Spot-check observational method for assessing hygiene practices 65 J HEALTH POPUL NUTR 2002 Mar;20(1):65-76 © 2002 ICDDR,B: Centre for Health and Population Research ISSN 1606-0997 $ 5.00+0.20 Correspondence and reprint requests should be addressed to: Dr. Marie T. Ruel Food Consumption and Nutrition Division International Food Policy Research Institute 2033 K Street, NW Washington, DC 20006 USA Email: m.ruel@cgiar.org INTRODUCTION Several studies have focused on the measurement of hygiene practices (1-4), and various qualitative and quantitative methods have been used for assessing hygiene practices. Many studies have mixed and sequenced the following approaches: survey methods based on recall, in-depth and key-informant interviews, focus groups, other participatory rapid assessment tools, semi-structured and structured observations, and spot- checks. Microbiological methods, involving sampling bacteria from hands, have also been used as a proxy measure of effective hand-washing practices (5,6). Spot-check Observational Method for Assessing Hygiene Practices: Review of Experience and Implications for Programmes Marie T. Ruel and Mary Arimond International Food Policy Research Institute, 2033 K Street, NW, Washington, DC 20006, USA ABSTRACT Structured observations, considered to be the method of choice for assessing hygiene practices, are time-consuming and expensive and are subject to reactivity (households modifying their behaviours in the presence of an observer). Hygiene practices also vary from day to day. Spot-checks, an alternative approach for observation, have recently gained increased popularity. In this approach, a list of predetermined conditions is observed at one point in time during a home visit. This paper reviewed experience with spot-checks for measuring hygiene practices and discussed strengths and weaknesses of the approach and its potential usefulness to those undertaking programmes. Review of seven studies carried out in various contexts confirmed that spot-checks are a promising alternative to structured observations, because these are less intrusive, less time-consuming, more economical, and less reactive. These are, however, equally affected by day-to-day variations in practices and conditions, and repeated observations are, thus, recommended. Additional research is needed to assess the validity, reactivity, and repeatability of hygiene indicators derived from spot-checks. Key words: Diarrhoea; Hygiene; Knowledge, attitudes, practice The limitations of recall methods for measuring hygiene practices are well-recognized. Several studies have demonstrated that respondents consistently and significantly over-report ‘good’ practices (7-10). Because of this, many researchers have employed structured observations, involving systematic recording of practices by passive observers. While these can provide detailed information and quantitative estimates of the prevalence of various practices, structured observations have three disadvantages. First, these are time-consuming and labour-intensive and require careful standardization of skilled observers. Second, these are subject to ‘reactivity,’ which occurs when individuals modify their behaviour because of the presence of an observer. Finally, these are affected by day-to-day variability, which is common to many types of behaviours, including hygiene. These latter two concerns have led to questions regarding the