Understanding the Influence of Context, Psychology, and Technology
Improving access to safe water, adequate sanitation, and good hygiene practices (WASH) is essential for reducing the global burden of diarrheal diseases, especially among children in low- and middle-income countries. While the provision of WASH infrastructure is a critical first step, the sustained adoption and use of these technologies requires careful consideration of the complex factors that influence household-level behaviours. Behaviour change interventions have emerged as a promising approach to drive positive WASH outcomes, but the evidence on their effectiveness has been mixed.
This article examines the latest research on household behaviour change interventions for WASH in urban settings, drawing insights from a comprehensive review of the literature. We explore the multifaceted nature of WASH behaviours, highlighting the dynamic interplay between contextual, psychosocial, and technological factors that shape household practices. By applying a holistic framework for understanding and designing behaviour change initiatives, we offer practical guidance to WASH practitioners, policymakers, and researchers on how to create and sustain impactful improvements in sanitation and hygiene at the household level.
Examining the Evidence on Behaviour Change Interventions
A recent scoping review assessed the effectiveness of behaviour change interventions on sanitation and hygiene practices in urban settings globally. The review, which included 13 studies ranging from low- to high-quality, found that the interventions had mixed effects on the targeted outcomes.
Key Findings:
- Latrine Quality Improvements: Behaviour change interventions were generally effective in improving the quality of household latrines, but did not consistently increase the safe disposal of child faeces.
- Handwashing Practices: The interventions often improved handwashing with soap at key times, and sometimes increased the presence of soap and water at handwashing facilities.
- Limited Evidence on Food Hygiene: There was limited evidence on the effect of the interventions on food hygiene practices.
- Sustainability Concerns: Most study outcomes were measured between 6 and 12 months after intervention implementation, raising questions about the long-term sustainability of the behaviour changes.
These mixed findings highlight the complexities involved in driving durable WASH behaviour change, especially in challenging urban environments. While certain targeted practices, such as handwashing and latrine quality, can be improved through behaviour change approaches, more ambitious and holistic interventions are needed to address the systemic barriers to universal WASH access and use.
Applying a Comprehensive Framework for WASH Behaviour Change
To better understand the multidimensional factors shaping WASH behaviours, researchers have developed the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH). This framework organizes the determinants of WASH practices into three key dimensions: Contextual Factors, Psychosocial Factors, and Technological Factors. These dimensions operate across five interconnected levels: Societal/Structural, Community, Interpersonal/Household, Individual, and Habitual.
By considering the dynamic interplay between these dimensions and levels, the IBM-WASH model provides a comprehensive lens for designing, implementing, and evaluating behaviour change interventions in infrastructure-constrained settings. Let’s explore each dimension in more detail:
Contextual Factors
The Contextual Dimension encompasses the broader environmental, socioeconomic, and demographic factors that shape household WASH practices. This includes access to WASH products and services, availability of enabling resources (such as water and space for handwashing), as well as characteristics of the built and natural environment. Crucially, the model recognizes that contextual factors can create both opportunities and barriers for behaviour change, and that these factors may vary significantly within the same community.
For example, a study in Kenya found that while media exposure and media ownership were associated with increased handwashing with soap, constraints imposed by limited water and sanitation access, as well as individual sociodemographic characteristics (e.g., lower education), were linked to reduced handwashing rates among the most impoverished population groups. Understanding and addressing these contextual realities is essential for designing effective and equitable WASH interventions.
Psychosocial Factors
The Psychosocial Dimension focuses on the individual, social, and behavioural determinants that influence WASH practices. This includes factors such as knowledge, perceived threat of illness, social norms, aspirations, disgust, and habit formation. Behaviour change strategies often target these psychosocial determinants, aiming to shift attitudes, motivations, and social influences to drive improved WASH behaviours.
For instance, research has demonstrated the importance of disgust in shaping handwashing and sanitation practices. Interventions that effectively elicit feelings of disgust towards poor WASH conditions have been shown to catalyze community-level behaviour change. Similarly, strengthening positive social norms around handwashing and latrine use can reinforce individual adoption and sustained use of these practices.
Technological Factors
The Technological Dimension examines the influence of the physical products, devices, and infrastructure required for WASH behaviours. This includes the location, accessibility, ease of use, and other attributes of handwashing stations, water treatment technologies, and sanitation facilities. The design and availability of these enabling technologies can significantly impact their acceptability and use at the household level.
Studies have found that the placement of handwashing stations, the design of taps and soap presentation, and the perceived convenience of water treatment options can all influence the adoption and continued use of WASH technologies. Ensuring that these technological factors are aligned with the contextual realities and psychosocial drivers of the target population is crucial for sustained behaviour change.
Designing Effective and Equitable WASH Behaviour Change Interventions
By applying the IBM-WASH framework, WASH practitioners can develop more comprehensive and targeted behaviour change strategies that address the multifaceted determinants of household practices. This holistic approach involves the following key steps:
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Conduct Formative Research: Utilize a combination of qualitative and quantitative methods to deeply understand the unique contextual, psychosocial, and technological factors influencing WASH behaviours within the target community. This formative research should inform the design of the behaviour change intervention.
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Integrate Behaviour Change Strategies Across Levels: Identify opportunities to address determinants at the individual, household, community, and societal/structural levels. This may include components such as interpersonal communications, community mobilization, policy advocacy, and improvements to WASH infrastructure and product design.
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Foster Habit Formation: Recognize the importance of habit in sustaining WASH practices over time. Incorporate strategies that make desired behaviours easy, intuitive, and automatically triggered by contextual cues.
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Monitor and Adapt Interventions: Continuously monitor the implementation and outcomes of the behaviour change intervention, using data to refine strategies and ensure long-term impact. Regularly assess the evolving contextual, psychosocial, and technological factors that may influence the sustained adoption of improved WASH practices.
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Advocate for Supportive Policies and Enabling Environments: Leverage the insights gained through the IBM-WASH framework to advocate for policies, investments, and systems-level changes that create supportive environments for households to adopt and maintain improved WASH behaviours.
By adopting this comprehensive, multi-level approach, WASH programmes can design and implement behaviour change interventions that are more responsive to the complex realities faced by urban households, ultimately driving sustainable improvements in sanitation, hygiene, and health outcomes.
Conclusion: Towards Equitable and Lasting WASH Behaviour Change
Household behaviour change is a critical component of efforts to achieve universal access to safe water, sanitation, and hygiene. However, the mixed results of existing interventions highlight the need for a more holistic and nuanced understanding of the factors influencing WASH practices, especially in infrastructure-constrained urban settings.
The Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH) provides a valuable framework for designing, implementing, and evaluating behaviour change initiatives. By considering the intricate interplay between contextual, psychosocial, and technological determinants across multiple levels, this model can guide the development of more effective and equitable WASH programmes.
Ultimately, driving sustainable behaviour change requires a commitment to understanding the lived experiences of target communities, designing tailored interventions, and advocating for systemic changes that create enabling environments for improved WASH practices. By embracing this holistic, evidence-based approach, we can make significant strides towards ensuring that every household has access to the safe water, adequate sanitation, and good hygiene practices that are essential for health, dignity, and sustainable development.
