Hand Washing Practice

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 in at least 3 out of 5 most important moments.

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 moments you remember. 

A1: _

1) after going to the 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

NOTES:

1) Probe: "Think about all the different things you did in the past two days. Are there any other moments before or after which you washed your hands?"

2) do not read the pre-defined answers

Q2: What did you wash your hands with?

A2: _

1) water and soap

2) water and ash/ sand

3) only water

4) other: ..................................

To calculate the indicator's value, divide the number of respondents who reported to wash their hands with soap or ash at least 3 out of 5 critical times by the total number of interviewed respondents. Multiply the result by 100 to convert it to a percentage. 

Disaggregate the data by gender and age groups.

1) 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.

2) Due to the social desirability bias, consider replacing this indicator with an indicator focusing on the availability of a handwashing facility with water and soap - it is likely to provide more accurate insights into people's handwashing practices. 

3) In many contexts, men and children do not prepare meals, feed children or attend to children who 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 occasions in the past 2 days" (i.e. before eating and after going to toilet). 

4) When asking people about when they wash their hands, one of the most common (and logical) answers is "When my hands were dirty". Although such an 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 were your hands dirty?"

5) 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. Therefore, do your best to collect baseline and endline data in the same period of a year; otherwise they might not be comparable.