Acceptability measures of water, sanitation and hygiene interventions in low- and middle-income countries, a systematic review

Abstract

Background Inadequate access to water, sanitation, and hygiene (WASH) is an environmental risk factor for poor health outcomes globally, particularly for children in low- and middle-income countries (LMIC). Despite technological advancements, many interventions aimed at improving WASH access return less than optimal results on long term impact, efficacy and sustainability. Research focus in the ‘WASH sector’ has recently expanded from investigating ‘which interventions work’ to ‘how they are best implemented’. The ‘acceptability’ of an intervention is a key component of implementation that can influence initial uptake and sustained use. Acceptability assessments are increasingly common for health interventions in clinical settings. A broad scale assessment of how acceptability has been measured in the WASH sector, however, has not yet been conducted. Methods/Principal findings We conducted a systematic literature review of intervention studies published between 1990 and 2021 that evaluated the acceptability of WASH interventions in LMIC settings. Using an implementation science approach, focused outcomes included how acceptability was measured and defined, and the timing of acceptability assessment. We conducted quality assessment for all included studies using the Cochrane Risk of Bias tool for randomised studies, and the Newcastle-Ottawa Scale for non-randomised studies. Of the 1238 records; 36 studies were included for the analysis, 22 of which were non-randomized interventions and 16 randomized or cluster-randomized trials. We found that among the 36 studies, four explicitly defined their acceptability measure, and six used a behavioural framework to inform their acceptability study design. There were few acceptability evaluations in schools and healthcare facilities. While all studies reported measuring WASH acceptability, the measures were often not comparable or described. Conclusions As focus in WASH research shifts towards implementation, a consistent approach to including, defining, and measuring acceptability is needed.

Prevention of human exposure to livestock faecal waste in the household: a scoping study of interventions conducted in sub-Saharan Africa

“…Acceptability is often central to WASH interventions. Various assessment measures, as described by Hosking et al [ 42 ] can be used to measure acceptability of an intervention. Articles identified in this search utilised validated behavioural frameworks including Trials of Improved Practices (TIPs) used by [ 30 , 36 ], a combination of TIPs and the COM – B framework [ 27 ], the Risks, Attitudes, Norms, Abilities, and Self-Regulation model [ 23 ] and the Integrated Behavioural Model (IBM) for WASH [ 31 ].…”

Sustainability of facilities built under the Community-Led Total Sanitation (CLTS) implementation: Moving from basic to safe facilities on the sanitation ladder

“…Frequent disasters such as floods that result in collapsed pits and latrines have deterred ODF communities from rebuilding their latrines, as reported in the Bangladesh study [66]. In addition to the rains, [70] reported that termites attacked the slabs of some pit latrines that were made of wood beams or branches which severely weakened the latrine structure often leading to its collapse. Local pit latrines were not expected to last an entire rainy season.…”

“…Social aspects are considered essential and, if not adequately addressed, the failure of the implemented solution is likely to occur [78][79][80]. A number of community, household, and structural factors besides technological factors were found to be associated with better toilet durability, including households with higher socioeconomic status, households with disabled members, living in communities with higher basic sanitation coverage, and having toilets in an area with a shallower water table [62,70]. Several other studies have reported that frequent personal contact with health promoters and accountability over a period of time [81] an enabling environment with market access to latrine products [82][83][84], follow-up monitoring [17,85], social cohesion and social capital among community members [50], effective community leadership and political will [17], access to markets and sanitation materials, and sustainable behavior change [17,50] can lead to increased sustainability of latrines.…”

Evaluating the acceptability of water, sanitation and hygiene interventions, with the case of a portable hygiene intervention (The Spatap) in three Fijian communities, a mixed-methods study.

“…Acceptability evaluations are increasingly common across the WASH and broader healthcare sector [16,18]. However, previous acceptability evaluations have lacked a consistent de nition of acceptability and a theoretical underpinning [20]. The local environmental context, including water availability and the frequency of extreme climate events, also affects sustainability of WASH interventions [21,22].…”