Latrine cleanliness increased in the intervention group compared to the control group (increase from 21 to 31 % of latrines classified as clean in intervention [N = 198] and decrease from 37 to 27 % in control [N = 91]). Improved habitual latrine cleaning lead to latrines being 3.5 times more likely to improve in observed latrine cleanliness (χ = 16.36, p < .001) and so did improvements in quality of latrine construction, eg households that had installed a lid were 7.39 times more likely to have a cleaner latrine (χ = 4.46, p < .05). Changes in psychosocial factors, namely forgetting, personal norm, satisfaction with cleanliness, explained much of the change in habitual latrine cleaning (adj. r = .46). Behaviour change interventions targeting psychosocial factors and quality of latrine construction seem promising to ensure clean and hygienic latrines.

Access to improved sanitation is fundamental for the prevention of diarrhoea and other diseases.However, for a sanitation facility to be safe, its cleanliness must be assured. The aim of the present study was, first, to assess how cleaning behaviour, household characteristics and infrastructural factors influenced latrine cleanliness and, second, to assess which psychological factors influenced cleaning behaviour. In a study in rural Burundi, 762 standardised household interviews with the primary household caregiver were carried out to assess habitual cleaning behaviour and psychological factors according to behaviour change models. In addition, the characteristics and cleanliness of the latrine were observed, and two multiple linear regressions were performed to analyse predictors of latrine cleanliness and of cleaning behaviour. Latrine cleanliness was determined by cleaning behaviour, the possibility of locking the door, the height of the superstructure, the material of the superstructure and the availability of an even slab. The number of households or people sharing the latrine was not influential. Commitment to cleaning, satisfaction with the cleanliness of the latrine and self-efficacy determined habitual cleaning behaviour. Interventions focussing on commitment, self-efficacy and satisfaction with a clean latrine like public commitment or guided practice interventions are recommended to promote cleaning behaviour.

Evidence suggests that the effectiveness of technology designed to provide safe and healthy water is dependent on the degree of its use. In addition to providing safe water "hardware" (i.e., new infrastructure or equipment) to populations at risk, it might be necessary to also provide suitable "software" programs (behavior change strategies) to support use. A longitudinal survey was conducted in rural Ethiopia following the distribution of fluoride-removal household filters. Three intervention groups were evaluated. Group 1 only received the hardware, i.e., the fluoride-removal filter. Groups 2 and 3 also received software in the form of two evidence-based psychological interventions: a planning and social prompts intervention and an educational workshop with pledging. Group 2 received both software interventions, and Group 3 only received the educational workshop. The effects of the hardware and software on behavior and thus filter use were analyzed along with specific psychological factors. The results showed that the provision of the hardware alone (the fluoride-removal filter) was not enough to ensure sufficient use of the equipment. The addition of a software component in the form of psychological interventions increased filter use up to 80%. An increase in filter use was measured following each intervention resulting in the health-risk being minimized. We conclude that it is necessary that the implementation of hardware of this nature is accompanied by evidence-based intervention software.

A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers' cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.

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