Effectiveness of Digital Handwashing Intervention as a Breakthrough to Control COVID-19 and Transmissible Disease Outbreaks: A Meta-Analysis of Clinical Trials

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Nathaniel Gilbert Dyson
Valerie Josephine Dirjayanto
Aldithya Fakhri
Stephanie Amabella Prayogo


Introduction: The unprepared global health community is severely impacted by COVID-19 pandemic, which increases the urgency of reducing disease transmission. Handwashing is a protective behaviour, but its practice is insufficient with current methods. Digital intervention is potentially efficient in promoting better handwashing not only in COVID-19 but also in other diseases.

Objective: This review is aimed to explore the effectiveness of digital handwashing interventions for transmissible diseases.

Method: Following PRISMA, we searched PubMed, Scopus, MEDLINE, Cochrane, EBSCOHost, Scopus, and Google Scholar, for clinical trials assessing handwashing behaviour change utilizing digital intervention from inception up to November 2021. Critical appraisal was performed using Cochrane Risk of Bias Tool 2.0 and converted to AHRQ standards. We utilised inverse variance, random effects model for quantitative synthesis.

Results: Four studies were included in this study. A significant handwashing frequency pooled mean difference (MD) of 0.71 [95%CI: 0.41-1.01, P<0.00001] towards the intervention group was obtained from this meta-analysis. The subgroup analysis done reported highest influence of digital intervention in frequency of handwashing before eating snacks (MD 1.04 [95%CI: 1.01-1.07]), after sneezing or coughing (MD 0.97 [95%CI: 0.85-1.08]), and after being close to ill person (MD 0.90 [95%CI: 0.97-0.93]). All of the results were found significant (P<0.0001) and homogenous (I2 <40%), except for handwashing after coming into the house subgroup. Another parameter, theory of planned behaviour (TPB), which may influence behavioural changes also gave a significant mean difference of 0.90 [95%CI: 0.54-1.27, P<0.0001]. In addition, notable MDs were obtained in attitude changes of participants (MD 2.01 [95%CI: 0.86-3.15, P=0.0006] and subjective norms (MD 0.57 [95%CI: 0.35-0.79, P<0.00001]) components.

Conclusion: Digital intervention significantly improves handwashing in terms of both frequency and planned behaviour, which leads to better transmission control. We recommend the possible widespread application of this intervention in facing the current pandemic and future outbreaks.

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How to Cite
Dyson, N. G., Dirjayanto, V. J., Fakhri, A. and Prayogo, S. A. (2022) “Effectiveness of Digital Handwashing Intervention as a Breakthrough to Control COVID-19 and Transmissible Disease Outbreaks: A Meta-Analysis of Clinical Trials”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia. Available at: https://jamsa.amsa-international.org/index.php/main/article/view/385 (Accessed: 25May2022).
Scientific Posters (AMSA Intl Academic Competition)


WHO Coronavirus (COVID-19) Dashboard. WHO Coronavirus (COVID-19) Dashboard With Vaccination Data [Internet]. [cited 2021 Nov 16]. Available from: https://covid19.who.int/

Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews. 2020.

Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand-washing promotion for preventing diarrhoea. Cochrane Database of Systematic Reviews. 2021.

Alzyood M, Jackson D, Aveyard H, Brooke J. COVID-19 reinforces the importance of handwashing. Journal of Clinical Nursing. 2020.

Yardley L, Miller S, Schlotz W, Little P. Evaluation of a web-based intervention to promote hand hygiene: exploratory randomized controlled trial. J Med Internet Res. 2011;

Brauer M, Zhao JT, Bennitt FB, Stanaway JD. Global access to Handwashing: Implications for COVID-19 control in low-income countries. Environ Health Perspect. 2020;

Janssen AP, Tardif RR, Landry SR, Warner JE. “Why tell me now?” the public and healthcare providers weigh in on pandemic influenza messages. J Public Heal Manag Pract. 2006;

Aboumatar H, Ristaino P, Davis RO, Thompson CB, Maragakis L, Cosgrove S, et al. Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviors among Healthcare Personnel. Infect Control Hosp Epidemiol. 2012;

Hanafi HF, Wahab MH, Wong KT, Selamat AZ, Adnan MHM, Naning FH. Mobile Augmented Reality Hand Wash (MARHw): Mobile Application to guide community to ameliorate handwashing effectiveness to oppose Covid-19 disease. Int J Integr Eng. 2020;

Ainsworth B, Miller S, Denison-Day J, Stuart B, Groot J, Rice C, et al. Infection control behavior at home during the COVID-19 pandemic: Observational study of a web-based behavioral intervention (Germ defence). J Med Internet Res. 2021;

Miller S, Ainsworth B, Weal M, Smith P, Little P, Yardley L, et al. A web-based intervention (germ defence) to increase handwashing during a pandemic: Process evaluations of a randomized controlled trial and public dissemination. J Med Internet Res. 2021;

Xiong P, Zhang J, Wang X, Wu TL, Hall BJ. Effects of a mixed media education intervention program on increasing knowledge, attitude, and compliance with standard precautions among nursing students: A randomized controlled trial. Am J Infect Control. 2017;

Little P, Stuart B, Hobbs FDR. Erratum: An internet-delivered handwashing intervention to modify infl uenza-like illness and respiratory infection transmission (PRIMIT): A primary care randomised trial (Lancet (2015) 386 (1631-391). The Lancet. 2015.