Understanding end-user preferences for hand hygiene enabling technologies: a mixed-methods study in peri-urban Lusaka

IntroductionHandwashing facilities (HWFs) are associated with higher rates of handwashing with soap, and the presence of a HWF is the global proxy indicator of household handwashing behaviour. There is limited information on attributes of HWFs important to end-users with few comparative assessments of HWFs from a user-perspective. We aimed to identify attributes of HWFs important to end-users and determine how pre-manufactured HWFs ranked against these attributes. MethodWe identified eight pre-existing HWFs: two locally manufactured (Kalingalinga bucket and Tippy tap) and six industrially produced designs (Jengu, SatoTap, SaniTap, HappyTap, SpaTap, and Kohler Cleanse). Two rounds of focus group discussions were conducted with a diverse group of targeted end-users in two peri-urban communities in Lusaka, Zambia. In the first, participants discussed aspects of each HWF they liked and disliked, and thematic analysis was used to define nine attributes for comparision across each HWF. In the second round, participants individually ranked each HWF against the identified attributes, their overall preference, and overall preference once estimated retail prices were revealed. Participants also ranked attributes by importance. Ranking data were modelled using rank-ordered logistic regression. ResultsDiscussions revealed nine attributes important to end users: appearance, water management, hygienic use, convenience, water disposal, vulnerability to theft or breakage, ease of use, price and maintenance. Hygienic use and water management were considered most important attributes. Excluding price, facilities resembling a sink, such as the Happy Tap (34%) and Jengu (28%), had the highest probability of being ranked first. With consideration for price, participants preferred lower-cost HWFs such as the Kalingalinga bucket (44%), Tippy Tap (13%) and SATO Tap (10%). ConclusionThis study identified nine attributes important to end-users that can inform future design efforts. Future work will explore user preferences in situ by rotating households through specific HWF for an extended period. Potential manufacturers should continue to iterate on HWF designs emphasizing on reducing costs.