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Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia

BACKGROUND: Hygiene promotion is a cornerstone of humanitarian response during infectious disease outbreaks. Despite this, we know little about how humanitarian organisations design, deliver or monitor hygiene programmes, or about what works to change hygiene behaviours in outbreak settings. This st...

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Autores principales: Czerniewska, Alexandra, White, Sian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995147/
https://www.ncbi.nlm.nih.gov/pubmed/32005207
http://dx.doi.org/10.1186/s12889-020-8240-9
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author Czerniewska, Alexandra
White, Sian
author_facet Czerniewska, Alexandra
White, Sian
author_sort Czerniewska, Alexandra
collection PubMed
description BACKGROUND: Hygiene promotion is a cornerstone of humanitarian response during infectious disease outbreaks. Despite this, we know little about how humanitarian organisations design, deliver or monitor hygiene programmes, or about what works to change hygiene behaviours in outbreak settings. This study describes humanitarian perspectives on changing behaviours in crises, through a case study of hygiene promotion during the 2014–2016 Liberian Ebola outbreak. Our aim was to aid better understanding of decision making in high-stress situations where there is little precedent or evidence, and to prompt reflection within the sector around how to improve and support this. METHODS: We conducted in-depth, semi-structured interviews with fourteen purposively-sampled individuals (key informants) from international organisations involved in hygiene behaviour change during the outbreak. Through thematic analysis we identified the decisions that were made and processes that were followed to design, deliver and monitor interventions. We compared our findings with theory-driven processes used to design behaviour change interventions in non-outbreak situations. RESULTS: Humanitarians predominantly focussed on providing hygiene products (e.g. buckets, soap, gloves) and delivering messages through posters, radio and community meetings. They faced challenges in defining which hygiene behaviours to promote. Assessments focused on understanding infrastructural needs, but omitted systematic assessments of hygiene behaviours or their determinants. Humanitarians assumed that fear and disease awareness would be the most powerful motivators for behaviour change. They thought that behaviour change techniques used in non-emergency settings were too ‘experimental’, and were beyond the skillset of most humanitarian actors. Monitoring focussed on inputs and outputs rather than behavioural impact. CONCLUSIONS: The experiences of humanitarians allowed us to identify areas that could be strengthened when designing hygiene programmes in future outbreaks. Specifically, we identified a need for rapid research methods to explore behavioural determinants; increased skills training for frontline staff, and increased operational research to explore behaviour change strategies that are suited to outbreak situations.
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spelling pubmed-69951472020-02-04 Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia Czerniewska, Alexandra White, Sian BMC Public Health Research Article BACKGROUND: Hygiene promotion is a cornerstone of humanitarian response during infectious disease outbreaks. Despite this, we know little about how humanitarian organisations design, deliver or monitor hygiene programmes, or about what works to change hygiene behaviours in outbreak settings. This study describes humanitarian perspectives on changing behaviours in crises, through a case study of hygiene promotion during the 2014–2016 Liberian Ebola outbreak. Our aim was to aid better understanding of decision making in high-stress situations where there is little precedent or evidence, and to prompt reflection within the sector around how to improve and support this. METHODS: We conducted in-depth, semi-structured interviews with fourteen purposively-sampled individuals (key informants) from international organisations involved in hygiene behaviour change during the outbreak. Through thematic analysis we identified the decisions that were made and processes that were followed to design, deliver and monitor interventions. We compared our findings with theory-driven processes used to design behaviour change interventions in non-outbreak situations. RESULTS: Humanitarians predominantly focussed on providing hygiene products (e.g. buckets, soap, gloves) and delivering messages through posters, radio and community meetings. They faced challenges in defining which hygiene behaviours to promote. Assessments focused on understanding infrastructural needs, but omitted systematic assessments of hygiene behaviours or their determinants. Humanitarians assumed that fear and disease awareness would be the most powerful motivators for behaviour change. They thought that behaviour change techniques used in non-emergency settings were too ‘experimental’, and were beyond the skillset of most humanitarian actors. Monitoring focussed on inputs and outputs rather than behavioural impact. CONCLUSIONS: The experiences of humanitarians allowed us to identify areas that could be strengthened when designing hygiene programmes in future outbreaks. Specifically, we identified a need for rapid research methods to explore behavioural determinants; increased skills training for frontline staff, and increased operational research to explore behaviour change strategies that are suited to outbreak situations. BioMed Central 2020-01-31 /pmc/articles/PMC6995147/ /pubmed/32005207 http://dx.doi.org/10.1186/s12889-020-8240-9 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Czerniewska, Alexandra
White, Sian
Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia
title Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia
title_full Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia
title_fullStr Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia
title_full_unstemmed Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia
title_short Hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the Ebola outbreak in Liberia
title_sort hygiene programming during outbreaks: a qualitative case study of the humanitarian response during the ebola outbreak in liberia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995147/
https://www.ncbi.nlm.nih.gov/pubmed/32005207
http://dx.doi.org/10.1186/s12889-020-8240-9
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