The effect of behaviour change interventions on use of public handwashing stations in Bangladesh

Last registered on November 11, 2021
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Pre-Trial

Trial Information

General Information

Title
The effect of behaviour change interventions on use of public handwashing stations in Bangladesh
RCT ID
AEARCTR-0006967
Initial registration date
December 22, 2020

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
December 22, 2020, 1:48 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
November 11, 2021, 5:42 AM EST

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
Bangladesh
Region
Dhaka division
Country
Bangladesh
Region
Khulna division
Country
Bangladesh
Region
Mymensingh division

Primary Investigator

Name
Dilhan Perera
Affiliation
Behavioural Insights Team
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Stewart Kettle
PI Affiliation
Behavioural Insights Team
Contact Investigator
PI Name
Dan Brown
PI Affiliation
Behavioural Insights Team
Contact Investigator
PI Name
Alexander Clark
PI Affiliation
Behavioural Insights Team
Contact Investigator
PI Name
Atiya Rahman
PI Affiliation
BRAC Institute of Governance and Development
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2021-01-03
End date
2021-09-24
Keywords
Behavior, Health
Additional Keywords
handwashing, nudges, incentives
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
As part of the COVID-19 response, BRAC has built 1000 public handwashing stations in several hundred villages in 20 sub-districts of Bangladesh. We plan to investigate the effects of two sets of behavioural interventions on use of the handwashing stations, compared to no additional interventions. The first set of interventions, which do not require ongoing labour (hence termed 'low intensity'), involve the installation of various 'nudges' (e.g. mirrors and signposts) on the station and in the surrounding area; these interventions are designed to attract attention and guide people to the stations. The second set of interventions, which do require ongoing labour ('high intensity'), involve 'promoters' visiting the stations a few times a week for three weeks to offer free bars of soap to station users, update a community board next to the station with cumulative usage numbers, and to encourage users to place comments or marks on the board as a form of social proof. Stations will be assigned to receive either the low intensity nudges, the high intensity intervention, or no additional intervention (beyond BRAC's planned community and communications programming) using a clustered covariate adaptive randomisation process. We will measure use of the stations for one week prior to the implementation of the behavioural interventions, and then for a further six weeks. Station usage will be measured by a combination of structured observations and tally counters attached to the foot pedals that operate the station.
External Link(s)

Registration Citation

Citation
Brown, Dan et al. 2021. "The effect of behaviour change interventions on use of public handwashing stations in Bangladesh." AEA RCT Registry. November 11. https://doi.org/10.1257/rct.6967-1.4000000000000004
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Experimental Details

Interventions

Intervention(s)
- High-intensity intervention bundle: a limited number of free soap bars and facemasks provided as a incentive to handwashing station users on specific days (5 days across 3 weeks); a community board which is manually updated to show the cumulative number of uses, as measured by tally counters attached to the station foot pedals, and encouragement by promoters on specific days (for the whole day; 5 days across 3 weeks) to use the station and engage with the community board. These interventions will be delivered for 3 weeks.
- Low-intensity intervention bundle: mirrors installed on handwashing station backboard and signposts installed and/or large arrows painted on the ground in the surrounding vicinity to guide people towards the station.
- All villages (including those in the control group) will also receive in-person community demonstrations delivered by BRAC, free soap distributed through village committees (not conditional on handwashing station usage), and small stickers/posters pointing to the stations and encouraging inclusive use.
Intervention Start Date
2021-01-10
Intervention End Date
2021-05-06

Primary Outcomes

Primary Outcomes (end points)
- Average soap pedal presses per day in the first three weeks post-intervention
- Estimated average handwashing station uses per day over in first three weeks post-intervention
Primary Outcomes (explanation)
Stations are operated via foot pedals, and we will attach tally counters to the pedals that increment each time the pedal is pressed. Soap pedal presses will be translated to station uses by estimating the relationship between presses and uses, as measured via structured observations. These observations, however, will only be made for a part of the day, so we are treating this is an estimate.

Secondary Outcomes

Secondary Outcomes (end points)
- Average soap pedal presses per day in the second three weeks (weeks 4, 5 and 6) post-intervention
- Estimated average handwashing station uses per day over in the second three weeks (weeks 4, 5 and 6) post-intervention
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Villages will be assigned to one of the three conditions using a covariate adaptive randomisation process. All stations in the same village will be assigned to the same condition. The randomisation will attempt to achieve balance on the subdistrict that the village is located in, the number of stations in the village, and location categories of stations (e.g. near a mosque, near a market, near a school).
Experimental Design Details
Villages are first assigned to one of four blocks, according to the date at which stations were first built in the village. The adaptive randomisation process is applied sequentially to villages within each block (villages are ordered randomly within the block prior to randomisation), with the randomisation taking into account the covariate balance in all previously assigned villages (including villages in previous blocks). Data collection and intervention delivery will occur at the same time in each block, but be spaced apart by three to four weeks between blocks.
Randomization Method
Covariate adaptive randomisation implemented using the Stata user-written command rct_minim.
Randomization Unit
Village
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
800 villages
Sample size: planned number of observations
869 stations, with 7 weekly outcome measures per station
Sample size (or number of clusters) by treatment arms
266 villages control
266 villages 'low-intensity'
266 villages 'high-intensity'
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Institutional Review Board of the BRAC James P Grant School of Public Health, BRAC University.
IRB Approval Date
2020-12-27
IRB Approval Number
IRB-14 November'20-047
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
April 15, 2021, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
May 06, 2021, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
540 villages
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
855 handwashing stations
Final Sample Size (or Number of Clusters) by Treatment Arms
180 villages control 180 villages low-intensity treatment 180 villages high-intensity treatment
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials