The lack of access to safe water and adequate sanitation has implications for the psychosocial well-being of individuals and households. To review the literature on psychosocial impacts, we completed a scoping review of the published literature using Medline, Embase, and Scopus. Fifteen studies met the inclusion criteria and were reviewed in detail. Of the included studies, six were conducted in India, one in Nepal, one in Mexico, one in Bolivia, two in Ethiopia, one in Zimbabwe, one in South Africa, and two in Kenya. Four interrelated groups of stressors emerged from the review: physical stressors, financial stressors, social stressors, and stressors related to (perceived) inequities. Further, gender differences were observed, with women carrying a disproportionate psychosocial burden. We argue that failure to incorporate psychosocial stressors when estimating the burden or benefits of safe water and sanitation may mask an important driver of health and well-being for many households in low- and middle-income countries. We propose further research on water-related stressors with particular attention to unique cultural norms around water and sanitation, short and long term psychosocial outcomes, and individual and collective coping strategies. These may help practitioners better understand cumulative impacts and mechanisms for addressing water and sanitation challenges.

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Recent years have witnessed an increase in the use of community based participatory research (CBPR) tools for understanding environment and health issues and facilitating social action. This paper explores the application and utility of photovoice for understanding water, sanitation, and hygiene (WASH) behaviours and catalysing community led solutions to change behaviours. Between June and August 2013, photovoice was conducted with eight (8) women in Usoma, a lakeshore community in Western Kenya with a follow-up community meeting (baraza) in May 2014 to discuss findings with the community members and government officials. In the first part of the study, photovoice one-on-one interviews were used to explore local perceptions and practices around water-health linkages and how the ecological and socio-political environment shapes these perceptions and practices. This paper, which is the second component of the study, uses photovoice group discussions to explore participants' experiences with and (re)action to the photographs and the photovoice project. The findings illustrate that photovoice was an effective CBPR methodology for understanding behaviours, creating awareness, facilitating collective action, and engaging with local government and local health officials at the water-health nexus.

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In low- and middle-income countries, a common component of water, sanitation, and hygiene (WASH) interventions is the goal of empowerment of beneficiaries, particularly poor households. Empowerment is viewed as an important development goal in itself, as well as a way to obtain improved WASH outcomes. However, empowerment is a complex and multi-dimensional concept, and it is often not clear how it is defined in WASH sector programming. This scoping review explores how concepts of empowerment have been used in the WASH sector and delineates relevant empowerment dimensions. Medline, Embase, and Global Health databases were searched for in the peer-reviewed literature published in English. A total of 13 studies were identified. Five major interrelated empowerment dimensions were identified: access to information, participation, capacity building, leadership and accountability, and decision-making. This review provides researchers and practitioners with a greater understanding of dimensions of empowerment that are relevant for strengthening WASH interventions, as well as tracking progress toward gender and social equality outcomes over time. This understanding can help ensure inclusive WASH service delivery to achieve gender-sensitive Sustainable Development Goal (SDG) targets for universal water and sanitation access.