Spot-check observational method for assessing hygiene practices: review of experience and implications for programmes.

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.