When Knowledge Fails: Hygiene in Rural Honduras

Background

Childhood diarrhea is a leading cause of morbidity and mortality in Honduras. Poor hygiene practices are one of the main risk factors for diarrheal transmission: 47% of mothers with children younger than five years old do not dispose of feces safely, while 57% of households in rural communities do not treat their water. Little research has been conducted in rural areas regarding hygiene behavior, beliefs and motivations.

Methods

Over the course of two months in 2008, we conducted formative research using focus groups, in-depth interviews and participant observations. The study assessed hygiene practices among women aged 19-59 years who cared for children aged five and under in San Antonio de la Libertad, a sparsely populated rural community in Central Honduras.

Results

Despite the presence of soap in households (93%), mothers did not use it when washing their hands. Mothers were aware of the causes of water contamination and the effects of diarrhea. Hygiene behavior, however, did not match this knowledge. The study found the motivation of mothers to appear clean, attractive, wealthy, and responsible drove hygiene behavior.

Discussion

These findings emphasize that hygiene promotion interventions should not rely solely on the public health and/or biomedical approaches. Rather, a hygiene behavior change program will succeed or fail depending on the understanding of the social and consumer motivations of the target population (e.g. mothers). This research suggests a successful hygiene behavior change campaign should incorporate a social marketing approach that retains its consumer focus and a sound understanding of user motivations.