Psychosocial factors influencing handwashing behaviour and the design of behaviour change interventions for the Rohingya camps in Bangladesh

This study sought to identify the psychosocial factors that influence handwashing behaviour and to design behaviour change techniques applying the risk, attitude, norm, ability, and self-regulation (RANAS) behaviour change approach in Rohingya camps in Cox's Bazar, Bangladesh. This was a cross-sectional study conducted in four Rohingya camps located in Ukhiya and Teknaf sub-districts. Participants were selected by systematic random sampling. A structured interviewer-administered questionnaire was used. Analysis of variance testing (ANOVA) was used to determine the significant predicting variables. A total of 1,358 individuals participated in the interview. The mean age was 31.11 ranging from 13 to 75 years. The majority were female (84.9%). Around 75% of participants reported practising handwashing. Several psychosocial predictors were identified for handwashing behaviour with medium to large effect size such as health knowledge, beliefs about costs and benefits, feelings, social norms, abilities, and self-regulation factors. Significant predictors were additionally identified in individual camps. The behaviour change techniques included providing information, demonstration of handwashing, providing rewards, evoking emotions, and public commitments amongst others proposed in this study. Identified psychosocial determinants should be considered while promoting sustainable handwashing behaviour along with adequate supplies and infrastructure. This study also suggests evaluating the proposed behaviour change interventions considering the contextual factors related to handwashing

The role of social identification for achieving an open-defecation free environment: A cluster-randomized, controlled trial of Community-Led Total Sanitation in Ghana

Unsafe sanitation practices are a major source of environmental pollution and are a leading cause of death in countries of the Global South. One of the most successful campaigns to eradicate open defecation is "Community-Led Total Sanitation" (CLTS). It aims at shifting social norms towards safe sanitation practices. However, the effectiveness of CLTS is heterogeneous. Based on social identity theory, we expect CLTS to be most effective in communities with stronger social identification, because in these communities individuals should rather follow social norms. We conducted a cluster-randomized controlled trial with 3,216 households in 132 communities in Ghana, comparing CLTS to a control arm. Self-reported open defecation rates and social identification were assessed pre-post. Generalized Estimating Equations showed that CLTS achieved lower open defecation rates compared to controls. This effect was significantly stronger for communities with stronger average social identification. The results confirm the assumptions of social identity theory. They imply that pre-existing social identification needs to be considered for planning CLTS, and strengthened beforehand if needed

Is Community-Led Total Sanitation connected to the rebuilding of latrines? Quantitative evidence from Mozambique.

To reduce open defecation, many implementers use the intervention strategies of Community-Led Total Sanitation (CLTS). But CLTS focuses on latrine construction and does not include latrine maintenance and repair damage or collapse. Some households rebuild their latrine while others return to open defecation. The reasons why are unknown. Using data from a cross-sectional survey, this article shows how physical, personal, and social context factors and psychosocial factors from the RANAS model are associated with CLTS participation, and how these factors connect to latrine rebuilding. In 2015, heavy rains hit the north of Mozambique and many latrines collapsed. Subsequently, 640 household interviews were conducted in the affected region. Logistic regression and mediation analyses reveal that latrine rebuilding depends on education, soil conditions, social cohesion, and a feeling of being safe from diarrhea, the perception that many other community members own a latrine, and high confidence in personal ability to repair or rebuild a broken latrine. The effect of CLTS is mediated through social and psychosocial factors. CLTS already targets most of the relevant factors, but can still be improved by including activities that would focus on other factors not yet sufficiently addressed

How does Community-Led Total Sanitation (CLTS) affect latrine ownership? A quantitative case study from Mozambique

Abstract Background Community-led total sanitation (CLTS) is a widely used, community-based approach to tackle open defecation and its health-related problems. Although CLTS has been shown to be successful in previous studies, little is known about how CLTS works. We used a cross-sectional case study to identify personal, physical, and social context factors and psychosocial determinants from the Risks, Attitudes, Norms, Abilities, and Self-Regulation (RANAS) model of behavior change, which are crucial for latrine ownership and analyze how participation in CLTS is associated with those determinants. Methods Structured interviews were conducted with 640 households in 26 communities, where CLTS had been completed before and compared to 6 control communities, all located in northern Mozambique in 2015. To identify crucial factors for latrine ownership, logistic regression analysis were conducted and mediation analysis were used to analyse the relationship between CLTS participation and latrine ownership mediated by factors identified by the logistic regression analyses. Results Mediation analysis reveal that the relationship of CLTS participation with probability of owning a latrine is mediated by social context factors and psychosocial determinants. Data analysis reveal that the probability of building a latrine depends on existing social context factors within the village, the behavior of others in the community, the (dis)approval of others of latrine ownership, personal self-confidence in latrine building, and a precise communication of the benefits of latrine ownership during a CLTS triggering event. Conclusions By including activities to focus on the mentioned factors, CLTS could be improved. Exemplary adaptations are discussed

Factors Associated with Levels of Latrine Completion and Consequent Latrine Use in Northern Ghana

Open defecation is still a major health problem in developing countries. While enormous empirical research exists on latrine coverage, little is known about households’ latrine construction and usage behaviours. Using field observation and survey data collected from 1523 households in 132 communities in northern Ghana after 16 months of implementation of Community Led Total Sanitation (CLTS), this paper assessed the factors associated with latrine completion and latrine use. The survey tool was structured to conform to the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) model. In the analysis, we classified households into three based on their latrine completion level, and conducted descriptive statistics for statistical correlation in level of latrine construction and latrine use behaviour. The findings suggest that open defecation among households reduces as latrine construction approaches completion. Although the study did not find socio-demographic differences of household to be significantly associated with level of latrine completion, we found that social context is a significant determinant of households’ latrine completion decisions. The study therefore emphasises the need for continuous sensitisation and social marketing to ensure latrine completion by households at lower levels of construction, and the sustained use of latrines by households

The importance of collective and individual psychological ownership for safe sanitation: A multilevel analysis in rural Ghana

Unsafe sanitation practices can severely affect public health. Strengthening psychological ownership, the feeling of owning an object (e.g. the latrine) individually or collectively, may promote safe sanitation practices, e.g. decreased open defecation. This study investigated psychological ownership in communities that participated in a sanitation intervention. We used follow-up survey data of a cluster-randomised controlled trial in rural Ghana (N = 2012 households), which assessed psychological ownership, and safe sanitation outcomes. The data were analysed using multilevel modelling and generalised estimating equations. In line with our assumptions, greater psychological ownership for the latrine related to decreased open defecation. Higher individual psychological ownership for the open defecation space related to safe sanitation outcomes, whereas collective ownership related to lesser safe sanitation. The present study shows that the concept of psychological ownership may play an important role in safe sanitation. Collective and individual psychological ownership seem to distinctly relate to safe sanitation outcomes, which has high relevance for promoting communities’ health behaviour