Practical Guidance for Measuring Handwashing Behavior: 2013 Update.
Pavani Ra, Water and Sanitation Program
Excerpts from the Executive Summary:
Self-reports via questionnaire are the easiest way to measure handwashing. Several studies have shown a relationship between self-reported handwashing behavior and disease risk. But, 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. Questionnaires remain an important source of information about handwashing knowledge and other determinants of handwashing behavior.
Studies with minimal funding should consider carrying out structured observations in a small sample of households, primarily to assess change in behaviors targeted by the handwashing intervention. Rapid observations are the most efficient source of household-level handwashing information. Rapid observations are markers for actual behavior. Self-reports may be used to measure knowledge and other possible determinants of handwashing behavior. Minimally funded studies that need affordable yet reliable methods to monitor handwashing behavior may warrant an investment in sample size estimates by a statistician or epidemiologist. These investments can frequently pay for themselves, as sample needs are frequently much lower than expected.