Assessing reach and perceptions of hygiene behaviour change interventions for people with disabilities and older...

People with disabilities and older adults are often disproportionately excluded from public health interventions. The study explored the reach and perceptions of hygiene behaviour change messages (e.g., handwashing, mask use, social distancing) and hygiene products (e.g., soap, mask, sanitiser) delivered through multiple channels among people with disabilities and older adults than those without disabilities and younger people.

A matched cross-sectional study was conducted in Indonesia, Kenya, and Zambia from December 2020 to November 2022, utilising three-stage stratified random sampling technique. Data were analysed using descriptive statistics and multivariate generalised estimating equation models.

Pooled analysis found people with disabilities were 64% less likely to report receiving hygiene behaviour change messages than those without disabilities (aOR = 0.36; 95% CI: 0.24-0.55). In Indonesia and Kenya, they were 59% (aOR = 0.41; 95% CI: 0.24-0.72) and 54% (aOR = 0.46; 95% CI: 0.28-0.76) less likely to receive messages. Message reach was higher among older adults (87%) and younger people (91%) in Indonesia. People with cognitive, vision, and self-care impairments had lower message reach. No significant difference was observed in hygiene product reach across disability status. In Kenya and Zambia, rural and higher socio-economic groups were more likely to report receiving products, but older women in Zambia were less reported. Across all countries, people with disabilities and older adults were less likely to report messages actionable or effective.

People with disabilities and older adults reported lower reach of hygiene behaviour change programs, with inequities based on impairment type and socio-demographic context. Inclusive and context-specific strategies are required to increase reach.