Journal Article

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

Lapinski, Maria Knight, Amon-Tanoh, Maud Akissi, Cousens, Simon, McCambridge, Jim, Ploubidis, George, Blon, Patrice Konan, Nguipdop-Djomo, Patrick, Kouamé, Hermann Aka

2022

Overview

ObjectivesTo 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).DesignScale 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.SettingThe study was conducted in communal housing compounds in Abidjan, Côte d’Ivoire.ParticipantsA convenience sample of 201 adult residents (≥16 years old) from 60 housing compounds completed the final questionnaire.Outcome measureConfirmatory 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).ResultsThe 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).ConclusionWe 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.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adolescent / Adult / Childrens health / community child health / Coronaviruses / Cote d'Ivoire / COVID-19 / Cross-Sectional Studies / Data collection / epidemiology / Field study / Global Health / Hand Disinfection / Households / Housing / Humans / Low income groups / Perceptions / preventive medicine / Psychometrics / Public health / Quantitative psychology / Questionnaires / Reproducibility of Results / Sanitation / Social desirability / Social Norms / Surveys and Questionnaires