{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:50:13Z","timestamp":1788198613602,"version":"build-2803163510"},"reference-count":47,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2017,1,10]],"date-time":"2017-01-10T00:00:00Z","timestamp":1484006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Johns Hopkins Center for Global Health"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Educ Behav"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:p>Inadequate hand hygiene is estimated to result in nearly 300,000 deaths annually, with the majority of deaths being among children younger than 5 years. In an effort to promote handwashing with soap and water treatment behaviors among highly susceptible household members of cholera patients, we recently developed the Cholera-Hospital-Based Intervention-for-7-Days (CHoBI7); chobi means picture in Bengali. This 1-week handwashing with soap and water treatment intervention is delivered by a promoter in the hospital and the home to cholera patients and their household members. In our randomized controlled trial of this intervention, we observed a significant reduction in symptomatic cholera infections during the 1-week intervention period compared to the control arm and sustained high uptake of observed handwashing with soap behaviors up to 12 months postintervention. The aim of the present study was to assess the underlying mechanism of change that led to the high handwashing with soap behavior observed among participants who received the CHoBI7 intervention. Handwashing with soap was measured using 5-hour structured observation, and psychosocial factors were assessed using a structured questionnaire among 170 intervention and 174 control household members enrolled in the CHoBI7 trial. To investigate potential mediators of the CHoBI7 intervention effect, mediation models were performed. Response efficacy was found to mediate the intervention\u2019s effect on habit formation for handwashing with soap at the 1-week follow-up, and disgust, convenience, and cholera awareness were mediators of habit maintenance at the 6- to 12-month follow-up. These results support the use of theory-driven approaches for the development and implementation of handwashing with soap interventions.<\/jats:p>","DOI":"10.1177\/1090198116683141","type":"journal-article","created":{"date-parts":[[2017,1,10]],"date-time":"2017-01-10T07:37:05Z","timestamp":1484033825000},"page":"613-625","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Psychosocial Factors Mediating the Effect of the CHoBI7 Intervention on Handwashing With Soap: A Randomized Controlled Trial"],"prefix":"10.1177","volume":"44","author":[{"given":"Christine Marie","family":"George","sequence":"first","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shwapon","family":"Biswas","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Jung","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Perin","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahmina","family":"Parvin","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirajum","family":"Monira","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. M.","family":"Saif-Ur-Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahamud-ur","family":"Rashid","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sazzadul Islam","family":"Bhuyian","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth D.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Dreibelbis","sequence":"additional","affiliation":[{"name":"University of Oklahoma, Norman, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzana","family":"Begum","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatema","family":"Zohura","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Sack","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munirul","family":"Alam","sequence":"additional","affiliation":[{"name":"International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Bradley","family":"Sack","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elli","family":"Leontsini","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Winch","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,1,10]]},"reference":[{"key":"bibr1-1090198116683141","doi-asserted-by":"publisher","DOI":"10.4135\/9781446288054.n7"},{"key":"bibr2-1090198116683141","volume-title":"From intentions to actions: A theory of planned behavior","author":"Ajzen I.","year":"1985"},{"key":"bibr3-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.10.038"},{"key":"bibr4-1090198116683141","volume-title":"Self-efficacy: The exercise of control","author":"Bandura A.","year":"1997"},{"key":"bibr5-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"bibr6-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70160-8"},{"key":"bibr7-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2009.02373.x"},{"key":"bibr8-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1080\/10410236.2010.521906"},{"key":"bibr9-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1007\/s10865-015-9661-2"},{"key":"bibr10-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2015.04.186"},{"key":"bibr11-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1353\/pbm.2001.0001"},{"key":"bibr12-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(10)70224-3"},{"key":"bibr13-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyp002"},{"key":"bibr14-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0100444"},{"key":"bibr15-1090198116683141","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2010892"},{"key":"bibr16-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-1015"},{"key":"bibr17-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(04)01253-8"},{"key":"bibr18-1090198116683141","volume-title":"Belief, attitude, intention, and behavior: An introduction to theory and research","author":"Fishbein M.","year":"1977"},{"key":"bibr19-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12339"},{"key":"bibr20-1090198116683141","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.15-0502"},{"key":"bibr21-1090198116683141","doi-asserted-by":"publisher","DOI":"10.3201\/eid2202.151175"},{"key":"bibr22-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000221"},{"key":"bibr23-1090198116683141","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph13090868"},{"key":"bibr24-1090198116683141","first-page":"431","volume":"74","author":"Hoque B. A.","year":"1996","journal-title":"Bulletin of the World Health Organization"},{"issue":"3","key":"bibr25-1090198116683141","first-page":"395","volume":"60","author":"Hughes J. M.","year":"1982","journal-title":"Bulletin of the World Health Organization"},{"key":"bibr26-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-877"},{"key":"bibr27-1090198116683141","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.13-0568"},{"key":"bibr28-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-0597.2008.00339.x"},{"key":"bibr29-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60560-1"},{"key":"bibr30-1090198116683141","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2009.81.140"},{"key":"bibr31-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1080\/0887044031000141199"},{"key":"bibr32-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvman.2010.02.012"},{"key":"bibr33-1090198116683141","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.13-0434"},{"key":"bibr34-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1037\/a0016943"},{"key":"bibr35-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.01.013"},{"key":"bibr36-1090198116683141","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.40.3.879"},{"key":"bibr37-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1093\/her\/1.3.153"},{"key":"bibr38-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12329"},{"key":"bibr39-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1108\/03090561111167298"},{"key":"bibr40-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(03)15328-7"},{"key":"bibr41-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czm016"},{"key":"bibr42-1090198116683141","first-page":"753","volume":"62","author":"Sinclair G.","year":"1982","journal-title":"South African Medical Journal = Suid-Afrikaanse tydskrif vir geneeskunde"},{"key":"bibr43-1090198116683141","first-page":"731","volume":"58","author":"Spira W.","year":"1980","journal-title":"Bulletin of the World Health Organization"},{"key":"bibr44-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1037\/a0015512"},{"key":"bibr45-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1086\/644779"},{"key":"bibr46-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1086\/503335"},{"key":"bibr47-1090198116683141","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2006.09.026"}],"container-title":["Health Education &amp; Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1090198116683141","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1090198116683141","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1090198116683141","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:35:53Z","timestamp":1777448153000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1090198116683141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,10]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1177\/1090198116683141"],"URL":"https:\/\/doi.org\/10.1177\/1090198116683141","relation":{},"ISSN":["1090-1981","1552-6127"],"issn-type":[{"value":"1090-1981","type":"print"},{"value":"1552-6127","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,10]]}}}