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Table 2 Modifications to the original intervention package based on formative research findings, and considerations for scalability

From: Formative research to scale up a handwashing with soap and water treatment intervention for household members of diarrhea patients in health facilities in Dhaka, Bangladesh (CHoBI7 program)

Original CHoBI7 Intervention DesignFormative Research FindingModified Intervention DesignConsiderations for Scalability
Health facility-initiated intervention delivered by health promoters to cholera patients and their household contacts over the 7-day high-risk period for transmission of disease to household members. Health facility-initiated intervention delivered by health promoters to diarrhea patients and their household contacts in the health facility over the 7-day high-risk period following admission to the health facility.Replacement for study-supported health promoters (e.g. health educators or nurses).
Utility of mass media channels to alleviate burden of health communication at the health facility.
Cost of program materials provided at scale.
Market availability of promoted enabling technologies and supplies (e.g. handwashing station, safe water storage bucket, and chlorine tablets)
Integration of intervention program into existing government health programs.
Pictorial module on how cholera spreads and can be prevented, delivered by a health promoter at the patient’s bedside. Pictorial module on how diarrhea spreads and can be prevented, delivered by a health promoter at the patient’s bedside.
Communication module reinforced during daily household visits during the one-week intervention period. Mobile messages reinforced either through only voice and text messages weekly for 1 year (mobile health (mHealth) with no home visits), or mHealth and two home visits.
Imported, sealed drinking water vessel.Importance of using locally available items to maximize sustainability and keep cost of intervention low.
Need for a durable tap.
Importance of elevating water storage container from the ground for hygiene purposes.
Absence of reliable potable water in some health facilities.
Recommendation (or preference) to bring in own source of drinking water for health facility stay.
Residue build-up in safe water storage bucket.
Locally made plastic bucket with lid and added durable tap.
Provision of a stool to elevate bucket.
Provision of chlorine tablets and one bottle of chlorine treated water for health facility stay.
Messaging around cleaning the safe water storage bucket regularly to avoid build-up related to long-term water storage.
Low-cost, durable, locally made option will need to be made available on the market.
Availability of potable water in health facilities.
Chlorine tablets for water treatmentDislike of bitter taste of chlorinated water.
Barriers to regular boiling of water.
Absence of safe drinking water source in health facility, or practice of bringing in own drinking water.
Trouble distinguishing chlorine as ‘water treatment agent’ rather than ‘medicine’.
Chlorine tablets for water treatment.
Messaging relating the taste of chlorine to local medicinal plants and bitter foods with health benefits.
Messaging around chlorine as water treatment, not curative medicine.
Taste tests of chlorinated water while in the health facility.
Messaging on boiling water after the 30-day supply of chlorine tablets is exhausted.
Low-cost, locally made option will need to be available via Bangladesh-based pharmaceutical companies
Handwashing stationHandwashing aid needed at bedside.
Misuse of enabling technologies.
Use of handwashing station by children.
Provision of bottle of soapy water bottle for duration of health facility stay.
Additional information in the communication module around importance of enabling technologies for a safe and healthy environment to avoid misuse.
Additional messaging around teaching children how to use enabling technologies.
Low-cost, durable, locally made option will need to be made available on the market.
Bottle of soapy waterNeed for healthy lather from soapy water without drying of hands.
Need for multiple soapy water bottles.
Increased the ratio from 4 capfuls per 500 mL to 6 capfuls per 500 mL.
Recommended households make multiple soapy water bottles for placement in home, latrine, and kitchen areas.
Current Government detergent subsidies likely to support soapy water as a low-cost alternative to bar or liquid soap.