Health Knowledge Attitudes and Practice, Hygiene, Vaccination, Vaccine Hesitancy
Conditions
Keywords
Microbe literacy, Germ watching, Lady health workers, Immunization, Handwashing, Health education, Cluster randomized trial
Brief summary
This cluster randomized controlled trial evaluated whether a single microscope-based "germ-watching" workshop, delivered by Lady Health Workers (LHWs) to mothers and female caregivers of children under three years, improves hygiene practices, vaccination attitudes and intentions, routine immunization, and trust in LHWs. Twelve Union Councils in Sargodha District, Pakistan, were allocated 1:1 to the intervention or routine services, with outcomes measured by structured baseline and endline surveys and facility immunization records.
Detailed description
In intervention clusters, LHWs used portable microscopes (\>=400x) to show caregivers the microorganisms present in their own household water and food samples during a single 120-minute workshop for 25-30 participants, linking observed microbes to hygiene and vaccine-preventable disease. Control clusters received routine LHW services and standard national health messaging. Allocation used restricted, covariate-constrained randomization at the Union Council level; outcome data entry and analysis were blinded to allocation. Analyses accounted for clustering.
Interventions
BEHAVIORALMicrobe-literacy germ-watching workshop
Group demonstration (25-30 participants) using portable microscopes to visualize microorganisms in participants' own environmental samples, linked to hygiene and immunization messages
Sponsors
Development Synergies International (Private) Limited
Microbe Literacy Initiative
National University of Science and Technology, Pakistan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
Outcome assessment/analysis blinded
Intervention model description
Cluster-randomized
Eligibility
Sex/Gender
FEMALE
Age
14 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Mother or female caregiver, permanent resident of the study area * At least one child aged under 3 years * Written informed consent
Exclusion criteria
* Already enrolled in a similar intervention * Unable to participate due to physical/psychological constraints * Intending to relocate during the study period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of caregivers/children reporting always washing hands (self-reported) | Baseline and 4 months (endline, immediately after the intervention period) | Percentage of caregivers (and their children) reporting they "always" wash hands with soap / before eating, from a structured interviewer-administered survey item, compared between arms. |
| Third-dose oral polio vaccine (OPV3) coverage (facility records) | 4 months (endline) | Percentage of index children with a documented third dose of oral polio vaccine, ascertained from facility immunization records, compared between arms. |
| Proportion with self-reported completion of the age-appropriate immunization schedule | Baseline and 4 months (endline) | Percentage of caregivers reporting the index child had received all age-appropriate vaccinations (structured survey item), compared between arms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion reporting high trust in Lady Health Workers | Baseline and 4 months (endline) | Percentage of caregivers responding "yes, a lot" to a single-item survey question on trust in Lady Health Workers for vaccine information, compared between arms. |
| Proportion aware that germs cause infectious disease | Baseline and 4 months (endline) | Percentage of caregivers identifying germs (rather than, e.g., "bad weather") as the cause of infectious disease on a survey item, compared between arms. |
| Proportion perceiving vaccines as safe | Baseline and 4 months (endline) | Percentage of caregivers responding "yes, safe" to a survey item on perceived vaccine safety, compared between arms. |
| Proportion intending to vaccinate ("very likely") | Baseline and 4 months (endline) | Percentage of caregivers responding "very likely" to a survey item on intention to vaccinate the child in future, compared between arms. |
| Proportion willing to recommend vaccination to others | Baseline and 4 months (endline) | Percentage of caregivers responding "yes" to a survey item on willingness to recommend vaccination to other mothers, compared between arms. |
Countries
Pakistan
Outcome results
None listed