TY - JOUR T1 - Nongovernmental Organization Practitioners’ Perspectives on the Challenges and Solutions to Changing Handwashing Behavior in Older Children: A Qualitative Study JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-22-00231 VL - 11 IS - 1 SP - e2200231 AU - Julie Watson AU - Oliver Cumming AU - Robert Dreibelbis Y1 - 2023/02/28 UR - http://www.ghspjournal.org/content/11/1/e2200231.abstract N2 - Key FindingsImproving handwashing with soap (HWWS) practice among older children can reduce disease transmission, but funding for these interventions targeting older children is insufficient and inconsistent.Practitioners report that most HWWS interventions targeting older children are resource-heavy, unengaging, and implemented within non-enabling physical environments, with little evidence of success.Lack of coordination within and between sectors creates major challenges to implementing HWWS interventions targeting children.Key ImplicationsThe nongovernmental organization (NGO) sector should prioritize improving older children’s handwashing and support programs accordingly.NGO practitioners should balance resource needs against using evidence-based, engaging approaches that address the drivers of handwashing among older children.NGOs should foster better intra- and intersectoral coordination to overcome challenges related to the integration of HWWS promotion within existing educational institutions, the standardization of implementation tools, and the sustainability of interventions.Background:Increasing handwashing with soap (HWWS) among older children (aged 5–14 years) can achieve a substantial public health impact. However, HWWS interventions targeting older children have had mixed success. Recent research has attempted to quantitatively identify effective intervention techniques; however, success is likely also influenced by the wider context of implementation. We explore nongovernmental organization (NGO) practitioners’ perspectives on the challenges and solutions to HWWS interventions targeting older children to enhance understanding of what is required, beyond intervention content, for them to be effective.Methods:We conducted in-depth, semistructured interviews in April–November 2020 with 25 practitioners employed across 11 NGOs and involved in HWWS interventions targeting older children in development and humanitarian settings. We used purposive and snowball sampling to recruit participants in roles at the global, national/regional, and local levels. Interviews were audio-recorded, transcribed, and thematically analyzed to identify challenges and solutions to HWWS interventions targeting older children. Results were organized according to program development cycle stages.Results:Twelve themes relating to perceived challenges emerged: (1) lack of prioritization, (2) funding inconsistency, (3) insufficient formative research, (4) demand on resources, (5) unengaging intervention content, (6) non-enabling physical environments, (7) availability of skilled implementers, (8) reaching out-of-school children, (9) community mistrust, (10) lack of coordination, (11) lack of evaluation rigor, and (12) failure to assign older children’s HWWS as a primary outcome in evaluations of hygiene interventions. Recommended solutions were at the intervention, organization, and sector levels.Conclusion:Intervention design and delivery are important for the success of HWWS interventions for older children, but contextual factors, such as the availability of human and material resources and the level of coordination within and beyond the NGO sector, should also be considered. NGOs need to prioritize HWWS promotion among older children and support programs accordingly. ER -