Persuasion factors influencing the decision to use sustainable household water treatment

Household and community systems for groundwater remediation in Bihar, India: Arsenic and inorganic contaminant removal, controls and implications for remediation selection

The presence of arsenic (As) and other inorganic contaminants in groundwater is a key public health issue in India and many other parts of the world. Whilst a broad range of remediation technologies exist, performance can be highly variable, and appropriate selection and management of remediation approaches remains challenging. Here, we have identified and tested the performance of a range of small-scale remediation technologies (e.g. sand filters, multi-stage filtration and reverse osmosis (RO)-based systems; n = 38) which have been implemented in Bihar, India. We have undertaken spot-assessments of system performance under typical operating conditions in household and non-household (e.g. community, hospital, hostel/hotel) settings. The removal of As and other inorganic contaminants varied widely (ranging from ~0-100%), with some solutes generally more challenging to remove than others. We have evaluated the relative importance of technology type (e.g. RO-based versus non-RO systems), implementation setting (e.g. household versus non-household) and source water geochemistry (particularly concentrations and ratios of As, Fe, P, Si and Ca), as potential controls on remediation effectiveness. Source water composition, particularly the ratio ([Fe] - 1.8[P])/[As], is a statistically significant control on As removal (p < 0.01), with higher ratios associated with higher removal, regardless of technology type (under the site-specific conditions observed). This ratio provides a theoretical input which could be used to identify the extent to which natural groundwater composition may be geochemically compatible with higher levels of As removal. In Bihar, we illustrate how this ratio could be used to identify spatial patterns in theoretical geochemical compatibility for As removal, and to identify where additional Fe may theoretically facilitate improved remediation. This geochemical approach could be used to inform optimal selection of groundwater remediation approaches, when considered alongside other important considerations (e.g. technical, managerial and socio-economic) known to impact the effective implementation and sustainability of successful groundwater remediation approaches.

How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

OBJECTIVE

To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.

DESIGN

Realist review.

DATA SOURCES

PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).

ANALYSIS

Inductive and deductive coding was used to generate context-mechanism-outcome configurations.

RESULTS

73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation.

CONCLUSIONS

The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.

Factors associated with adherence to safe water chain practices among refugees in Pagirinya refugee settlement, Northern Uganda

Poor adherence to safe water chain practices is a major obstacle to consumption of safe drinking water. In refugee settings, adherence to safe water chain is critical in minimizing water-related diseases. Despite this, little is known about the level of adherence to safe water chain and associated factors, especially in emergency settings. In this study, we interviewed 400 household heads in Pagrinya refugee camp in Northern Uganda and assessed household level adherence to safe water chain practice and associated factors. Modified Poisson regression was used to model the association between adherence to safe water chain and independent variables. All households utilized improved water sources and 74.0% had high adherence to safe water chain. Having post-primary education and high level of knowledge about the safe water chain were positive predictors of high adherence to the safe water chain while round travel time exceeding 1 hour during water collection was negatively associated with high adherence. There is a need for awareness campaigns on safe water chain maintenance among refugees without any formal education. Constructing more water sources would also minimize round travel time during water collection and enable households to collect sufficient water that enables hygienic water storage and use.

Barriers and Enabling Factors Associated with the Implementation of Household Solar Water Disinfection: A Qualitative Study in Northwest Ethiopia

Household water treatment including solar disinfection (SODIS) is recognized worldwide as an important intervention for prevention and control of diarrheal and other waterborne diseases. However, in Ethiopia's countryside, SODIS is not being practiced. Therefore, the objective of this qualitative study conducted in villages of Dabat district in northwest Ethiopia was to explore barriers to and enabling factors for consistent and wider implementation of SODIS. This phenomenological study design included four focus group discussions with 25 parents of children younger than 5 years and interviews with four key informants to elicit their experiences and opinions. ATLAS.ti 8.0 software (GmbH, Berlin, Germany) was used for data organization, and the content was analyzed thematically. Enabling factors were categorized into four themes, such as supportive values for SODIS (positive attitude, advantage of SODIS, and cultural acceptance of SODIS), consistent use of SODIS (community's interest, health education, availability of bright sunlight, and simplicity of the method), participation of family and community in daily implementation of the SODIS process (controlling theft of bottles and recognizing the importance of SODIS technology), and willingness to pay for new polyethylene terephthalate (PET) bottles. On the other hand, barriers were grouped into three themes such as sociocultural (poor knowledge, hesitation to leave SODIS bottles unguarded outdoor, less attention, and unplanned social events), environmental (cloud, shadow over SODIS bottles, turbidity and leeches in source water, and geographical settings), and behavioral (mishandling of SODIS bottles and drinking water). The analysis of the data revealed that all the participants had positive attitude toward the implementation of SODIS, and it was culturally accepted. They identified the barriers to and enabling factors for the implementation of SODIS. Promoting enabling factors and mitigating barriers are substantially important for consistent implementation of SODIS as a long-term interventional measure widely in rural Ethiopia for the achievement of the goal of safe drinking water for all.

When can a green entrepreneur manage the local environment?

How do we deal with environmental management issues at the local level? Traditionally, the approach proposed from an environmental management perspective has involved various kinds of "top-down" regulatory measures, such as defining a standard that must be satisfied or a tax on pollution. Conversely, there has been less focus on the analysis of local, bottom-up approaches, as for example the effectiveness of various ways of organizing a local environmental transition process. Our focus is on analyzing of under what conditions it is possible for a "green entrepreneur" (GE) to manage a transition from brown to green energy? Theoretically, we consider four entrepreneurial skills, at least two of which must be present for the GE to succeed. In the case of the Danish island of Samsø and its rapid introduction of renewable energy, three of these skills are found to be present: profits, communication, and trustworthiness. The GE, however, failed to activate the fourth skill concerning the ability to persuade local non-green actors regarding the value of the green component. Thus, a main result is that it is crucial to convince non-green locals about the profitability of local environmental management rather than its potentially green components.

Explaining low rates of sustained use of siphon water filter: evidence from follow-up of a randomised controlled trial in Bangladesh

OBJECTIVE

To assess sustained siphon filter usage among a low-income population in Bangladesh and study relevant motivators and barriers.

METHODS

After a randomised control trial in Bangladesh during 2009, 191 households received a siphon water filter along with educational messages. Researchers revisited households after 3 and 6 months to assess filter usage and determine relevant motivators and barriers. Regular users were defined as those who reported using the filter most of the time and were observed to be using the filter at follow-up visits. Integrated behavioural model for water, sanitation and hygiene (IBM-WASH) was used to explain factors associated with regular filter use.

RESULTS

Regular filter usage was 28% at the 3-month follow-up and 21% at the 6-month follow-up. Regular filter users had better quality water at the 6-month, but not at the 3-month visit. Positive predictors of regular filter usage explained through IBM-WASH at both times were willingness to pay >US$1 for filters, and positive attitude towards filter use (technology dimension at individual level); reporting boiling drinking water at baseline (psychosocial dimension at habitual level); and Bengali ethnicity (contextual dimension at individual level). Frequently reported barriers to regular filter use were as follows: considering filter use an additional task, filter breakage and time required for water filtering (technology dimension at individual level).

CONCLUSION

The technological, psychosocial and contextual dimensions of IBM-WASH contributed to understanding the factors related to sustained use of siphon filter. Given the low regular usage rate and the hardware-related problems reported, the contribution of siphon filters to improving water quality in low-income urban communities in Bangladesh is likely to be minimal.

Shared toilet users' collective cleaning and determinant factors in Kampala slums, Uganda

Background

Dirty shared toilets are a health risk to users in urban slum settlements. For health and non-health benefits among users of shared toilets to be guaranteed, their cleanliness is important. The objective of this study was to investigate the cleanliness situation of shared toilets in Kampala’s slums and the psychological and social dilemma factors influencing users’ cleaning behaviour and commitment by using the risks, attitudes, norms, ability and self-regulation (RANAS) model and factors derived from the social dilemma theory.

Methods

We conducted a cross-sectional study in three slums of Kampala between December 2012 and January 2013. Data were collected from 424 household respondents that were primarily using shared toilets. Semi-structured questionnaires administered through face-to-face interviews were used in data collection. Linear regression was done for the multivariate analysis to test for the association between respondent cleaning behaviour and a combination of RANAS and social dilemma predictors.

Results

Out of 424 respondents interviewed, 44.3% reported cleaning the shared toilet daily, 34.4% cleaned once or several times a week, 1.4% cleaned every second week, 5.4% cleaned once or several times a month and 14.4% did not participate in cleaning. The main RANAS factors significantly associated with respondents’ cleaning behaviour were: attitudinal affective belief associated with cleaning a shared toilet (β = −0.13, P = 0.00) and self-regulating factors, such as coping planning (β = 0.42, P = 0.00), commitment (β = 0.24, P = 0.00), and remembering (β = 0.10, P = 0.01). For social dilemma factors, only the social motive factor was statistically significant (β = 0.15, P = 0.00). The R square for the linear model on factors influencing cleaning behaviour was 0.77 and R square for factors influencing cleaning commitment was 0.70.

Conclusion

The RANAS factors provide a more robust understanding of shared toilet users’ cleaning behaviour than social dilemma factors. Self-regulating factors and changing the negative affective cleaning feelings are shown to be very important for interventions to increase shared toilet users’ collective participation in their cleaning. In addition to RANAS, social dilemma factors have an important influence on slum residents’ commitment to clean their shared toilets.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1260) contains supplementary material, which is available to authorized users.

Developing and testing theory-based and evidence-based interventions to promote switching to arsenic-safe wells in Bangladesh

Millions of people in Bangladesh drink arsenic-contaminated water despite increased awareness of consequences to health. Theory-based and evidence-based interventions are likely to have greater impact on people switching to existing arsenic-safe wells than providing information alone. To test this assumption, we first developed interventions based on an empirical test of the Risk, Attitudes, Norms, Abilities and Self-regulation (RANAS) model of behaviour change. In the second part of this study, a cluster-randomised controlled trial revealed that in accordance with our hypotheses, information alone showed smaller increases in switching to arsenic-safe wells than information with reminders or information with reminders and implementation intentions.

Solar water disinfection (SODIS): a review from bench-top to roof-top

Solar water disinfection (SODIS) has been known for more than 30 years. The technique consists of placing water into transparent plastic or glass containers (normally 2L PET beverage bottles) which are then exposed to the sun. Exposure times vary from 6 to depending on the intensity of sunlight and sensitivity of the pathogens. Its germicidal effect is based on the combined effect of thermal heating of solar light and UV radiation. It has been repeatedly shown to be effective for eliminating microbial pathogens and reduce diarrhoeal morbidity including cholera. Since 1980 much research has been carried out to investigate the mechanisms of solar radiation induced cell death in water and possible enhancement technologies to make it faster and safer. Since SODIS is simple to use and inexpensive, the method has spread throughout the developing world and is in daily use in more than 50 countries in Asia, Latin America, and Africa. More than 5 million people disinfect their drinking water with the solar disinfection (SODIS) technique. This review attempts to revise all relevant knowledge about solar disinfection from microbiological issues, laboratory research, solar testing, up to and including real application studies, limitations, factors influencing adoption of the technique and health impact.

Determining behavioral factors for interventions to increase safe water consumption: a cross-sectional field study in rural Ethiopia

In developing countries, the lack of safe water options leads to many health risks. In the Ethiopian Rift Valley, most water sources are contaminated with an excess of fluoride. The consumption of fluoride-contaminated water leads to dental and skeletal fluorosis. The article presents an approach to designing community interventions based on evidence from quantitative data. After installing a community filter, a baseline study was conducted in 211 households to survey the acceptance and usage of the filter. To identify important psychological factors that lead to health behavior change, the Risk, Attitude, Norm, Ability, Self-regulation (RANAS) model was taken into account. Descriptive statistics were calculated for behavioral determinants, and their influence on consumption was analyzed with a linear regression. For every behavioral factor, an intervention potential (IP) was calculated. It was found that perceived distance, factual knowledge, commitment, and taste strongly influenced participants' consumption behavior and therefore should be tackled for interventions.

Systematic review of behavior change research on point-of-use water treatment interventions in countries categorized as low- to medium-development on the human development index

Point-of-use water treatment (i.e., water purification at the point of consumption) has proven effective in preventing diarrhea in developing countries. However, widespread adoption has not occurred, suggesting that implementation strategies have not motivated sustained behavior change. We conducted a systematic literature review of published behavioral research on factors influencing adoption of point-of-use water treatment in countries categorized as low- to medium-development on the United Nations Development Programme Human Development Index. We used 22 key words to search peer-reviewed literature from 1950 to 2010 from OVID Medline, CINAHL, and PsycINFO. Twenty-six (1.7%) of 1551 papers met our four inclusion criteria: 1) implemented a point-of-use water treatment intervention, 2) applied a behavioral intervention, 3) evaluated behavior change as the outcome, and 4) occurred in a low- or medium-development country. We reviewed these 26 publications for detailed descriptions of the water treatment intervention, theoretical rationales for the behavioral intervention, and descriptions of the evaluation. In 5 (19%) papers, details of the behavioral intervention were fully specified. Seven (27%) papers reported using a behavioral theory in the design of the intervention and evaluation of its impact. Ten (38%) studies used a comparison or control group; 5 provided detailed descriptions. Seven (27%) papers reported high sustained use of point-of-use water treatment with rates >50% at the last recorded follow-up. Despite documented health benefits of point-of-use water treatment interventions in reducing diarrheal diseases, we found limited peer-reviewed behavioral research on the topic. In addition, we found the existing literature often lacked detailed descriptions of the intervention for replication, seldom described the theoretical and empirical rationale for the implementation and evaluation of the intervention, and often had limitations in the evaluation methodology. The scarcity of papers on behavior change with respect to point-of-use water treatment technologies suggests that this field is underdeveloped.

A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline

Public health practitioners increasingly agree that it is not enough to provide people with water and sanitation hardware. Numerous approaches are used to tackle the "software" which means to ensure behavior change necessary to come along with the sanitation hardware. A review of these approaches reveals several shortcomings, most importantly that they do not provide behavioral change interventions which correspond to psychological factors to be changed. This article presents a sound psychological model, which postulates that for the formation of new habitual behavior, five blocks of factors must be positive with regard to the new behavior: risk factors, attitudinal factors, normative factors, ability factors, and self-regulation factors. Standardized tools for measuring the factors in face-to-face interviews are presented, and behavioral interventions are provided for each factor block. A statistical analysis method is presented, which allows the determination of the improvement potential of each factor.

Sustainable use of arsenic-removing sand filters in Vietnam: psychological and social factors

Elevated arsenic concentrations in drinking water pose a health threat to millions of people. Although point-of-use sand filters provide an effective technical solution for mitigating arsenic exposure, the actual reduction in health risk also depends on psychological factors that influence behaviors related to this device. For example, acquiring a sand filter must be preferred to competing options for investing effort and money and, once installed, the users must regularly maintain the filters. These key behaviors of sustainable use are related to psychological factors, such as problem awareness, benefits and costs, social and affective influences, and the perception of practical difficulties. This study investigated the sustainable use of arsenic-removing sand filters in Vietnam. Based on questionnaire surveys, data were gathered in 319 rural households and analyzed with regression models. Psychological factors explained significant variance in the investigated key behaviors. Significant factors included perceived improvements in water healthiness and taste, monetary costs, social norms, and affective influences. In questions with open answers, interviewees mentioned various practical problems, particularly those related to the inflexibility of the device and the effort of changing the sand. Interestingly, many interviewees operate the sand filters for removing iron from the water but are unaware of problems with arsenic.

Factors associated with compliance among users of solar water disinfection in rural Bolivia

BACKGROUND

Diarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year. Promotion of Solar Water Disinfection (SODIS) has been suggested as a strategy for reducing the global burden of diarrhoea by improving the microbiological quality of drinking water. Despite increasing support for the large-scale dissemination of SODIS, there are few reports describing the effectiveness of its implementation. It is, therefore, important to identify and understand the mechanisms that lead to adoption and regular use of SODIS.

METHODS

We investigated the behaviours associated with SODIS adoption among households assigned to receive SODIS promotion during a cluster-randomized trial in rural Bolivia. Distinct groups of SODIS-users were identified on the basis of six compliance indicators using principal components and cluster analysis. The probability of adopting SODIS as a function of campaign exposure and household characteristics was evaluated using ordinal logistic regression models.

RESULTS

Standardised, community-level SODIS-implementation in a rural Bolivian setting was associated with a median SODIS use of 32% (IQR: 17-50). Households that were more likely to use SODIS were those that participated more frequently in SODIS promotional events (OR=1.07, 95%CI: 1.01-1.13), included women (OR=1.18, 95%CI: 1.07-1.30), owned latrines (OR=3.38, 95%CI: 1.07-10.70), and had severely wasted children living in the home (OR=2.17, 95%CI: 1.34-3.49).

CONCLUSIONS

Most of the observed household characteristics showed limited potential to predict compliance with a comprehensive, year-long SODIS-promotion campaign; this finding reflects the complexity of behaviour change in the context of household water treatment. However, our findings also suggest that the motivation to adopt new water treatment habits and to acquire new knowledge about drinking water treatment is associated with prior engagements in sanitary hygiene and with the experience of contemporary family health concerns.Household-level factors like the ownership of a latrine, a large proportion of females and the presence of a malnourished child living in a home are easily assessable indicators that SODIS-programme managers could use to identify early adopters in SODIS promotion campaigns.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00731497.

Why Do People Stop Treating Contaminated Drinking Water With Solar Water Disinfection (SODIS)?

Solar Water Disinfection (SODIS) is a simple method designed to treat microbiologically contaminated drinking water at household level. This article characterizes relapse behavior in comparison with continued SODIS use after a 7-month nonpromotion period. In addition, different subtypes among relapsers and continuers were assumed to diverge mainly in their intention to use SODIS and their degree of cognition intensity. Data were taken from a longitudinal SODIS promotion study. Cluster analyses were applied to find subtypes among 166 relapsers and 123 continuers. Overall relapsers have lower values for all psychological variables compared to overall continuers. A low-value and a high-value relapser subtype as well as a low-value and a high-value continuer subtype were found. Low-value relapsers differ from high-value relapsers in one central belief (taste), in affective connotation, social norms, and dissonance. Interestingly, high-value relapsers have values almost as high as low-value continuers, differing only in their degree of habit. Only high-value continuers seem to be stable and did not show a decrease in critical habit variables over time. The different subtypes are placed along the behavior change process, and possible interventions for each type are highlighted.