Abstract：
Handwashing with soap has the potential to curb cholera transmission. This research explores how populations experienced and responded to the 2017 cholera outbreak in the Democratic Republic of the Congo and how this affected their handwashing behaviour.
Cholera cases were identified through local cholera treatment centre records. Comparison individuals were recruited from the same neighbourhoods by identifying households with no recent confirmed or suspected cholera cases. Multiple qualitative methods were employed to understand hand hygiene practices and their determinants, including unstructured observations, interviews and focus group discussions. The data collection tools and analysis were informed by the Behaviour Centred Design Framework. Comparisons were made between the experiences and practices of people from case households and participants from comparison households.
Cholera was well understood by the population and viewed as a persistent and common health challenge. Handwashing with soap was generally observed to be rare during the outbreak despite self-reported increases in behaviour. Across case and comparison groups, individuals were unable to prioritise handwashing due to competing food-scarcity and livelihood challenges and there was little in the physical or social environments to cue handwashing or make it a convenient, rewarding or desirable to practice. The ability of people from case households to practice handwashing was further constrained by their exposure to cholera which in addition to illness, caused profound non-health impacts to household income, productivity, social status, and their sense of control.
Even though cholera outbreaks can cause disruptions to many determinants of behaviour, these shifts do not automatically facilitate an increase in preventative behaviours like handwashing with soap. Hygiene programmes targeting outbreaks within complex crises could be strengthened by acknowledging the emic experiences of the disease and adopting sustainable solutions which build upon local disease coping mechanisms.
Cholera cases were identified through local cholera treatment centre records. Comparison individuals were recruited from the same neighbourhoods by identifying households with no recent confirmed or suspected cholera cases. Multiple qualitative methods were employed to understand hand hygiene practices and their determinants, including unstructured observations, interviews and focus group discussions. The data collection tools and analysis were informed by the Behaviour Centred Design Framework. Comparisons were made between the experiences and practices of people from case households and participants from comparison households.
Cholera was well understood by the population and viewed as a persistent and common health challenge. Handwashing with soap was generally observed to be rare during the outbreak despite self-reported increases in behaviour. Across case and comparison groups, individuals were unable to prioritise handwashing due to competing food-scarcity and livelihood challenges and there was little in the physical or social environments to cue handwashing or make it a convenient, rewarding or desirable to practice. The ability of people from case households to practice handwashing was further constrained by their exposure to cholera which in addition to illness, caused profound non-health impacts to household income, productivity, social status, and their sense of control.
Even though cholera outbreaks can cause disruptions to many determinants of behaviour, these shifts do not automatically facilitate an increase in preventative behaviours like handwashing with soap. Hygiene programmes targeting outbreaks within complex crises could be strengthened by acknowledging the emic experiences of the disease and adopting sustainable solutions which build upon local disease coping mechanisms.
摘要：
用肥皂洗手有可能抑制霍乱的传播。这项研究探讨了人口如何经历和应对2017年刚果民主共和国霍乱疫情，以及这如何影响他们的洗手行为。
霍乱病例是通过当地霍乱治疗中心的记录确定的。通过识别最近没有确诊或疑似霍乱病例的家庭，从同一社区招募了比较个体。采用多种定性方法来了解手卫生习惯及其决定因素，包括非结构化观察，访谈和焦点小组讨论。数据收集工具和分析由行为中心设计框架提供信息。对案例家庭的人和比较家庭的参与者的经验和实践进行了比较。
霍乱已被人们充分理解，并被视为一种持续和共同的健康挑战。尽管自我报告的行为有所增加，但在爆发期间，用肥皂洗手通常很少见。在病例组和比较组中，由于相互竞争的食物短缺和生计挑战，个人无法优先洗手，而且在物理或社会环境中几乎没有什么可以提示洗手或使其变得方便，值得练习的或值得练习的。病例家庭的人洗手的能力进一步受到霍乱的限制，霍乱除了疾病之外，对家庭收入造成了深远的非健康影响，生产力,社会地位,和他们的控制感。
尽管霍乱爆发会对许多行为决定因素造成干扰，这些变化不会自动促进预防行为的增加，比如用肥皂洗手。通过承认该疾病的流行经验并采取建立在当地疾病应对机制基础上的可持续解决方案，可以加强针对复杂危机中爆发的卫生计划。
霍乱病例是通过当地霍乱治疗中心的记录确定的。通过识别最近没有确诊或疑似霍乱病例的家庭，从同一社区招募了比较个体。采用多种定性方法来了解手卫生习惯及其决定因素，包括非结构化观察，访谈和焦点小组讨论。数据收集工具和分析由行为中心设计框架提供信息。对案例家庭的人和比较家庭的参与者的经验和实践进行了比较。
霍乱已被人们充分理解，并被视为一种持续和共同的健康挑战。尽管自我报告的行为有所增加，但在爆发期间，用肥皂洗手通常很少见。在病例组和比较组中，由于相互竞争的食物短缺和生计挑战，个人无法优先洗手，而且在物理或社会环境中几乎没有什么可以提示洗手或使其变得方便，值得练习的或值得练习的。病例家庭的人洗手的能力进一步受到霍乱的限制，霍乱除了疾病之外，对家庭收入造成了深远的非健康影响，生产力,社会地位,和他们的控制感。
尽管霍乱爆发会对许多行为决定因素造成干扰，这些变化不会自动促进预防行为的增加，比如用肥皂洗手。通过承认该疾病的流行经验并采取建立在当地疾病应对机制基础上的可持续解决方案，可以加强针对复杂危机中爆发的卫生计划。
