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Background. Children in humanitarian situations are particularly vulnerable to diseases such as diar- rhoea. Handwashing with soap can greatly reduce transmission but handwashing rates are often low and traditional interventions ineffective. To aid future intervention design, this study aims to understand the determinants of child handwashing and the key motivational drivers of children’s behaviour within a specific humanitarian setting.

Methods. In an internally displaced persons camp in Northern Iraq we conducted a series of 36 friend- ship-paired interviews with children aged 7–12 years, six semi-structured caregiver inter- views, and three semi-structured hygiene promoter interviews. Perceived determinants of child handwashing were explored qualitatively, and motivational drivers were explored quantitatively with children in a rating exercise. Qualitative data were analysed thematically, using an inductive approach, and logistic regression analyses of motive rating data were performed to determine the predicted probabilities of motives being rated as important.

Results. Access to soap and water was perceived to be high across all participant groups. Children, caregivers and hygiene promoters all perceive the determinants of child handwashing to be associated with familial role, environmental factors pertaining to location and quality of hand- washing materials and facilities, and level of exposure to hygiene promotion, and children also attribute their handwashing to social norms. We find that children in this context are motived most by play and nurture.

 
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julie.watson@lshtm.ac.uk