Transcript Presentation File - The Water Institute at UNC

Improved Latrine Cleanliness through
Behavior Change and Changes in Quality of
Latrine Construction: A Longitudinal
Intervention Study in Rural Burundi
Ina Sonego & Hans-Joachim Mosler
Environmental and Health Psychology EhPsy
Eawag: Swiss Federal Institute of Aquatic Science and Technology
Relevance of latrine cleanliness
o Important for well-being of users
o Unhygienic latrines are a risk factor for health
o Stepping down the sanition ladder
o
Risk of return to open defecation if latrines (e.g. Kwiringira,
Atekyereza, Niwagaba, & Günther, 2014 in Uganda; McFarlane,
2008 in India)
o Behavior change to ensure latrine cleanliness!
Kwiringira, J., Atekyereza, P., Niwagaba, B. C., & Günther, I. (2014). Descending the sanitation ladder in urban Uganda. BMC
public health, 2014(14), 624-634.
McFarlane, C. (2008). Sanitation in Mumbai's informal settlements: State,‘slum’, and infrastructure. Environment and planning
A, 40(1), 88-107.
Introduction – Methods – Results – Conclusion
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Research questions
o How can we improve latrine cleanliness?
o What determines latrine cleanliness?
o
Contextual factors?
o
Habitual cleaning behavior?
o What determines habitual latrine cleaning?
Introduction – Methods – Results – Conclusion
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Systematic behavior change in water,
sanitation and hygiene.
A practical guide using the RANAS approach
Mosler, H.-J., & Contzen, N. (2016). Systematic behavior change in water, sanitation and hygiene. A practical guide using
the RANAS approach. Version 1.1. Dübendorf, Switzerland: Eawag.
Introduction – Methods – Results – Conclusion
4
Data collection
o Face-to-face interviews with primary caregivers
Team of local interviewers
Structured questionnaire
Spot-checks
Baseline: 761 households
Follow-up: 287 households
o
o
o
o
o
Introduction – Methods – Intervention – Evaluation – Conclusion
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Variables
o Habitual latrine cleaning
Self-report
o Habit and frequency
o E.g. how often do you clean the latrine (5 point scale)
Psychosocial factors (RANAS)
o Self-report
o E.g. do you think it is disgusting to use a dirty latrine (5 point scale)
Observed latrine cleanliness
o Spot-check
o
o
o
Clean: no dirt, no feces (1)
mediocre: some dirt, no feces (0)
Introduction – Methods – Intervention – Evaluation – Conclusion
dirty: feces on floor (-1)
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Sanitary situation revealed by baseline study
o Most households have latrines
o Quality of latrines mostly low
o Cleanliness mediocre
Sonego, I. L., & Mosler, H. J. (2014). Why are some latrines cleaner than others? Determining the
factors of habitual cleaning behaviour and latrine cleanliness in rural Burundi. Journal of Water,
Sanitation and Hygiene for Development, 4(2), 257-267.
Introduction – Methods – Intervention – Evaluation – Conclusion
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Evidence based Intervention 1
o Aim
To increase observed latrine cleanliness
o To increase quality of latrine construction
Baseline revealed it would be promising to target
o Positive emotions
o Satisfaction with latrine cleanliness
o Commitment strength
o
o
Introduction – Methods – Intervention – Evaluation – Conclusion
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Evidence based Intervention 2
o Household visits by local health promotors
Poster and group discussion
o Promoting positive picture of having a well-built and clean latrine
o Joy, pride and satisfaction
o Self-commitment at the end of the visit
Target group
o 4 villages
o Around 4000 households
o
o
Introduction – Methods – Intervention – Evaluation – Conclusion
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Effect of intervention on observed latrine
cleanliness
Intervention group
N = 198
Control group
N = 91
Wilcoxon sign-rank test: increase in intervention group Z = -3.00, p = .003, r = .23.
(no significant change in control group
Mann-Whitney U-Test: Intervention group is more likely to improve cleanliness
compared to control group (U = 6000, z = 2.42, p = .02, r = .15).
Introduction – Methods – Intervention – Evaluation – Conclusion
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Effects of intervention on quality of latrine
construction
*
***
***
**
***
**
Intervention group increased quality of latrine construction more than control group
**
Introduction – Methods – Intervention – Evaluation – Conclusion
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Influences on observed latrine cleanliness
Habitual latrine
cleaning
3.5***
Lid covering slab
hole
7.4*
Higher/better
leads to
latrines being
Availability of door
Material of
superstructure
3.3†
times more
likely to
increase in
cleanliness as
well!
2.8**
†p
Introduction – Methods – Intervention – Evaluation – Conclusion
< .1; *p < .05; **p < .005; ***p < .001
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Influences on habitual latrine cleaning
Commitment
strength
Satisfaction
with
Cleanliness
.18***
Adj. R2 = .46
.15***
.17***
Habitual latrine
cleaning
Personal norm
-.23***
Forgetting
N = 287
Introduction – Methods – Intervention – Evaluation – Conclusion
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Conclusion
o Habitual latrine cleaning is the strongest predictor of
o
observed latrine cleanliness
 People have control over the cleanliness of their
latrines
 Behavior change interventions make sense
 Further enhancement of latrine cleanliness
through better quality of latrine construction
Behavior change interventions to increase habitual
latrine cleaning should target:
 Commitment strength
 Positive emotions regarding latrine cleanliness:
joy, pride and satisfaction a clean latrine brings
to the whole family!
Introduction – Methods – Intervention – Evaluation – Conclusion
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Thank you very much for your attention!
Gratefully acknowledged are Andrea
Stocker, Christoph Häfliger, Christine
Oberbeck, Nabil Chemaly, the whole data
collectors team, all of the promotors, GIZ
Burundi, and of course all of the study
participants
Side event on behavior change in the WASH sector:
A practical guide for systematic behavior change using the RANAS
approach: Applications in WASH projects demonstrating its practicability
Convened by Eawag, Environmental Social Sciences, Environmental and Health Psychology
Friday 10/14, 8:30 – 10:00 AM, Mountain Laurel
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