Analysis of behavioral change techniques in community-led total sanitation programs

Abstract

The lack of sanitation facilitates the spread of diarrheal diseases-a leading cause of child deaths worldwide. As of 2012, an estimated 1 billion people still practiced open defecation (OD). To address this issue, one behavioral change approach used is community-led total sanitation (CLTS). It is now applied in an estimated 66 countries worldwide, and many countries have adopted this approach as their main strategy for scaling up rural sanitation coverage. While it appears that many of the activities used in CLTS-that target community-level changes in sanitation behaviors instead of household-level changes-have evolved out of existing behavior change frameworks and techniques, it is less clear how these activities are adapted by different organizations and applied in different country contexts. The aims of this study are to (i) show which behavior change frameworks and techniques are the most common in CLTS interventions; (ii) describe how activities are implemented in CLTS interventions by region and context; and (3) determine which activities program implementers considered the most valuable in achieving open defecation free (ODF) status and sustaining it. The results indicate that a wide range of activities are conducted across the different programs and often go beyond standard CLTS activities. CLTS practitioners ranked follow-up and monitoring activities as the most important activities for achieving an ODF community, yet only 1 of 10 organizations conducted monitoring and follow-up throughout their project. Empirical studies are needed to determine which specific behavioral change activities are most effective at ending OD and sustaining it.

Beliefs, Behaviors, and Perceptions of Community-Led Total Sanitation and Their Relation to Improved Sanitation in Rural Zambia

“…23 We find the Integrated Behavioural Model for WASH (IBM-WASH), proposed by Dreibelbis and others, 24 to be a particularly useful conceptual and practical tool for understanding the multilevel factors that influence sanitation behavior change. In the IBM-WASH model, there are three intersecting dimensions (contextual, psychosocial, and technological) that operate across levels (societal/structural, community, interpersonal/ household, individual, and habitual).…”

“…However, with careful program implementation and properly trained champions, we would argue that it is possible to use the CLTS methodology to change community behaviors without infringing on human rights and that CLTS is currently being implemented in such a manner in Zambia. As Sigler and others illustrate, 23 there is wide variation in implementation on CLTS in different contexts. Throughout our extensive qualitative work, there were no reports of CLTS having a negative impact on individuals or communities.…”

Promoting latrine use in India

“…In this regard, Community-Led Total Sanitation (CLTS), developed by Kamal Kar in the late 1990s, is the most common approach taken towards ending open defecation. Although CLTS has been used in 66 countries, its effectiveness in low-and middle-income countries has been highly variable (Sigler et al 2015). In India, its effectiveness has been described as 'mixed' (Chambers 2009).…”

“…Other demand-driven approaches to sanitation have typically focused on triggering shame and disgust, providing knowledge and developing action plans (Sigler et al 2015). In this regard, information, education and communication (IEC) campaigns, often in tandem with community mobilisation activities, have been used frequently to develop individuals' intrinsic motivation to use a toilet after demonstrating the harmful effects of open defecation.…”

Biopshychosocial and Economic Determinants of Personal Hygiene in the Prevention of Diarrheal Diseases in Sragen District, Central Java

“…Individual absorbs new behaviors; at the begining he or she should understand first the meaning or the benefit of these new behaviors for himself or herself and for his or her family (Hayden, 2010;Sigler, 2015). The behaviors that have been based on knowledge will last longer than the ones that have not been based on knowledge.…”