Development of a Behaviour Change Intervention to promote latrine use and reduce open defecation in rural India

Abstract

Objectives Conduct a formative research and feasibility evaluation of behavioural intervention designed to improve latrine use in rural India.Methods Study conducted in four villages of Rajasthan, where latrine use is low and open defecation may spread disease. To identify the intervention, we conducted a literature review, a survey of 497 households, focus groups in village households (8–10 women and children). We also conducted seven focus groups with 63 women. Based on the survey results, we developed behaviour change intervention utilising on the Capability-Opportunity-Motivation-behaviour model and MINDSPACE framework. One intervention component involves psychological aspects that engage villagers through a pledge; the other component is provision of small incentives to facilitate latrine use. We also examined whether our intervention is feasible and acceptable in our study population. We delivered the 30-day intervention to women in 38 randomly selected households who despite having a functional latrine did not use it. Post-intervention, we obtained feedback from 22 participating households.Results Analysis involved thematic analysis, binary logistic regression analysis and feasibility evaluation of the intervention. We found the piloted intervention was feasible and so offer a revised design. Results driving this evaluation include barriers identified, and used to improved intervention design in the current study. Village authority figures influenced behaviours across the villages and so did factors of convenience (β = 5.28, p = 0.00), relief (β = 5.49, p = 0.00), comfort (β = 2.36, p = 0.00), Construction cost (β=-1.98, p = 0.00) and safety (β = 2.93, p = 0.01) were significant concerns associated with latrine use in the context of prevalent OD in the region. The logistic regression baseline model for the dependant variables indicated a significant increase in latrine use. Based on the feasibility study, we refined our intervention in several ways.Conclusions Our theory-driven approach improves latrine use in Rajasthan and offers a useful tool to facilitate hygiene behaviour.