers of neonates/other caregivers in Habigonj, Bangladesh, 2011
See this image and copyright information in PMC

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