What causes sustainable changes in hygiene behaviour? A cross-sectional study from Kerala, India.

This study was designed and the field work carried out by a non-governmental organisation ( NGO) responsible for implementing hygiene promotion. The sustainability of changed hygiene behaviour was studied at various periods up to nine years after the conclusion of a multifaceted hygiene promotion intervention in Kerala, India. Various methods including a questionnaire to assess knowledge, spot observation, demonstration of skills on request, and household pocket voting were used and compared for the measurement of the hygiene outcome. Pocket voting gave the lowest prevalence of good practice, which we infer to be the more accurate. Good handwashing practice was reported by more than half the adults in intervention areas, but