Hand Washing Practice
English: % of respondents who washed their hands with soap or ash in at least 3 out of 5 critical occasions in the past 2 days
French: % des répondants qui déclarent s’être lavé les mains avec du savon ou de la cendre au moins 3 fois sur 5 moments clés au cours des deux derniers jours
Czech: % respondentů, kteří si v posledních 2 dnech myli ruce mýdlem či popelem alespoň ve 3 z 5 klíčových situacích
What is its purpose?
Washing hands with soap is the most effective way for preventing life-threatening diarrhoeal diseases. This indicator therefore measures whether people (report to) wash their hands with soap or ash at least 3 out of 5 most important moments.
How to Collect and Analyse the Required Data
Collect the following data by conducting individual interviews with a representative sample of your target group members:
RECOMMENDED SURVEY QUESTIONS (Q) AND POSSIBLE ANSWERS (A)
Q1: In the past two days, on which occasions did you wash your hands? Please mention all the situations you remember.
1) after going to toilet
2) after attending to a child who has defecated
3) before preparing food
4) before feeding a child
5) before eating
6) other: ................................
7) other: ................................
8) I don't know
Q2: What did you wash your hands with?
1) water and soap
2) water and ash/ sand
3) only water
4) other: ..................................
NOTE: 1) multiple answers possible; 2) do not read the pre-defined answers
Calculate the indicator's value by dividing the number of respondents who report to wash their hands with soap or ash at least 3 out of 5 critical times by the total number of interviewed respondents and multiplying the result by 100.
1) In many contexts, men and children do not prepare meals, feed children or attend to children which have defecated (i.e. the three situations when hands should be washed). Therefore, if your target groups are men or children, revise the indicator to "% of respondents who washed their hands with soap or ash in at least 2 critical occasionsin in the past 2 days" (i.e. before eating and after going to toilet).
2) Reporting on hand washing is prone to so called "social desirability bias" - people overestimate their positive and underestimate negative practices. In a study by Manun’Ebo et al. (1997), the frequency of washing hands with soap and water before eating was reported by 14 percent of respondents but observed for only 2 percent of respondents. In Bangladesh, 77 percent of respondents reported washing hands with soap or ash after defecation; however, only 32 percent were observed to do so. Read IndiKit's Rapid Guide to Individual Interviews to learn how to reduce such risk.
3) Always assess the indicator together with assessing also the following two indicators: 1) availability of soap in the household and the 2) availability of a designated place for hand washing. Always analyse the proportion of respondents who reported to wash their hands versus the proportion of those who have soap at home/ who have hand washing station with water and soap at home. This proportion will indicate to what extent the reported hand washing practice is likely to be accurate.
4) Although people usually over-report their hand washing practices, they also sometimes forget to mention the occasions on which they usually wash their hands. Therefore it is important that after the respondent replies, the data collector keeps probing by asking, for example: "Are there any other moments when you usually wash your hands?" or "Think about all the different things you are doing during the day. Are there any before or after which you wash your hands?" (at the same time, ensure that the data collectors never read the pre-defined answers)
5) When asking people about when they wash their hands, one of the most common (and logical) answers is "When my hands are dirty". Although such answer is not included among the commonly promoted "5 critical moments", it is of course a correct answer. When your data collector receives such answer, s/he should always probe further by asking, for example, "Before and after which occasions are your hands dirty?" or "On what occasions do you think that hands must be washed, so that they are clean?"
6) Handwashing practice depends on households' access to water. Since access to water is often prone to seasonal variations, the data required for this indicator might be prone to seasonal differences. Thereore, do your best to collect baseline and endline data in the same period of a year; otherwise they might not be comparable.
7) Disaggregate the data by sex.