Factors of Social Cognitive Theory Mediating Intervention Effects on Handwashing: a Longitudinal Study

Abstract

Diarrhoea, a leading cause of death in children under the age of five years, is best prevented by handwashing (HW). Standard education compared to theory-based approaches are rarely effective to promote HW, and their change mechanisms are often unknown. We therefore aimed to test the change mechanisms of two HW interventions based on social cognitive theory (SCT), extended by forgetting. The two interventions, a public commitment and an infrastructure promotion, were combined with education and compared to education only in a nonrandomized trial in Ethiopia. Data were collected before and after the interventions by interviewing 408 randomly selected households’ primary caregivers. Mediation analyses were conducted. In comparison to the education intervention, the SCT interventions were more successful in changing handwashing, because they successfully changed SCT-factors and forgetting (total indirect effects [CI]: 0.08 [0.01, 0.14] to 0.14 [0.07, 0.21]). The study emphasizes not only the relevance of SCT in informing health interventions, but also highlights the importance of forgetting. The results confirmed the relevance of testing interventions’ underlying change processes.