Dataset Information

Is Using a Latrine "A Strange Thing To Do"? A Mixed-Methods Study of Sanitation Preference and Behaviors in Rural Ethiopia.

ABSTRACT: Latrines are the most basic form of improved sanitation and are a common public health intervention. Understanding motivations for building and using latrines can help develop effective, sustainable latrine promotion programs. We conducted a mixed-methods study of latrine use in the Amhara region of Ethiopia. We held 15 focus group discussions and surveyed 278 households in five communities. We used the Integrated Behavioral Model for Water, Sanitation, and Hygiene interventions to guide our qualitative analysis. Seventy-one percent of households had a latrine, but coverage varied greatly across communities. Higher household income was not associated with latrine use (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 0.5, 7.7); similarly, cost and availability of materials were not discussed as barriers to latrine use in the focus groups. Male-headed households were more likely to use latrines than households with female heads (OR = 3.5; 95% CI = 1.6, 7.7), and households with children in school were more likely to use latrines than households without children in school (OR = 2.3; 95% CI = 1.6, 3.3). These quantitative findings were confirmed in focus groups, where participants discussed how children relay health messages from school. Participants discussed how women prefer not to use latrines, often finding them strange or even scary. These findings are useful for public health implementation; they imply that community-level drivers are important predictors of household latrine use and that cost is not a significant barrier. These findings confirm that school-aged children may be effective conduits of health messages and suggest that latrines can be better marketed and designed for women.

SUBMITTER: Aiemjoy K

PROVIDER: S-EPMC5239711 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Is Using a Latrine "A Strange Thing To Do"? A Mixed-Methods Study of Sanitation Preference and Behaviors in Rural Ethiopia.

Aiemjoy Kristen K Stoller Nicole E NE Gebresillasie Sintayehu S Shiferaw Ayalew A Tadesse Zerihun Z Sewent Tegene T Ayele Bezuayehu B Chanyalew Melsew M Aragie Solomon S Callahan Kelly K Stewart Aisha A Emerson Paul M PM Lietman Thomas M TM Keenan Jeremy D JD Oldenburg Catherine E CE

The American journal of tropical medicine and hygiene 20161114 1

Latrines are the most basic form of improved sanitation and are a common public health intervention. Understanding motivations for building and using latrines can help develop effective, sustainable latrine promotion programs. We conducted a mixed-methods study of latrine use in the Amhara region of Ethiopia. We held 15 focus group discussions and surveyed 278 households in five communities. We used the Integrated Behavioral Model for Water, Sanitation, and Hygiene interventions to guide our qua ...[more]

PMID: 28077741

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Project description:BackgroundAcross developing countries poor sanitation is associated with disease often found widespread in rural populations.ObjectivesThis objective of this study was to conduct a formative research and feasibility evaluation of the behavioural intervention designed to improve latrine use in rural India.MethodsStudy conducted in four villages of Rajasthan, where latrine use is low and open defecation may spread disease. To identify the intervention a literature review was conducted, a survey of 497 households, and focus groups in village households (8-10 women and children). Seven focus groups with 63 women were conducted. Based on the survey results, the behaviour change intervention is developed utilising 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. Feasibility and acceptability of the intervention was examined in the study population. The 30-day intervention was delivered to women in 38 randomly selected households who despite having a functional latrine did not use it. Thematic analysis, binary logistic regression analysis and feasibility evaluation of the intervention conducted. Post-intervention feedback from 22 participating households was obtained.ResultsThe piloted intervention was feasible and so a revised design is offered. 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 < 0.01), relief (β = 5.49, p < 0.01), comfort (β = 2.36, p < 0.01), Construction cost (β=-1.98, p < 0.01) 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, the intervention is refined in several ways.ConclusionsOur theory-driven approach improves latrine use in Rajasthan and offers a useful tool to facilitate hygiene behaviour.

Project description:BackgroundEven though evidence shows that access to and use of improved latrines is related to healthful families and the public, obstacles to the adoption and use of improved latrine facilities remain. Globally, not many inquiries appear to have been carried out to satisfactorily inform us regarding the multi-level barriers influencing the adoption and utilization of improved latrines facilities. Related studies in Ethiopia are even fewer.MethodsTwo qualitative data gathering methods, viz., key informant interviews and focus group discussions, were employed to collect data for this study. A total of fifteen focus group discussions were conducted with members of the community in the rural Wonago district of Ethiopia. Similarly, ten key informant interviews were conducted with water, sanitation, and hygiene officers, and health extension workers responsible for coordinating sanitation and hygiene activities. Open code software 4.03 was used for thematic analysis.ResultBarriers to adoption and use of improved latrine facilities were categorized into Contextual factors (e.g. Gender, educational status, personal preference for using the field, limited space, population density, the status of land ownership), Psychosocial factors (Culture, beliefs, attitudes, and perceptions of minimal health threat from children's feces), and Technological factors (inconveniences in acquiring materials and cost of constructing a latrine).ConclusionThere are a series of multi-leveled barriers to the sustained adoption and use of latrines. Providing funding opportunities for the underprivileged and offering training on the engineering skills of latrine construction at the community level based on the contextual soil circumstances could expand the latrine coverage and use. Similarly, taking into account the variability in motivations for adopting and using latrines among our study in Ethiopia and other studies, we implore public health experts to recognize behaviors and norms in their target communities in advance of implementing sanitation interventions.

Project description:BackgroundCaring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding.MethodsA multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results.ResultsThe overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=-0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=-0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data.ConclusionDiscrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors.

Project description:BackgroundMulti-month dispensing (MMD) of antiretroviral therapy (ART) represents one approach of differentiated service delivery (DSD) aiming to improve quality and cost-effectiveness for HIV services in resource-limited settings. However, reduction in clinic visits for people living with HIV (PLWH) should go along with out-of-clinic care tailored to PLWH`s preferences and comorbidities to maintain quality of care. eHealth supported MMD offers a potential solution.MethodsBetween October 2019 and January 2020 we assessed preferences on an eHealth supported MMD package among adult PLWH attending routine ART care at a rural clinic in Lesotho using a mixed-methods approach. Participants reported their preferences among different refill and eHealth options. They were invited to test automated text messages (SMS) informing about their viral load results, an automated tuberculosis symptoms screening call and telemedical support by an expert nurse. Telemedical service comprised a call-back option if participants required any additional support and adherence counselling for closer follow-up of participants with unsuppressed viral loads. After 6 weeks, participants were followed-up to assess perception of the chosen eHealth support using a qualitative approach.ResultsAmong 112 participants (median age = 43 years; 74% female), 83/112 (75%) preferred MMD for 6-12 months (median = 9 months, IQR = [5, 12]). Neither sex, age, employment, costs and time for travel to clinic, nor the duration of taking ART correlated with the MMD preference. All 17 participants attending routine viral load measurement wished to receive the result via SMS. Fifteen (19.2%) participants requested a telemedical nurse call-back during the study period. All participants with recent unsuppressed viral load (N = 13) requested telemedical adherence counselling for closer follow-up. Among 78 participants followed-up, 76 (97%) would appreciate having the call-back option in future. Seventy-five participants (67%) received and evaluated the automated symptomatic tuberculosis screening call, overall 71 (95%) appreciated it.ConclusionsThe great majority of PLWH in this study preferred 6-12 months MMD and appreciated the additional eHealth support, including viral load results via SMS, telemedical nurse consultations and automated tuberculosis symptom screening calls. eHealth supported MMD packages appear to be a promising approach for DSD models and should be assessed for clinical endpoints and cost-effectiveness in larger studies.

Project description:BackgroundAn estimated 2.4 billion people still lack access to improved sanitation and 946 million still practice open defecation. The World Health Organization (WHO) commissioned this review to assess the impact of sanitation on coverage and use, as part of its effort to develop a set of guidelines on sanitation and health.Methods and findingsWe systematically reviewed the literature and used meta-analysis to quantitatively characterize how different sanitation interventions impact latrine coverage and use. We also assessed both qualitative and quantitative studies to understand how different structural and design characteristics of sanitation are associated with individual latrine use. A total of 64 studies met our eligibility criteria. Of 27 intervention studies that reported on household latrine coverage and provided a point estimate with confidence interval, the average increase in coverage was 14% (95% CI: 10%, 19%). The intervention types with the largest absolute increases in coverage included the Indian government's "Total Sanitation Campaign" (27%; 95% CI: 14%, 39%), latrine subsidy/provision interventions (16%; 95% CI: 8%, 24%), latrine subsidy/provision interventions that also incorporated education components (17%; 95% CI: -5%, 38%), sewerage interventions (14%; 95% CI: 1%, 28%), sanitation education interventions (14%; 95% CI: 3%, 26%), and community-led total sanitation interventions (12%; 95% CI: -2%, 27%). Of 10 intervention studies that reported on household latrine use, the average increase was 13% (95% CI: 4%, 21%). The sanitation interventions and contexts in which they were implemented varied, leading to high heterogeneity across studies. We found 24 studies that examined the association between structural and design characteristics of sanitation facilities and facility use. These studies reported that better maintenance, accessibility, privacy, facility type, cleanliness, newer latrines, and better hygiene access were all frequently associated with higher use, whereas poorer sanitation conditions were associated with lower use.ConclusionsOur results indicate that most sanitation interventions only had a modest impact on increasing latrine coverage and use. A further understanding of how different sanitation characteristics and sanitation interventions impact coverage and use is essential in order to more effectively attain sanitation access for all, eliminate open defecation, and ultimately improve health.

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Dataset Information

Is Using a Latrine "A Strange Thing To Do"? A Mixed-Methods Study of Sanitation Preference and Behaviors in Rural Ethiopia.

Publications

Is Using a Latrine "A Strange Thing To Do"? A Mixed-Methods Study of Sanitation Preference and Behaviors in Rural Ethiopia.

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