Behaviour change intervention to reduce caregivers’ exposure to patients’ oral and nasal secretions in Bangladesh

Abstract

Family caregivers are at risk for acquiring Nipah virus from patients in Bangladesh through exposure to patients’ respiratory secretions. We conducted a formative study to assess the acceptability and feasibility of behaviour change messages to reduce this exposure in a hospital in Bangladesh. We delivered a bar of soap with behaviour change messages to caregivers asking them to: 1) wash hands with soap at key times; 2) not eat patient’s leftover food; 3) sleep with their back to the patient or with the patient’s face to their chest; and 4) maintain more than one hand’s distance between patient’s and caregiver’s faces. Structured observations and semi-structured interviews with caregivers were used to assess acceptability and feasibility. Caregivers of 15 patients were enrolled. We observed an opportunity for caregiver handwashing 172 times, and in 20 (12%) of these opportunities caregivers washed hands with soap. Caregivers cited an inability to leave a severely ill patient unattended and lack of access to water as barriers to handwashing. Caregivers abstained from sharing food with patients in 82% (61/74) of observations with an opportunity to do so, and followed our sleeping suggestions in 88% (113/128). In only 12% (40/336) of observation sessions did the caregiver keep their face more than one hand’s distance from the patient’s. Behavioral messages regarding sleeping position and food-sharing were both acceptable and feasible; maintaining a distance from the patient was neither. Handwashing was acceptable, but not feasible. Interventions to target this at-risk group should include improved access to handwashing stations.