Global scaling up handwashing project : measuring the behavioral determinants of handwashing with soap

This Technical Paper presents lessons learned from the application of the Focus, Opportunity, Ability, and Motivation (FOAM) framework to identify handwashing determinants. The analysis presented used data derived from formative research studies, monitoring surveys, and impact evaluation
baseline studies conducted by the Water and Sanitation Program (WSP) through its Global Scaling Up Handwashing Project. That project (2007–2012) was implemented by national and local national governments in Peru, Senegal, Tanzania, and Vietnam with technical support from WSP. The discussion focuses on findings from the analysis of data collected in Peru and Senegal and provides practical recommendations for researchers and program managers working in handwashing promotion. In addition to offering a rationale for measuring handwashing  determinants, the paper describes the FOAM framework and details the process used to measure the determinants, focusing on lessons learned.  Using the six-step approach to measure determinants requires rigor, and should not be undertaken without sufficient resources to support the process. At very least, programs considering this approach should be able to accommodate piloting and an adequate sample size, as well as provide appropriate analytical and statistical skills. [authors abstract]