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General

Study Overview

Title:

Evaluation of the impact of the HiFive for HySan program on pupil independent hand-washing practices in elementary schools in the Philippines

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-5a12613323ff9

Initial Registration Date:

11/19/2017

Last Update Date:

07/02/2019

Study Status:

Completed

Change History for Status

Changed On	Previous Value
01/11/2019	Ongoing

Location(s):

Philippines

Abstract:

Schoolchildren in the Philippines suffer from a high burden of preventable diseases, with hygiene deficiencies identified as a common cause. Hand-washing with soap is a simple yet highly effective strategy to reduce respiratory tract infections and diarrhea. In an effort to promote improved hand-washing behaviors, the International WaterCentre (IWC), in collaboration with UNICEF and the Philippine Department of Education (DepEd), designed the school-based HiFive for Hygiene and Sanitation Program (HiFive). This program trains teachers to conduct a series of fun classroom activities, which include songs, stories, games, and art, that reinforce students’ understanding of hygiene and deliver tailored messages to motivate independent hand-washing with soap. This cluster randomized experiment across 196 primary schools assesses the impact of the HiFive intervention on hand-washing behavior of students. The findings from this evaluation will inform the possible scale-up of the HiFive intervention to other schools in the Philippines.

Change History for Abstract

Changed On

Previous Value

07/02/2019

Schoolchildren in the Philippines suffer from a high burden of preventable diseases, with hygiene deficiencies identified as a common cause. Hand-washing with soap is a simple yet highly effective strategy to reduce respiratory tract infections and diarrhea. In an effort to promote improved hand-washing behaviors, the International WaterCentre (IWC), in collaboration with UNICEF and the Philippine Department of Education (DepEd), designed the school-based HiFive for Hygiene and Sanitation Program (HiFive). This program trains teachers to conduct a series of fun classroom activities, which include songs, stories, games, and art, that reinforce students’ understanding of hygiene and deliver tailored messages to motivate independent hand-washing with soap. This cluster randomized experiment across 196 primary schools assesses the impact of the HiFive intervention on hand-washing behavior of students. The findings from this evaluation will inform the possible scale-up of the HiFive intervention to other schools in the Philippines.

Registration Citation:

Lehmann, L., Bisserbe, C., Jetha, Q. and Waldrop, D., 2017. Evaluation of the impact of the HiFive for HySan program on pupil independent hand-washing practices in elementary schools in the Philippines. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie123

Categories:

Water and Sanitation

Additional Keywords:

Secondary ID Number(s):

Principal Investigator(s)

Name of First PI:

Lilian Lehmann; Clément Bisserbe; Qayam Jetha; Daniel Waldroop

Affiliation:

IDinsight

Name of Second PI:

Affiliation:

Study Sponsor

Name:

Bill and Melinda Gates Foundation

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

UNICEF, DepEd

Type of Organization:

Location:

Philippines

Intervention

Intervention Overview

Intervention:

The HiFive for HySan intervention is a behaviour-change approach that was developed through research conducted in Philippine elementary schools, and is designed to help schools achieve three key outcomes: 1) independent hand-washing by pupils before eating and after using the toilet (defined as “critical times”); 2) operation and maintenance of toilet and hand-washing facilities; and 3) improved toilet use by school children. The HiFive for HySan intervention focuses on motivating improved hand-washing behaviors and triggering discussions on how to better maintain clean and functional toilets. Designed to not overload teachers or pupils, HiFive for HySan includes five main steps that are supported by five tools, leading to five key results. The five tools are: (1) HiFive Storyboard - A storyboard to share key messages (2) iWash Song - A song to help remember the key messages (3) Poo-Tag - A game to reinforce understanding of contamination and introduce pupil roles in toilet use (4) Storyboard stencils - Stencils for painting school murals (5) HiFive Star-chart - A Star-chart for helping school implement HySan interventions

Change History for Intervention

Changed On

Previous Value

07/02/2019

The HiFive for HySan intervention is a behaviour-change approach that was developed through research conducted in Philippine elementary schools, and is designed to help schools achieve three key outcomes: 1) independent hand-washing by pupils before eating and after using the toilet (defined as “critical times”); 2) operation and maintenance of toilet and hand-washing facilities; and 3) improved toilet use by school children. The HiFive for HySan intervention focuses on motivating improved hand-washing behaviors and triggering discussions on how to better maintain clean and functional toilets. Designed to not overload teachers or pupils, HiFive for HySan includes five main steps that are supported by five tools, leading to five key results. The five tools are: (1) HiFive Storyboard - A storyboard to share key messages (2) iWash Song - A song to help remember the key messages (3) Poo-Tag - A game to reinforce understanding of contamination and introduce pupil roles in toilet use (4) Storyboard stencils - Stencils for painting school murals (5) HiFive Star-chart - A Star-chart for helping school implement HySan interventions

Private Intervention Details:

Theory of Change:

.

Multiple Treatment Arms Evaluated?

No

Implementing Agency

Name of Organization:

The Philippine Department of Education (DepEd)

Change History for Name of Organization

Changed On	Previous Value
07/02/2019	the Philippine Department of Education (DepEd)

Type of Organization:

Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:

Philippine Department of Education and UNICEF Philippines

Type of Organization:

Public Sector, e.g. Government Agency or Ministry

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

07/01/2017

End Date:

08/31/2017

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Randomized control trial

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

In order to evaluate the HiFive for HySan intervention and answer the evaluation questions identified above, IDinsight will conduct a clustered randomized controlled trial in 196 elementary schools in Camarines Norte Province and Puerto Princesa City. These participating schools were randomly assigned into two groups of an equal number of schools in each location. In the treatment group, both the Wash in Schools (WinS) program (a nationwide program to improve water, sanitation, and hygiene in schools) and the HiFive intervention are being implemented; in the control group, only the WinS program is being implemented. The study will evaluate the impact of the HiFive for HySan intervention by comparing the hand-washing behavior of pupils in these two groups of schools. Random assignment was stratified by province and by “WinS implementation quality index score”, a measure of pre-program water, sanitation, and hygiene infrastructure and characteristics of a school (sourced from administrative data). No baseline data collection was conducted due to the rapid roll-out of the HiFive intervention.

Change History for Details of Evaluation Approach

Changed On

Previous Value

07/02/2019

In order to evaluate the HiFive for HySan intervention and answer the evaluation questions identified above, IDinsight will conduct a clustered randomized controlled trial in 196 elementary schools in Camarines Norte Province and Puerto Princesa City. These participating schools were randomly assigned into two groups of an equal number of schools in each location. In the treatment group, both the Wash in Schools (WinS) program (a nationwide program to improve water, sanitation, and hygiene in schools) and the HiFive intervention are being implemented; in the control group, only the WinS program is being implemented. The study will evaluate the impact of the HiFive for HySan intervention by comparing the hand-washing behavior of pupils in these two groups of schools. Random assignment was stratified by province and by “WinS implementation quality index score”, a measure of pre-program water, sanitation, and hygiene infrastructure and characteristics of a school (sourced from administrative data). No baseline data collection was conducted due to the rapid roll-out of the HiFive intervention.

Private Details of Evaluation Approach:

Outcomes (Endpoints):

Research Question (RQ) 1 - Does the HiFive intervention increase the prevalence of independent hand-washing with soap (IHWWS) at critical times by pupils at school? Outcomes: (1) Pupil washed hands with soap and water after toilet use (2) Pupil washed hands with water after toilet use (3) Pupil washed hands with soap and water before eating (4) Pupil washed hands with water before eating RQ 2.1 - Does the HiFive for HySan intervention increase the frequency of daily supervised group handwashing activities in schools? Outcomes: (1) Class conducted group hand-washing activity RQ 2.2 - Does the HiFive for HySan intervention affect pupil perception of critical times and motivations to practice iHWWS at critical times? Outcome categories: (1) Perceived critical times to practice IHWWS (2) Motivations to practice IHWWS (3) Beliefs and expectations around hand-washing (4) Barriers to practice IHWWS RQ 2.3 - Does the HiFive for HySan intervention increase sanitation infrastructure? Outcome categories: (1) Availability of hand-washing facilities with water and soap (2) Availability of functional and clean toilet facilities

Change History for Outcomes (Endpoints)

Changed On

Previous Value

07/02/2019

Research Question (RQ) 1 - Does the HiFive intervention increase the prevalence of independent hand-washing with soap (IHWWS) at critical times by pupils at school? Outcomes: (1) Pupil washed hands with soap and water after toilet use (2) Pupil washed hands with water after toilet use (3) Pupil washed hands with soap and water before eating (4) Pupil washed hands with water before eating RQ 2.1 - Does the HiFive for HySan intervention increase the frequency of daily supervised group handwashing activities in schools? Outcomes: (1) Class conducted group hand-washing activity RQ 2.2 - Does the HiFive for HySan intervention affect pupil perception of critical times and motivations to practice iHWWS at critical times? Outcome categories: (1) Perceived critical times to practice IHWWS (2) Motivations to practice IHWWS (3) Beliefs and expectations around hand-washing (4) Barriers to practice IHWWS RQ 2.3 - Does the HiFive for HySan intervention increase sanitation infrastructure? Outcome categories: (1) Availability of hand-washing facilities with water and soap (2) Availability of functional and clean toilet facilities

Unit of Analysis:

School children

Hypotheses:

.

Unit of Intervention or Assignment:

Schools

Number of Clusters in Sample:

196; 98 in Treatment and 98 in Control

Number of Individuals in Sample:

Approximately 8,600 students, although this number is dependent on the number of students who use the restroom in a two hour class.

Size of Treatment, Control, or Comparison Subsamples:

N/A

Supplementary Files

Analysis Plan:

HiFive Analysis Plan.pdf

Other Documents:

Data

Outcomes Data

Description:

Two data collection visits will be completed at each of the 196 sample schools. The following data collection tools will be used during each visit: Visit 1 - Pupil classroom observation tool (grades 1-6), Hand-washing facility observation tool, & Toilet facility observation tool Visit 2 - Pupil survey (grades 4-6)

Data Already Collected?

No

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 1: Data for measuring impacts have not been collected

Completion

Completion Overview

Intervention Completion Date:

09/15/2017

Data Collection Completion Date:

12/15/2017

Unit of Analysis:

Opportunities for hand-washing with soap and water after toilet use.

Clusters in Final Sample:

196 schools.

Total Observations in Final Sample:

5507 pupils.

Size of Treatment, Control, or Comparison Subsamples:

Treatment: 2948 pupils. Control: 2559 pupils.

Findings

Preliminary Report:

Yes

Preliminary Report URL:

Summary of Findings:

The overall rate of hand-washing with soap after toilet use is extremely low, with an average rate of 2.2% [0.8%, 3.6%] across grades 1-6 in non-HiFive schools. While the HiFive intervention did not lead to a substantial increase in iHWWS after toilet use, there is evidence of a slight increase of 3.7 percentage points (pp.) (p=0.03*) in HiFive schools for pupils in grades 1-3. The results for this oucome are depicted in Figure 1. The observed rate of iHWWS after toilet use in grades 4-6 was 2.1 pp. higher at HiFive schools, though this difference is not statistically significant (p=0.15). Reported rates of iHWWS before eating were 4.5 pp. higher in HiFive schools (p=0.07), suggesting a minor increase because of the intervention. No observed data was available on hand-washing before eating.

In light of these evaluation findings, DepEd and UNICEF revised the HiFive intervention to strengthen the communication of key behavioral motivators for a phase 2 pilot the following school year. IDinsight conducted a pre-post event study comparing control schools from the RCT to those same schools after having received the revised intervention the following year. Hand-washing rates after toilet use in HiFive schools increased from 2.5% to 7.6% (+5.1 percentage points), driven primarily by increased hand-washing among pupils in grades 1-3. This change is slightly larger than the program effect found by the evaluation of the phase 1 pilot (+3.7 percentage points). In particular, teacher training and curriculum integration are believed to have led to a more effective rollout in phase 2. Findings from the process evaluation also suggests stronger implementation and monitoring than the phase 1 pilot. However, the post-program rate of hand-washing remains critically low.

Change History for Summary of Findings

Changed On

Previous Value

07/02/2019

The overall rate of hand-washing with soap after toilet use is extremely low, with an average rate of 2.2% [0.8%, 3.6%] across grades 1-6 in non-HiFive schools. While the HiFive intervention did not lead to a substantial increase in iHWWS after toilet use, there is evidence of a slight increase of 3.7 percentage points (pp.) (p=0.03*) in HiFive schools for pupils in grades 1-3. The results for this oucome are depicted in Figure 1. The observed rate of iHWWS after toilet use in grades 4-6 was 2.1 pp. higher at HiFive schools, though this difference is not statistically significant (p=0.15). Reported rates of iHWWS before eating were 4.5 pp. higher in HiFive schools (p=0.07), suggesting a minor increase because of the intervention. No observed data was available on hand-washing before eating.

Paper:

Yes

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

No--Data not expected to be available

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

No

Survey Instrument Links or Contact:

Program Files:

No

Program Files Links or Contact:

.

External Link:

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: