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Vaparshun Improving Toilet Use in Rural India

Vaparshun Improving Toilet Use in Rural India (The 5 Star Toilet Campaign)

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04526171
Enrollment
2483
Registered
2020-08-25
Start date
2018-08-01
Completion date
2019-03-31
Last updated
2020-08-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Behavior

Keywords

sanitation, toilet, behavior, evaluation

Brief summary

Vaparshun intervention aimed to inspire the target audience to use a toilet. It aimed to revalue their toilets by recognizing that they provide benefits associated with the motives of hoard, create, convenience (comfort) and affiliation, and provide a reward pathway for transitioning to a new toilet use routine.

Detailed description

Our intervention consists of four different streams of activity. The outcome is that family members and men improve and use their contractor-built toilets. The activities are listed below. 1. Create Motive: Toilet Makeover: Conduct a lottery and perform makeovers of select government built toilets in the village, with the involvement of the community. Demonstrate improvements in comfort (light, space, ventilation, latrine chair/handle) and aesthetics (stencil painting of door and walls). Challenge/Opportunity: Many of the 'contractor' toilets are built with low engagement from family members and are uncomfortable to use. People are left with toilets they are not proud of or engaged with. Insight (from 'makeover' trial): If families invest in creating an attractive toilet they are be more likely adopt and use them. Inputs: Materials for the physical and aesthetic improvement of a toilet, manuals for conducting the community event. Outputs: Greater engagement with, and pride in, the toilet after makeover; others in the village inspired to conduct their own makeover. Those who use the upgraded toilet find it a more comfortable experience than they had expected causing reinforcement learning. 2. Hoard motive: Pit Emptying Demo and Pit Filling Estimation Demo A community event-based discussion of the 'real' aspects related to pit filling/emptying designed to graphically overcome their perceptual barriers (e.g., squeezing a watermelon to show how little material there is in faeces). Challenge/Opportunity: People over-estimate the speed at which a pit fills and are uncertain about the emptying process. Therefore they hoard the 'limited' pit space by using the toilet only partially. Insight from FR: There are gaps between perception and reality which can be addressed. For example; water doesn't stay in the pit but seeps into the soil, faeces are composed mainly of water, decomposition reduces volume, compost doesn't smell and twin pits can be used interchangeably forever. Inputs: Films and 'emo-demos' (emotional demonstrations). Outputs: Participants are less anxious about pit filling and emptying. 3. Affiliation/convenience motives: Community Motivational Events: Small and large community events such as street plays, films, posters and pledging activities to bring alive convenience/comfort motives by amplifying problems associated with OD and rewards of using toilets; use of affiliation through testimonials films, posters, village maps, etc. Challenge/Opportunity: Even if the barriers around pits and toilet comfort are addressed, it may still not be enough to motivate men with entrenched habits of OD to start using toilets. Insights: Convenience/comfort can be a powerful drive for toilet usage. Those who use toilets in the village (women, children and elderly) find it is much more convenient and therefore do not return to OD. However, men who are non-users may not have experienced this and need to be convinced. Affiliation can be another strong drive for toilet usage. It is possible to exploit the emerging norms of toilet use and encourage men 'not to be left behind'. Inputs: Scripts, props, invitations, loud hailers, audio-visual equipment, etc. Outputs: Men use toilets because they 'get' how convenient they are, and so as not to be 'left behind'. 4. Transition to a new toilet use This would include testimonial videos of toilet users and toilet board of household members who improved their toilets. Providing certificate to households who improved their toilets. Challenge/Opportunity: Those who use toilets for a specific period tend to stick with the habit; however, some people, especially men, do not try out the toilet or find the first experience unpleasant. Insight: Reward the use of toilets for a specific period so new habits can form. Inputs: Stimuli and nudges. Outputs: The entire family, especially men, form the habit of using a toilet. In addition, village authorities will also be recruited to support delivery of the intervention.

Interventions

BEHAVIORALVaparshun

Participants in the intervention clusters were encouraged to improve their existing toilets.

Sponsors

London School of Hygiene and Tropical Medicine
CollaboratorOTHER
Public Health Foundation of India
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE

Intervention model description

The study was a cluster-randomised trial with 47 intervention and 47 control clusters, with a baseline and an endline survey conducted in the district of Bhavnagar, Gujarat, India. Briefly, 94 villages were randomised to intervention or control groups. We carried out a household census and from this we selected 10 households with a functional 'government' toilet for a baseline and 30 for follow up at endline using random sampling from the census list for each village. Outcomes were measured as the proportion of households where all members were reported to use the toilet and the overall usage of toilets by individuals, employing a standard questionnaire.

Eligibility

Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes

Inclusion criteria

\- Households with a functional government or contractor built toilet.

Exclusion criteria

* Households with self built toilet.

Design outcomes

Primary

MeasureTime frameDescription
Proportion of households where all members above the age of 5 years were reported to use the toilet the last time they defecated.A gap of 6 weeks was maintained between campaign roll out and endline data collectionThe survey was addressed to one adult respondent per household, preferably the male or female household head

Secondary

MeasureTime frameDescription
Exposure to the interventionSix weeks post intervention deliveryProportion of population in intervention arm that reports attending intervention events
Perceptions related to toilet useSix weeks post intervention deliveryAgreement with statements reflecting important campaign messages such as Toilets are not just for women; men should use them too, A smart person is one who uses a toilet, or (phrased negatively) Toilet pits fill quickly if too many people in the household use them

Countries

India

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 26, 2026