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TitleFactors determining the effectiveness of Oxfam’s public health promotion approach in Haiti
Publication TypeMiscellaneous
Year of Publication2012
AuthorsContzen, N, Mosler, H-J
Pagination73 p.; 32 fig.; 13 tab.
Date Published2012-02-29
PublisherSwiss Federal Institute for Environmental Science and Technology (EAWAG)
Place PublishedDuebendorf, Switzerland
Keywordsdata analysis, data processing, haiti, hand washing, public health, sanitation, water consumption

In response to the devastating earthquake of january 12th 2010 and the cholera outbreak of october of that same year Oxfam Great Britain, Oxfam Quebec and Intermón Oxfam conducted public health promotion and cholera response in Haiti. Different promotion activities were applied which aimed at changing hygiene behavior by changing perceptions and beliefs about healthy behaviors amongst people affected by crisis. In february 2011 four Oxfam affiliates in Haiti in partnership with a team of behavior change researchers from Eawag launched the present research project to do an in-depth evaluation of the promotional activities that had been conducted with the goal of further improving the WASH situation for people in Haiti and worldwide by understanding how to make hygiene promotion more effective. The main focus of the research project was around the question which specific promotion activities were strongly associated with perceptions and beliefs about handwashing with soap and were thus capable of changing handwashing behavior at key times. To address this question, 811 structured interviews with the primary caretaker of a household were conducted in may and june 2011 in camps and neighborhoods in Port-au-Prince, Gressier, Petit Goâve, Grand-Goâve, and Léogâne. Regression analysis revealed that attitudes, norms and ability beliefs are most important in determining handwashing behavior at key times while health risk beliefs and health knowledge are of only minor importance. In terms of promotion activities, regression and mediation analysis revealed hygiene radio spots, material distributions with instructions for use, information from friends or neighbors, and hygiene theater were strongly associated with feces and food related handwashing. In addition, radio programs with experts answering listener’s questions fostered feces related hand washing while community clubs were beneficial for food related handwashing. However, some of the promotion activities are negatively associated with handwashing at key times. Respondents who experienced a focus group, stickers, posters and paintings, and hygiene songs wash their hands less often after any contact with feces or before handling food than respondents who did not experience
these promotion activities. Moreover, special hygiene days and home visits are negatively associated with food related handwashing as well. Further analyses revealed that a combination of effective promotion activities (e.g. radio spots, material distributions, and community clubs) is more effective than applying only one fostering promotion. On the down side it is more hampering when a combination of hindering promotion activities (e.g. focus group, stickers, posters, paintings, and hygiene songs) are experienced than if only one hindering promotion is experienced. However, if fostering and hindering promotion activities are experienced, the effectiveness of the fostering promotion activities is stronger, overlaying the effect of the hindering promotion activities.In summary, some of the promotion activities which have been applied by Oxfam are positively associated with behavior, some are negatively associated, while other promotion activities have no effect at all. Accordingly, some of the promotion activities should be seriously revised and others although successful still have the potential to be improved. Carefully redesigning some activities, conducting pre-tests, and subsequently protocoling the behavior change effects of the promotion activities in the field is necessary to  ensure reliable and effective promotion activities. [authors abstract]

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