Exploring behavioral determinants of handwashing with soap after defecation in an urban setting in Bangladesh: findings from a barrier analysis

Social and behavior change (SBC) has long been recognized as a necessary step in the promotion of handwashing with soap (HHWS), and identifying the barriers and enablers of this behavior are key to increasing its adoption. Based on the health belief model (HBM), the theory of reasoned action (TRA) and other behavioral models, this barrier analysis study was conducted to identify the barriers and enablers of HWWS after defecation in an urban setting in Bangladesh. We conducted interviews with 45 adults who washed their hands with soap after defecation (doers) and compared them to 45 adults who did not (non-doers). The analysis showed that the main barriers of HWWS after defecation were related to perceived self-efficacy, difficulty to remember to buy soap, access to low-cost soap, low perceived severity of diarrhea, and not believing that HWWS would reduce diarrhea. Believing that it is Allah's will when one gets diarrhea was mentioned more frequently by the non-doers, while feeling clean and keeping free from illness were reported as benefits of HWWS significantly by the doers. The results suggest that an SBC strategy that addresses these key barriers and enablers would be more effective in promoting the adoption of HWWS.