Mental Well-being, Sustained Behavior Change
Conditions
Keywords
Sanitation, Hygiene, Public Health, Behavior change, Neglected tropical diseases, Demand-side sanitation and hygiene, Mental well-being, Water insecurity, Sanitation insecurity, Collective efficacy
Brief summary
This study is a two-year evaluation investigating the impacts of an enhanced, demand-side sanitation and hygiene intervention on sustainable adoption of improved water, sanitation, and hygiene (WASH) practices and mental well-being.
Detailed description
This study utilizes a cluster randomized, controlled trial design to examine the impacts of an enhanced, demand-side sanitation and hygiene intervention on behavior change and health in Amhara, Ethiopia. The study will test hypotheses set out in the investigation team's theory of change through the measurement and evaluation of process indicators, intermediate and shorter-term behavioral outcomes, and longer-term behavioral and health impacts, including mental well-being. The study aims to: (1) identify ways in which WASH-related behavior change components preventive for neglected tropical diseases (NTDs) can be mainstreamed into the government-led Health Extension Program; (2) document the effectiveness of an enhanced demand-side sanitation and hygiene intervention; (3) investigate whether changes in personal hygiene, sanitation, and water behaviors are sustained; (4) document the cost-effectiveness of integrated WASH-related NTD-preventive behavior change promotion; and (5) assess whether collective efficacy and water security modify intervention effectiveness.
Interventions
BEHAVIORALEnhanced demand-side sanitation, hygiene
The enhanced, demand-side sanitation and hygiene intervention package will be informed by findings from formative research, and will consist of interventions designed to enhance sanitation and hygiene messaging to better facilitate behavior change, and intensify implementation of related community-based interventions via engagement of various delivery modalities.
BEHAVIORALStandard of care
The comparison group will receive the current standard of care, including potential implementation of government-led policies and programs.
Sponsors
Emory Ethiopia
Amhara Regional Health Bureau
Federal Democratic Republic of Ethiopia Ministry of Health
Emory University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Households residing in kebeles in select woredas of Amhara National Regional State * Households with at least one adult (18 years of age or older) who provides consent to serve as the survey respondent * Households with at least one child aged 1-9 years (at baseline) living in the household and consenting to enrollment in the study, including study staff observation of children, specifically their faces and hands
Exclusion criteria
* Households that refuse to provide consent to enroll in the study or have one adult consent to serve as the survey respondent * Households that are repeatedly vacant or do not have an appropriate member of the household home to serve as the household's respondent (capable adult 18 years or older) after three attempts within the course of one day (for study enrollment and baseline) * Households that do not have a household member aged 0-5 years of age (at baseline) living in the household
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sustainability of WASH-related behaviours, including NTD-preventive WASH behavior measures | Endline (Up to two years) | Sustainability of WASH-related behaviors, as measured through changes in the proportion of individuals and households practicing targeted improved NTD-preventive WASH behaviors. |
| Mental well-being measures | Up to two years | Mental well-being, as measured through the changes in mental well-being scale scores |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Water insecurity measures | Up to two years | Water insecurity, as measured through changes in water insecurity scale scores |
| Shorter-term behavioral outcome measures | Up to two years | Proportion of households with improved or shared, but otherwise improved household latrine and washing facilities that are functional and available for use; proportion of households using functional latrines and washing facilities; proportion of households with all members exclusively using a latrine for defecation purposes; proportion of households disposing of child feces in an improved latrine; proportion of households with all children in the household with a clean face and hands. |
| Collective efficacy measures | Up to two years | Collective efficacy, as measured through changes in collective efficacy scale scores |
| Sanitation insecurity measures | Up to two years | Sanitation insecurity, as measured through changes in sanitation insecurity scale scores |
| Intermediate behaviour change antecedent measures | Up to two years | Proportion of households with improved knowledge regarding the implications of improved WASH practices; proportion of households that indicate positive attitudes, perceptions toward improved sanitation and good hygiene practices; change in normative beliefs and behaviors related to open defecation, exclusive latrine use for defecation, and personal hygiene practices. |
Countries
Ethiopia
Outcome results
None listed