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Table 1 Adapted BCD checklist of handwashing behavioural components and determinants [35]

From: Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study

BCD component Determinant Definition of each determinant adapted to handwashing
Brain Executive Brain • The extent to which knowledge of handwashing behaviour and its benefits affects handwashing intentions and plans, and eventually performance of the behaviour
Motivated Brain • The goal-related drivers of behaviour. Motives for handwashing can include (but is not limited to) disgust (the desire to avoid cues to sources of infection), affiliation (the desire to fit in with others) and nurture (the desire to care for your child)
Reactive Brain • The extent to which handwashing can be automatically triggered based on past experience and repetition
Discounts • The perceived time, effort and costs of washing hands with soap as compared to other courses of action
Body Characteristics • Socio-demographic characteristics that may affect handwashing, including gender, wealth, age, education and employment
Senses • The sensory perceptions that may cue handwashing behaviour or be experienced during or after handwashing
Capabilities • Whether an individual has the skills required to wash their hands with soap
• Whether an individual perceives themselves to be able and willing to actually wash their hands at the times required
Behaviour settings Stage • The design and set up of the specific physical spaces where handwashing behaviour takes place
Infrastructure • Durable infrastructure associated with handwashing such as water supply systems, sanitation, kitchen facilities and handwashing facilities
Props • The value, characteristics, usability, ownership and accessibility of soap and other objects used for handwashing
Roles • The ways in which an individual’s role, identity or responsibilities influence their handwashing practices
Routine • The sequence of behaviours regularly performed in association with handwashing
Norms • The extent to which an individual’s handwashing practice is influenced by their perception of normative setting-specific rules. This includes an individual’s perception of whether handwashing is commonly practiced in their community (descriptive norm); whether handwashing is part of their role and their normal behaviour (personal norm); whether handwashing is socially approved of (injunctive norm); and whether handwashing is practiced by their ‘valued others’ (subjective norm)
Environment Physical environment • Factors in the physical or built environment including climate and geography
Biological Environment • Factors associated with an individual’s interaction within their biological environment
Social Environment • The structure of an individual’s social environment, including how they interact with it and perceive themselves within it
External context Political and historical context • The historical and cultural events that have shaped current perceptions and practices of handwashing. The extent to which handwashing-related policies or local and national leadership on handwashing issues, shape handwashing perceptions and practices at the individual level