This integrative review aimed to identify, define and categorise the determinants of handwashing behaviour in domestic settings. The most reported determinants of handwashing were knowledge, risk, psychological trade-offs or discounts, characteristic traits (like gender, wealth and education), and infrastructure. There was insufficient data to on the determinants of behaviour in outbreaks or crises. Overall the review demonstrates that understanding of behavioural determinants remains sub-optimal and that hygiene promotion programmes are likely to be most successful if they use multi-modal approaches, combining infrastructural improvement with ‘soft’ hygiene promotion which addresses a range of determinants rather than just education about disease transmission.
Who is it for? Hygiene and behaviour change specialists and researchers
Why is it valuable? It reviews the literature to identify common determinants of handwashing which can be used to inform the design of more effective interventions. It provides a useful insight into the state of the evidence at the date of publication. As an academic paper, it is more likely to be accessible to specialists designing programmes rather than implementers. It also highlights significant evidence gaps around the determinants of handwashing, particularly in outbreaks or crisis settings, which may be of interest to researchers.