Measuring social norms related to handwashing: development and psychometric testing of measurement scales in a low-income urban setting in Abidjan, Côte d'Ivoire.

OBJECTIVES: To design and test the psychometric properties of four context-specific norm-related scales around handwashing with soap after toilet use: (1) perceived handwashing descriptive norms (HWDN); (2) perceived handwashing injunctive norms (HWIN); (3) perceived handwashing behaviour publicness (HWP); and (4) perceived handwashing outcome expectations (HWOE). DESIGN: Scale items were developed based on previous work and pilot tested in an iterative process. Content experts and members of the study team assessed the face validity of the items. The psychometric properties of the scales were assessed in a cross-sectional study. SETTING: The study was conducted in communal housing compounds in Abidjan, Côte d'Ivoire. PARTICIPANTS: A convenience sample of 201 adult residents (≥16 years old) from 60 housing compounds completed the final questionnaire. OUTCOME MEASURE: Confirmatory factor analysis was used to assess the goodness of fit of the global model. We assessed the internal consistency of each scale using Cronbach's alpha (α) and the Spearman-Brown coefficient (ρ). RESULTS: The results of the psychometric tests supported the construct validity of three of the four scales, with no factor identified for the HWOE (α=0.15). The HWDN and HWP scales were internally consistent with correlations of ρ=0.74 and ρ=0.63, respectively. The HWIN scale appeared reliable (α=0.83). CONCLUSION: We were able to design three reliable context-specific handwashing norm-related scales, specific to economically disadvantaged community settings in Abidjan, Côte d'Ivoire, but failed to construct a reliable scale to measure outcome expectations around handwashing. The social desirability of handwashing and the narrow content area of social norms constructs relating to handwashing present significant challenges when designing items to measure such constructs. Future studies attempting to measure handwashing norm-related constructs will need to take this into account when developing such scales, and take care to adapt their scales to their study context.

Attribute-centred theorizing to address behavioural changes.

Despite the importance of behaviours in promoting health and wellness, persuading people to adopt and sustain healthy behaviours remains a significant public health challenge. Considerable progress has been made in developing and testing theories about the personal, social, environmental and structural drivers of behaviours. However, theorizing about behaviours themselves has remained elusive, as evidenced by the absence of a widely accepted taxonomy of behaviours. By carefully examining the nature of behaviours, practitioners and researchers can identify the most effective ways to promote behavioural change. We propose attribute-centred theorizing as an approach for defining behaviours based on their relevant properties, which can then assist in developing a taxonomy of behaviours and theorizing about them. Behaviours differ because of their underlying properties; for example, some behaviours are addictive, others are publicly observable and others are expensive. Addictiveness, privacy and cost are therefore three (of the many) attributes relevant for theorizing about behaviours. We describe a framework for operationalizing attribute-centred theorizing, which includes generating behavioural attributes, verifying and testing those attributes, and constructing a behavioural matrix to inform campaigns or interventions. We illustrate this framework using the examples of Guinea-worm disease and cardiovascular diseases. The benefits of our approach include the ability to inform intervention development and the ability to generalize across different behaviours; however, more research on converting the behavioural matrix into actual policy is needed.

Malgré l'importance des comportements dans la promotion de la santé et du bien-être, persuader les gens d'adopter et de conserver un mode de vie sain représente toujours un défi de santé publique non négligeable. Des progrès considérables ont été accomplis en ce qui concerne le développement et l'évaluation des théories sur les motivations personnelles, sociales, environnementales et structurelles exerçant une influence sur les comportements. Cependant, formuler des théories à ce propos demeure complexe, comme en atteste l'absence de taxinomie largement admise en la matière. En examinant attentivement la nature des comportements, les chercheurs et praticiens peuvent identifier les moyens les plus efficaces pour les faire évoluer. Nous proposons d'opter pour une théorisation axée sur les attributs afin de définir les comportements en fonction de leurs propriétés utiles, ce qui permettrait ensuite d'instaurer une taxinomie des comportements et d'énoncer les hypothèses qui en découlent. Les comportements varient en raison de leurs propriétés sous-jacentes; certains par exemple sont liés à une dépendance, d'autres sont clairement visibles et d'autres encore sont onéreux. La dépendance, l'intimité et le coût constituent donc trois (des nombreux) attributs utiles à l'élaboration d'hypothèses sur les comportements. Dans le présent document, nous traçons un cadre servant à concrétiser cette théorisation axée sur les attributs; il prévoit notamment de générer des attributs comportementaux, de vérifier et de tester ces attributs, et d'imaginer une matrice qui fournirait des orientations pour diverses campagnes ou interventions. Nous illustrons également ce cadre en prenant pour exemples la dracunculose et les maladies cardiovasculaires. Parmi les avantages de notre approche figurent la possibilité de guider le développement des interventions et celle d'intégrer différents comportements; néanmoins, une étude approfondie est nécessaire pour définir comment convertir la matrice comportementale en réelle politique.

A pesar de la importancia de los comportamientos en la promoción de la salud y el bienestar, persuadir a las personas para que adopten y mantengan comportamientos saludables sigue siendo un importante reto para la salud pública. Se ha avanzado considerablemente en el desarrollo y la comprobación de teorías sobre los factores personales, sociales, ambientales y estructurales que impulsan los comportamientos. Sin embargo, teorizar sobre los comportamientos en sí sigue siendo difícil, como demuestra la ausencia de una taxonomía de comportamientos ampliamente aceptada. Al examinar cuidadosamente la naturaleza de los comportamientos, los profesionales e investigadores pueden identificar las formas más eficaces de promover el cambio de comportamiento. Proponemos una teoría centrada en los atributos como enfoque para definir los comportamientos en función de sus propiedades relevantes, lo que puede ayudar a desarrollar una taxonomía de comportamientos y a teorizar sobre ellos. Los comportamientos difieren por sus propiedades subyacentes; por ejemplo, algunos comportamientos son adictivos, otros son observables públicamente y otros son costosos. La adicción, la privacidad y el coste son, por tanto, tres (de los muchos) atributos relevantes para teorizar sobre los comportamientos. Describimos un marco para hacer operativa la teoría centrada en los atributos, que incluye la generación de atributos de comportamiento, la verificación y comprobación de dichos atributos y la construcción de una matriz de comportamiento para informar sobre campañas o intervenciones. Ilustramos este marco con los ejemplos de la enfermedad del gusano de Guinea y las enfermedades cardiovasculares. Las ventajas de nuestro enfoque son la capacidad de informar sobre el desarrollo de intervenciones y la capacidad de generalizar entre diferentes comportamientos; sin embargo, es necesario investigar más sobre la conversión de la matriz de comportamiento en una política real.

Too stringent or too Lenient: Antecedents and consequences of perceived stringency of COVID-19 policies in the United States.

In the United States, federal and local governments have attempted to contain the spread of Coronavirus Disease 2019 (COVID-19) by implementing a variety of policies such as stay-at-home orders and mask mandates. Perceptions can influence behaviors; therefore, it is important to understand how people perceive the stringency of COVID-19 policies, what factors shape perceived policy stringency, and whether and how policy perceptions impact the practice of prevention behaviors. With rolling-cross sectional survey data collected in the US from June to October 2020 and other external sources of data, the study examines the impact of objective risk of the pandemic, information seeking, and political ideology at the individual and the state levels on perceived policy stringency, and the impact of perceived policy stringency on prevention behaviors such as mask wearing and social distancing. The findings reveal that objective risk and political ideology are significantly associated with perceived policy stringency. The perceived policy stringency has negative associations with prevention behaviors. The findings provide important implications for the development process of compulsory public health policies during the pandemic.