Thomas, Elizabeth (Liz)
School of Public Health - International Health
Multi-level behavioral determinants of sustained water, sanitation, and hygiene behavior change for household contacts of hospitalized diarrhea patients
Diarrhea is a leading cause of childhood morbidity and mortality. Access to a safe domestic water source and handwashing with soap are demonstrated to reduce burden of disease, but interventions to address these factors rely on sustained behavior change in order to succeed. The Cholera-Hospital-Based Intervention for 7 days (CHoBI7) is a water treatment and handwashing with soap intervention that uses the time patients and caregivers spend in the health facility for intervention delivery. The intervention package has demonstrated success at short and long-term behavior uptake for hospitalized cholera patients, and is now being evaluated for effectiveness of a scalable approach designed for household contacts of hospitalized patients with any type of diarrhea. Households enrolled in the ongoing CHoBI7 randomized controlled trial are reaching the end of the 12-month intervention and evaluation period. As part of dissertation research, I propose to do a doer/non-doer analysis of intervention households in order to identify individual, household, and community-level determinants of sustained behavior change among households that received the CHoBI7 intervention. Objectives for the proposed research period include (1) identification of doer and non-doer households, (2) in-depth exploration of barriers and facilitators to sustained behavior change, (3) development of a conceptual framework for multi-level factors that determine behavior uptake, (4) evaluation of doer and non-doer households on key factors identified, and (5) analytic comparison of doer and non-doer households to identify salient determinants for sustained behavior change. The proposed research will inform large-scale implementation of the CHoBI7 intervention for hospitals in Dhaka, Bangladesh.