Beliefs, Behaviors, and Perceptions of Community-Led Total Sanitation and Their Relation to Improved Sanitation in Rural Zambia

Abstract

Abstract. Inadequate hygiene and sanitation remain leading global contributors to morbidity and mortality in children and adults. One strategy for improving sanitation access is community-led total sanitation (CLTS), in which participants are guided into self-realization of the importance of sanitation through activities called "triggering." This qualitative study explored community members' and stakeholders' sanitation, knowledge, perceptions, and behaviors during early CLTS implementation in Zambia. We conducted 67 in-depth interviews and 24 focus group discussions in six districts in Zambia 12-18 months after CLTS implementation. Triggering activities elicited strong emotions, including shame, disgust, and peer pressure, which persuaded individuals and families to build and use latrines and handwashing stations. New sanitation behaviors were also encouraged by the hierarchical influences of traditional leaders and sanitation action groups and by children's opinions. Poor soil conditions were identified as barriers to latrine construction. Taboos, including prohibition of different generations of family members, in-laws, and opposite genders from using the same toilet, were barriers for using sanitation facilities. CLTS, through community empowerment and ownership, produced powerful responses that encouraged construction and use of latrines and handwashing practices. These qualitative data suggest that CLTS is effective for improving sanitation beliefs and behaviors in Zambia.

Approaches to promote handwashing and sanitation behaviour change in low‐ and middle‐income countries: a mixed method systematic review

“…Being unaware of disease spread was reported to be a barrier for implementation in two studies on a community-and an approach containing elements of psychosocial theories Lawrence et al, 2016). Conversely, being aware of disease spread was considered a facilitator for implementation in an approach based on sanitation and hygiene messaging, a community-based approach and an approach containing elements of psychosocial theories Andrade, 2013;Brooks et al, 2015;Lawrence et al, 2016;Smith et al, 2004;. Another factor that was a facilitator for the implementation of community-based approaches was the induction of feelings of shame and disgust in response to old habits and practices (Lawrence et al, 2016;Malebo et al, 2012).…”

“…A facilitator for the implementation of a social marketing-based approach was living in city centres, as people living there tend to be wealthier (Emerging Markets Consulting, 2014). Living in remote areas, with lesser access to water or sanitation facilities, was suggested to be a barrier towards the implementation of a community-based approach (Lawrence et al, 2016) or a programme using sanitation and hygiene messaging (Graves et al, 2013).…”

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d’Ivoire

“…Lawrence et al [48] identified shame from the CLTS triggering as one of the most important factors for behavioural change in rural Zambia. Yet, CLTS may also influence adherence through other social and emotive factors that include disgust, pressure from hierarchical powers and community groups, and competition among villages to achieve ODF status.…”

Power of Networks and Peer Pressure: An analysis of Slum Sanitation Program in Mumbai

“…From studies on this basis using experimental public goods games (PGG), economic models of peer pressure, microfinance institutions and natural resource usage; peer pressure mechanism is found to increase cooperative behaviour [20][21][22][23][24]. The strategy has been used in the case of sanitation in Zambia, India, Bangladesh [25][26]. These programs are known to use shaming, as a strategy in these schemes.…”