Social Influence on Handwashing with Soap: Results from a Cluster Randomized Controlled Trial in Bangladesh

Am J Trop Med Hyg. 2018 Oct;99(4):934-936. doi: 10.4269/ajtmh.17-0903.


We analyzed data from a cluster-randomized controlled trial conducted among 20 schools in Rajshahi, Bangladesh, to explore the role of social influence on handwashing with soap (HWWS) in a primary school setting. Using data collected through covert video cameras outside of school latrines, we used robust Poisson regression analysis to assess the impact of social influence-defined as the presence of another person near the handwashing location-on HWWS after a toileting event. In adjusted analyses, we found a 30% increase in HWWS when someone was present, as compared with when a child was alone (Prevalence ratio 1.30; 95% confidence interval: 1.14-1.47, P < 0.001). The highest prevalence of HWWS was found when both child(ren) and adult(s) were present or when just children were present (64%). Our study supports the conclusion that the presence of another individual after a toileting event can positively impact HWWS in a primary school setting.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Bangladesh
  • Child
  • Child, Preschool
  • Female
  • Hand Disinfection / trends*
  • Health Behavior*
  • Health Education / methods*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Peer Influence
  • Schools
  • Soaps
  • Students / psychology*
  • Video Recording


  • Soaps