Community Perceptions of a Multilevel Sanitation Behavior Change Intervention in Rural Odisha, India

• Type of Material: Article
• Authors: Renee De Shay, Emory University; Dawn Comeau, Emory University; Gloria D. Sclar, Emory University; Parimita Routray, Independent Consultant; Bethany Caruso, Emory University
• Language: English
• Date: 2020-06-01
• Publisher: MDPI Publishing
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph17124472
• Title of Journal or Parent Work: International Journal of Environmental Research and public Health
• Volume: 17
• Issue: 12
• Start Page: 1
• End Page: 16
• Grant/Funding Information: This research was funded by the International Initiative for Impact Evaluation (3ie) [TW14.1006], which was funded by the Bill & Melinda Gates Foundation (OPP1148651).
• Keywords: Diarrhea; Environmental Sciences; Environmental Sciences & Ecology; Disease; WASH; process evaluation; Child growth; Impact; Infection; latrine use; gender; Science & Technology; Health; Association; Nutritional inventions; Adoption; Public, Environmental & Occupational Health; Water quality; collective efficacy; qualitative research; Life Sciences & Biomedicine
• Research Categories: Psychology, Behavioral; Health Sciences, Hygiene; Health Sciences, Public Health; Health Sciences, Nutrition; Environmental Sciences

Abstract

While latrine coverage is increasing in India, not all household members use their latrines. Cost-effective, culturally appropriate, and theory-informed behavior change interventions are necessary to encourage sustained latrine use by all household members. We qualitatively examined community perceptions of sanitation interventions broadly, along with specific impressions and spillover of community-level activities of the Sundara Grama latrine use behavior change intervention in rural Odisha, India. We conducted sixteen sex-segregated focus group discussions (n = 152) in three intervention and three nonintervention villages and thematically analyzed the data. We found Sundara Grama was well-received by community members and considered educative, but perceptions of impact on latrine use were mixed and varied by activity. Intervention recruitment challenges prevented some, such as women and households belonging to lower castes, from attending activities. Spillover occurred in one of two nonintervention villages, potentially due to positive relations within and between the nonintervention village and nearby intervention village. Community-level sanitation initiatives can be hindered by community divisions, prioritization of household sanitation over community cleanliness, and perceptions of latrine use as a household and individual issue, rather than common good. Community-centered sanitation interventions should assess underlying social divisions, norms, and perceptions of collective efficacy to adapt intervention delivery and activities.