Hand WashingNCT04765540
The Effect of Behaviour Change Interventions on Use of Public Handwashing Stations in Bangladesh
A study testing Low Intensity Nudges, High Intensity Activities and BRAC's business-as-usual in people with Hand Washing and Handwashing, run by The Behavioural Insights Team at 3 sites in Bangladesh.
Trial 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. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Hand Washing, Handwashing, Covid19
- What is being tested?
- Low Intensity Nudges, High Intensity Activities and BRAC's business-as-usual
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 855 participants
- Where
- 3 sitesBangladesh
- Study dates
- 3 Jan 2021to 6 May 2021
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- 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
Who cannot join
- 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
Trial locations and contacts
3 sites in 1 country.
Bangladesh3 sites
BRAC
Dhaka, Dhaka-1212
BRAC Khulna
Khulna
BRAC Mymensingh
Mymensingh
About this study
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.
Read the 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.
- Conditions
- Hand Washing, Handwashing, Covid19
- Being tested
- Low Intensity Nudges, High Intensity Activities, BRAC's business-as-usual
- 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
- Medical subject headings
- COVID-19
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Low Intensity NudgesBehavioural
A bundle of 'low-intensity' passive interventions, including:
Large Mirrors \& hand-shaped sign posts pointing to the station
High Intensity ActivitiesBehavioural
A bundle of 'high-intensity' active interventions delivered for three weeks, including:
Free soap and free facemasks for handwashing station users, a community message board \& general encouragement
BRAC's business-as-usualBehavioural
A set of community activities to increase awareness of public handwashing stations and the need to use them. This includes in-person group sessions demonstrating hand hygiene as well as stickers and posters placed in the community to alert people to the handwashing stations.
| Study group | Role | What they receive |
|---|---|---|
| T1: Business as Usual (BAU) | Active comparator | Handwashing station plus standard BRAC programming, i.e. in-person community WASH (water, sanitation and hygiene) demonstrations conducted in households/communal areas, and sticker signs/posters placed on walls in the 'catchment area' of the handwashing station, alerting people to the stations and roughly pointing the way. Receives: Behavioral: BRAC's business-as-usual |
| T2: BAU + Low Intensity Nudges | Experimental | T1 plus a bundle of 'low-intensity' passive interventions, including:
* Large mirrors installed above handwashing station sinks to attract more people to the station
* 7 to 8 large hand-shaped signposts pointing to the station and leading up to the station, placed on the ground in the vicinity of the station, starting from the nearest 'busy spot' Receives: Behavioral: Low Intensity Nudges; Behavioral: BRAC's business-as-usual |
| T3: BAU + High Intensity Activities | Experimental | T1 plus an additional bundle of 'high-intensity' active interventions delivered for three weeks, including:
* Free soap and free facemasks provided to handwashing station users in regular giveaways at key times, along with encouragement to return to the station and to spread the word.
* A 'community message board' along with encouragement to make a mark on a "scoreboard" at the top of the board before/after use of the station to increase commitment and as an additional social cue. This will also visually show cumulative number of uses as a persistent cue of the social norm.
* General encouragement to use the stations, provided by the intervention delivery team while they are at the station. Intervention team members are equipped with a loudhailer to assist this.
* In addition, village handwashing station committees will be encouraged to try out their own ideas for encouraging more people to use the stations. Receives: Behavioral: High Intensity Activities; Behavioral: BRAC's business-as-usual |
What is being measured
The primary outcome is the main question the study is designed to answer.
Average handwashing station soap pedal presses per day (in weeks 1 to 3)
The investigators will use the number of times the soap pedals on the handwashing stations are pressed as a proxy measure of the frequency of use of the handwashing station for handwashing with soap. This data will be collected via mechanical tally counters ('clickers') connected to the soap pedals such that their count increments when the soap pedal is pressed. The clicker counts will be recorded at 4 points each day for 5 days per week. The investigators will use this information to infer the average number of soap pedal presses per day in the three weeks after the T2 and T3 interventions are first installed or delivered.
The investigators will also attempt to translate this outcome to an estimate of the number of times the handwashing station was used per day, by correlating soap pedal presses with counts of handwashing station users gathered via structured observations in 3 half-hour periods each day.
Measured: At the end of 3 weeks post-implementation
Secondary outcomes (1)
Average handwashing station soap pedal presses per day (in weeks 4 to 6)
This outcome will be measured identically to the primary outcome, but measures usage over the slightly longer term (the second three-week period after the T2 and T3 interventions are first installed or delivered).
The investigators will also attempt to translate this outcome to an estimate of the number of times the handwashing station was used per day, by correlating soap pedal presses with counts of handwashing station users gathered via structured observations in 3 half-hour periods each day.
Measured: At the end of 6 weeks post-intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Feb 2021
- Study start3 Jan 2021
- Primary completion6 May 2021
- Study completion6 May 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Hand WashingStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- 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.
- Masking
- None (open label)
- Enrolment
- 855 participants (actual)
Sponsor and investigators
- Lead sponsor
- The Behavioural Insights Team
- Sponsor type
- University, hospital or other
- Collaborators
- Brac, BRAC Institute of Governance and Development, Unilever U.K. Central Resources Limited, D2 Technologies Ltd, Bangladesh, Foreign, Commonwealth and Development Office, U.K.
- Responsible party
- Principal investigator, Stewart Kettle, The Behavioural Insights Team
- Investigators
- Stewart Kettle, PhD, Principal investigator, Behavioural Insights Team
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04765540
- Sponsor's protocol ID
- 2020091
- Status last verified
- Jul 2021
- First submitted
- 6 Jan 2021
- Last updated
- 22 Jul 2021
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 22 Jul 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of Behaviour Change Interventions on Use of Public Handwashing Stations in Bangladesh
- ClinicalTrials.gov ID
- NCT04765540
- Acronym / sponsor ID
- 2020091
- Conditions
- Hand Washing, Handwashing, Covid19
- Keywords
- Covid19, Handwashing, Hand Washing, COVID-19 Virus Prevention, COVID-19 Virus Infection, Behavioural Science, Nudges, Incentives
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 855 participants (actual)
- Lead sponsor
- The Behavioural Insights TeamUniversity, hospital or other
- Collaborators
- Brac, BRAC Institute of Governance and Development, Unilever U.K. Central Resources Limited, D2 Technologies Ltd, Bangladesh, Foreign, Commonwealth and Development Office, U.K.
- Study start
- 3 Jan 2021 (actual)
- Primary completion
- 6 May 2021 (actual)
- Study completion
- 6 May 2021 (actual)
- First posted
- 21 Feb 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
- 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.
| Arm | Type | Receives |
|---|---|---|
| T1: Business as Usual (BAU) | Active comparator | Behavioral: BRAC's business-as-usualHandwashing station plus standard BRAC programming, i.e. in-person community WASH (water, sanitation and hygiene) demonstrations conducted in households/communal areas, and sticker signs/posters placed on walls in the 'catchment area' of the handwashing station, alerting people to the stations and roughly pointing the way. |
| T2: BAU + Low Intensity Nudges | Experimental | Behavioral: Low Intensity Nudges, Behavioral: BRAC's business-as-usualT1 plus a bundle of 'low-intensity' passive interventions, including: * Large mirrors installed above handwashing station sinks to attract more people to the station * 7 to 8 large hand-shaped signposts pointing to the station and leading up to the station, placed on the ground in the vicinity of the station, starting from the nearest 'busy spot' |
| T3: BAU + High Intensity Activities | Experimental | Behavioral: High Intensity Activities, Behavioral: BRAC's business-as-usualT1 plus an additional bundle of 'high-intensity' active interventions delivered for three weeks, including: * Free soap and free facemasks provided to handwashing station users in regular giveaways at key times, along with encouragement to return to the station and to spread the word. * A 'community message board' along with encouragement to make a mark on a "scoreboard" at the top of the board before/after use of the station to increase commitment and as an additional social cue. This will also visually show cumulative number of uses as a persistent cue of the social norm. * General encouragement to use the stations, provided by the intervention delivery team while they are at the station. Intervention team members are equipped with a loudhailer to assist this. * In addition, village handwashing station committees will be encouraged to try out their own ideas for encouraging more people to use the stations. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (6 listed)
- 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
Key exclusion criteria (3 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Low Intensity NudgesA bundle of 'low-intensity' passive interventions, including: Large Mirrors \& hand-shaped sign posts pointing to the station | Behavioural | T2: BAU + Low Intensity Nudges |
| High Intensity ActivitiesA bundle of 'high-intensity' active interventions delivered for three weeks, including: Free soap and free facemasks for handwashing station users, a community message board \& general encouragement | Behavioural | T3: BAU + High Intensity Activities |
| BRAC's business-as-usualA set of community activities to increase awareness of public handwashing stations and the need to use them. This includes in-person group sessions demonstrating hand hygiene as well as stickers and posters placed in the community to alert people to the handwashing stations. | Behavioural | T1: Business as Usual (BAU), T2: BAU + Low Intensity Nudges, T3: BAU + High Intensity Activities |
Primary outcome
Average handwashing station soap pedal presses per day (in weeks 1 to 3)
Time frame: At the end of 3 weeks post-implementation
The investigators will use the number of times the soap pedals on the handwashing stations are pressed as a proxy measure of the frequency of use of the handwashing station for handwashing with soap. This data will be collected via mechanical tally counters ('clickers') connected to the soap pedals such that their count increments when the soap pedal is pressed. The clicker counts will be recorded at 4 points each day for 5 days per week. The investigators will use this information to infer the average number of soap pedal presses per day in the three weeks after the T2 and T3 interventions are first installed or delivered. The investigators will also attempt to translate this outcome to an estimate of the number of times the handwashing station was used per day, by correlating soap pedal presses with counts of handwashing station users gathered via structured observations in 3 half-hour periods each day.
1 secondary outcome
Average handwashing station soap pedal presses per day (in weeks 4 to 6)
Time frame: At the end of 6 weeks post-intervention
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Jul 2021.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Stewart Kettle, PhD principal investigator
Behavioural Insights Team
3 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Low Intensity Nudges, High Intensity Activities and BRAC's business-as-usual in people with Hand Washing and Handwashing, run by The Behavioural Insights Team at 3 sites in Bangladesh.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 22 Jul 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in Bangladesh. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Average handwashing station soap pedal presses per day (in weeks 1 to 3) (time frame: At the end of 3 weeks post-implementation). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jul 2021.