Development of a Quantitative Personal Hygiene Assessment Tool (qPHAT)

Personal hygiene practices are believed to represent intermediate behavioral factors along the causal pathways that lead to diseases. Consequently, many public health programs promote the adoption of improved personal hygiene practices for disease prevention and control. In low and middle-income settings, interventions promoting personal hygiene are often undertaken within community-based water, sanitation, and hygiene (WASH) and neglected tropical disease (NTD) programming. Valid, reliable measurement of personal hygiene practices would be useful for monitoring, evaluation, and development of better interventions. However, within the trachoma community, there is no universally endorsed operational definition of facial cleanliness (or, conversely poor facial hygiene, poor facial “cleanliness”, or “unclean” face) or recommendations for the standardized measurement of F in SAFE programming (e.g., facial and hand hygiene, specific indicators of established F-related risk factors and related measurement metrics).

Using color theory principles, we developed and tested a novel metric that generates quantitative measures of facial and hand cleanliness, proxy indicators of personal hygiene practices. The quantitative personal hygiene assessment tool (qPHAT) uses an 11-point color scale to rate the color of a wipe taken from the skin along the face and hand of individuals, which indicates facial and hand cleanliness. We tested this new measurement method in the Amhara region of Ethiopia during our Andilaye Trial, and found that the new way of measuring facial and hand cleanliness is reliable, meaning different people rated the wipes similarly.

With these promising results, Emory University, and its collaborating partners are conducting a follow-up study with the following objectives:

  • To replicate the reliability of the new facial and hand cleanliness measurement method;

  • To assess ability of the new method to detect recent cleansing practices; and

  • To determine whether facial and hand cleanliness, as measured through the use of the new method, reflect trachoma risk factors.

This study is part of a multi-site, multi-country analysis of F-related assessments known as “Re-envisioning the F in SAFE,” which is sponsored by the NTD Support Center with funds from the Department for International Development. Data generated from this operational research study will inform evidence-based recommendations for the operational definition and measure (e.g., specific indicators, methods) of facial and hand cleanliness and hygiene. We will translate research findings into guidance documents and policy briefs that can be used to inform NTD and integrated WASH programming and policy.

Publications:

  1. Development and reliability of a quantitative personal hygiene assessment tool (2020)

Training materials:

  1. qPHAT Data collection training manual - This training manual provides guidance on procedures to standardize the collection of qPHAT data including a background of qPHAT, materials required, preparation for data collection, procedures for face and hand wipes, photographs for densitometry, and scoring of wipes.

  2. qPHAT Data collection training video - This training video provides step by step visuals guidance on procedures to standardize the collection of qPHAT data.

  3. qPHAT Data collection training presentation - This training presentation summarizes details from the training manual and provides step by step visuals guidance on procedures to standardize the collection of qPHAT data.

Media:

 

Study Location

Amhara, Ethiopia

 

Target Population

WASH and NTD program practitioners

 

Principal Investigators

Maryann Delea (Principal), Matthew Freeman (Principal), Abebe Gebremariam Gobezayehu (Local Co-PI)

 

IMPLEMENTING partners

Amhara Regional Health Bureau

 

Funders

Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD)

 

Project Staff

Jedidiah Snyder, Kassahun Zewudie, Becky Kann, Mulat Woreta

 

Co-Investigators

Johns Hopkins University: Meraf Wolle

Fred Hollows Foundation: Sarity Dodson

University of California, San Francisco: Dionna Wittberg

 

Enumerators

Adanech Admasu, Asayech Bimrew, Ayalnesh Belay, Balemlaye Addisu, Destaw Asnakew, Eleni Nebiyu, Mahider Adamu, Maritu Yibrie, Mulubirhan Shitu, Rahel Tsegaye, Selamawit Abebe, Senait Mulualem, Sintayehu Wasihun, Tibeltalech Mihiret, Tigist Abebe, Tigist Bitew, Tirusew Alayu, Tiruzer Engidaw, Woyneshet Genetu, Yeserash Gashu, Yeworkwuha Abay