Draft Hand Sanitizer Satisfaction Protocol
November 29, 2006

Michael Stone                    		Stephanie Koskowich
mstone1@swarthmore.edu           	skoskow1@swarthmore.edu

Introduction
The purpose of this study is to figure out what kind of hand sanitizer should be bought by Swarthmore College as a part of Swat Clean Hands' efforts to improve hand hygiene on campus. The study is important because hand sanitizers come in a variety of formulations which may affect long-term usage rates. 

We hypothesize that the primary factors affecting long-term usage of a hand sanitizer product are dispenser placement, advertising & education, predetermined feelings about hand hygiene in general and hand sanitizers in particular, and the incidence of "side-effects" like dryness or an unpleasant residue after usage. 

Since we wish to maximise long-term usage, we think it prudent to try to pick the right formulation for the Swarthmore population by measuring some hypothesized indicators of long-term usage like how satisfied users express themselves to be with each product, how dry users hands feel after usage, and whether the product leaves an unpleasant residue on the hands.

Overview & Setup
We propose to study these indicators from a table located at the main entrance of the Sharples Dining Hall between the peak traffic times of 11:20 - 11:50 AM and 12:20 - 12:50 PM for the duration of a week. From this table, we will invite passing students to review a hand sanitizer formulation.

We will encourage students to participate through several media: 
•	Most prominently with the phrase:
o	"Would you please try this hand sanitizer and answer a few questions about it?"
•	With a sign announcing our study, perhaps reading "SCH Hand Sanitizer Study"
•	With a bag or bowl of candy which we will offer to anyone passing by.

When a passing student agrees to participate, we will ask them to use use a hand sanitizer. Then we'll provide them with a numbered, dated response sheet and a pen so that they can answer our questions. We'll collect the data and analyze it as described below.

Design Decisions
Steph and I have some disagreements about how we ought to match participants up with an application of hand sanitizer. There are two major debates: one about treatment assignment and one about using branded vs. unmarked products.

Treatment Assignment:

With regard to treatment assignment, we've proposed are include a one-formulation-per-day "1/day" design and a random assignment of participants to treatments.

The pros for the "1/day" design are its simplicity, and the fact that it won't assign the same treatment to a single participant more than once. The con is that each product is essentially tested on a different population. If particpation varies from day to day, some formulations may receive much less study than others. Also, the variation will be
dependent on date; some people will participate on Day 2 specifically because they didn't on Day 1 and some will choose not to participate on Day 2 because they did participate on Day 1. Finally, the population being measured will have changed simply by virtue of of having become more experienced with their response to hand sanitizers and with our
questions from day to day. 

The pros of the randomized design are that makes sure that each treatment receives equal amounts of study and that it controls for changes in the population being measured both due to experience effects and due to temporally-correlated bias. The cons are that it's more complex than a "1/day" design, leaves more room for data recording
mistakes, and, with a small number of treatments, it will assign the same treatment to a participant with some regularity. Arguably, the last point is not a con if we say that we wish to extrapolate satisfaction with the *experience* of using hand sanitizer: certainly, we ultimately expect many of our participants to use whichever hand sanitizer we
decide to recommend on a regular basis. 

Walter Stromquist suggests a stratified design - randomly assigning one treatment to each five-minute block of observations - which preserves some of the simplicity of the "1/day" design while controlling for the temporal and experiential biases like the fully randomized design. 

Branding:

With regard to branding vs. unmarked treatments, we're really not sure what to do. The issues are the same as in any other institutional decision to purchase branded products. Branding might cause participants to prefer a more expensive product that, in an unbranded trial, would be indistinguishable from a generic formulation or which would be dominated by preference for a different product. On the other hand, since the
ultimate purchase probably will be branded, it makes some sense to try to measure the effect of branding on users. 

Measurements
We want to measure satisfaction and the incidence of side-effects like dryness or residue.

Therefore, we propose to ask the following questions, to be answered by circling responses or by writing in responses on a printed form. 

Questions:

1. How dry does the hand sanitizer leave your hands?
      
      1	     2          3         4       5

    not dry      mildly dry     very dry

2. How unpleasant is any residue left on your hands?

      1	     2          3         4       5

     not               mildly            very     (unpleasant)

3. Would you use this hand sanitizer if it were readily available?
      
      1	     2          3         4       5

  certainly         maybe         certainly
      not 

4. How do your hands feel after using this hand sanitizer?
(Please include any other comments)

Analysis
Details haven't yet been determined. We basically intend to graphically compare the response distributions, perhaps to try to code some of the free responses, and we hope that there will be a clear best choice. Failing that... we'll have new decisions to make.

Risks to Participants
Hand sanitizers are in widespread commercial use, are well-tolerated, and have no significant side-effects when used topically. They cause open cuts to sting, and perhaps could remove ink on someone's hand, but pose little other danger. They are flammable, but Sharples is a non-smoking building with no open flames near the test site.

Since we will be anonymously gathering non-personal data, there is little risk  to the privacy of the participants. 

Ultimately, we believe that these risks are more than out-weighted by the benefit of the study, which advances an important public health agenda that promises to substantially improve the health of the entire Swarthmore campus community.