Little, Paul, Stuart, Beth, Hobbs, F.D.R., Moore, Mike, Barnett, Jane, Popoola, Deborah, Middleton, Karen, Kelly, Joanne, Mullee, Mark, Raftery, James, Yao, Guiqing, Carman, William, Fleming, Douglas, Stokes-Lampard, Helen, Williamson, Ian, Joseph, Judith, Miller, Sascha and Yardley, Lucy (2015) An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. The Lancet, 386 (10004), 1631-1639. (doi:10.1016/S0140-6736(15)60127-1). (PMID:26256072)
Abstract
Background. Hand-washing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic, but the role of hand-washing is debated, and no good randomised evidence exists among adults in non-deprived settings. This study aimed to demonstrate whether an intervention to modify hand-washing reduces RTIs among adults.
Methods. Individuals sharing a household were recruited by mailed invitation through their general practice. Following consent, participants were randomised on-line by an automated computer-generated random number programme either to no access, or to access a bespoke automated web-based intervention which maximised hand-washing intention, monitored hand-washing behaviour, provided tailored feedback, reinforced helpful attitudes and norms and addressed negative beliefs. Participants could not be blinded, but the analysis syntax was constructed blind to group.
Results. 20,066/16,908 (84%) participants were followed up. An intention-to-treat analysis documented fewer RTIs reported after 16 weeks (intervention 51% (4242/8241); controls 59% (5135/8667); multivariate risk ratio 0.86; 95% confidence intervals 0.83 to 0.89). The intervention reduced transmission of RTIs (reported within one week of another household member) both to and from the index person. There was a modest increase in minor self-reported skin irritation (4.3% (231/5429) versus 1.3% (79/6087)) and no serious adverse events.
Interpretation. In non-pandemic years an effective internet intervention designed to increase hand-washing could have an important impact in reducing infection transmission. Given the heightened concern during a pandemic and the likelihood of accessing the internet for advice, the intervention also has potential for effective implementation during a pandemic.
Registration: ISRCTN75058295http://www.controlled-trials.com/ISRCTN75058295.
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