Structured observations of hygiene behaviours in Burkina Faso : validity, variability, and utility

The use of observation techniques has been promoted for the study of hygiene practices; however, questions still remain about the validity and repeatability of such techniques. In this article data on hygiene behaviours obtained from questionnaires are compared with data obtained using a structured observation approach and the repeatability of structured observations of behaviours and spot observations of environmental conditions are examined. Poor agreement between questionnaire responses and observations was found for child defaecation and stool disposal practices. There was evidence of overreporting "good" behaviour. Repeated observations of child defaecation and stool disposal behaviours showed better agreement based on small sample sizes. These findings suggest that the questionnaire data are less valid than data obtained by direct observation. However, different approaches to questioning may be less prone to over-reporting of "good" behaviours than our approach. Further research into the validity of different forms of question is warranted. Behaviours and conditions related to hygiene vary. Observations may be useful in determining the frequency of different behaviour/conditions in the community. However, individual practices may be too variable to assign individuals to exposed and non-exposed groups for the purpose of identifying links with health outcomes.