Disgust, Shame, and Soapy Water: Tests of Novel Interventions to Promote Safe Water and Hygiene

Guiteras, Raymond; Levine, David I.; Luby, Stephen P.; Polley, Thomas H.; Khatun-e-Jannat, Kaniz; Unicomb, Leanne

doi:10.1086/684161

Cited by 29 publications

(22 citation statements)

References 53 publications

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“…While Dupas (2011) shows that girls in Kenya select younger (and safer) partners after learning age-specific rates of HIV prevalence, Luo et al (2012) and Wong et al (2014) show that nutrition education for parents in China does not reduce child anaemia. Guiteras et al (2014) find that neither messages appealing to negative emotions or social pressure improve hand washing or increase the willingness to pay for water chlorination in Bangladesh.…”

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confidence: 70%

“…1 In health, there is a distinction between programmes that offer personalised and general information. Guiteras et al (2014) show that message framing does not influence hand washing or the willingness to pay for water chlorination in Bangladesh. However, the evidence regarding general prevention messages is mixed.…”

Section: Information Hygiene and Healthmentioning

confidence: 87%

“…For instance, Bowen et al (2012) find an impact of a nine-month hygiene promotion campaign in Pakistan, while Luo et al (2012) and Wong et al (2014) show that nutrition information does not change nutrition and anaemia for children in China. Guiteras et al (2014) show that message framing does not influence hand washing or the willingness to pay for water chlorination in Bangladesh.…”

Section: Information Hygiene and Healthmentioning

confidence: 87%

“…Interventions range from cigarette warning labels to community health worker programmes (WHO 2008;Kamyab et al, 2014). Guiteras et al (2014) find that neither messages appealing to negative emotions or social pressure improve hand washing or increase the willingness to pay for water chlorination in Bangladesh. While Dupas (2011) shows that girls in Kenya select younger (and safer) partners after learning age-specific rates of HIV prevalence, Luo et al (2012) and Wong et al (2014) show that nutrition education for parents in China does not reduce child anaemia.…”

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confidence: 99%

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Learning, Hygiene and Traditional Medicine

Bennett

Naqvi

Schmidt

2018

The Economic Journal

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Information provision is only an effective behaviour-change strategy if the information is credible. A novel programme augments conventional hygiene instruction by showing participants everyday microbes under a microscope. Through a randomised evaluation in Pakistan, we show that this programme leads to meaningful hygiene and health improvements, while instruction alone does not. Traditional medicine, which offers an alternative disease model, may undermine learning by strengthening prior beliefs about hygiene. We show that believers in traditional medicine have smaller impacts, suggesting that traditional and modern medical beliefs are substitutes and that traditional medicine may exacerbate the infectious disease burden in this context. medical beliefs may attenuate the impact of information by increasing the prior precision. Alternatively, traditional beliefs could strengthen the impact of information by reducing the prior mean. The negative interaction between ML and traditional medical beliefs suggests that traditional beliefs influence the prior precision.This study makes two primary contributions. Using a rigorous, randomised design, we show that an intervention designed to educate participants about microbes has a strong, lasting impact while instruction alone does not. Notwithstanding several caveats, this finding suggests that the provision of corroborating evidence (which is not the default approach in this area) may strengthen the impact of health recommendations. It may also help to explain heterogeneity across studies in the impact of hygiene promotion (Curtis and Cairncross, 2003;Fewtrell et al., 2005;Aiello et al., 2008;Waddington and Snilstveit, 2009). Our findings also contribute to a broader literature on learning and technology adoption (Conley and Udry, 2010;Argent et al., 2014).Secondly, this article is one of the first well-identified analyses of the role of traditional medical beliefs. We uncover substantial heterogeneity in the impact of information according to beliefs in traditional medicine. Despite the ubiquity of traditional medicine (WHO 2003), very little social science research considers its implications (Leonard, 2003;Leonard and Graff Ziven, 2005;Wang et al., 2010;Kooreman and Baars, 2012; Sato, 2012a,b). Traditional medical beliefs may help to explain the low demand for ostensibly valuable health products like deworming treatment, antimalarial bed nets, and low-emission cook stoves (Kremer and Miguel, 2007;Cohen and Dupas, 2010;Mobarak et al., 2012). Although it is difficult to generalise, results suggest that traditional beliefs exacerbate the burden of infectious disease in this setting by discouraging healthy behaviour. F547 1 A literature in economics examines the role of learning in agricultural technology diffusion (Foster and Rosenzweig, 1995; Conley and Udry, 2010; Argent et al., 2014). Genius et al. (2014) and Krishnan and Patnam (2014) examine the impact of agricultural extension services on technology adoption. The credibility of extension agents has parallels to the...

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confidence: 70%

Section: Information Hygiene and Healthmentioning

confidence: 87%

Section: Information Hygiene and Healthmentioning

confidence: 87%

mentioning

confidence: 99%

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Learning, Hygiene and Traditional Medicine

Bennett

Naqvi

Schmidt

2018

The Economic Journal

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“…(Thaler and Sunstein 2008, page 5, italics in original) It may also be difficult to learn much from asking them to rate their sanitation experience. That's because CLTS-type interventions foster, through disgust and shaming (Guiteras et al 2015b), a social norm that may make ODers less likely to state they are happy with their experience.…”

Section: Satisfaction and Perceived Amenitiesmentioning

confidence: 99%

A Community-Based Program Promotes Sanitation

Alzúa

Djebbari

Pickering

2020

Economic Development and Cultural Change

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Basic sanitation facilities are still lacking in large parts of the developing world, engendering serious environmental health risks. Interventions commonly deliver in-kind or cash subsidies to promote private toilet ownership. In this paper, we assess an intervention that provides information and behavioral incentives to encourage villagers in rural Mali to build and use basic latrines. Using an experimental research design and carefully measured indicators of use, we find a sizeable impact from this intervention: latrine ownership and use almost doubled in intervention villages, and open defecation was reduced by half. Our results partially attribute these effects to increased knowledge about cheap and locally available sanitation solutions. They are also associated with shifts in the social norm governing sanitation. Taken together, our findings, unlike previous evidence from other contexts, suggest that a progressive approach that starts with ending open defecation and targets whole communities at a time can help meet the new Sustainable Development Goal of ending open defecation.

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Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low‐ and middle‐income countries: An evidence and gap map of effectiveness studies

Chirgwin

Cairncross

Zehra

et al. 2021

Campbell Systematic Reviews

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Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub‐Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to “leave none behind” will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged. Objectives Decision makers need access to high‐quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews. Methods This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill‐health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low‐ and middle‐income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory‐based, mixed‐methods evidence synthesis. Results There has been an enormous growth in impact evaluations and systematic reviews of WASH ...

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Disgust, Shame, and Soapy Water: Tests of Novel Interventions to Promote Safe Water and Hygiene

Cited by 29 publications

References 53 publications

Learning, Hygiene and Traditional Medicine

Learning, Hygiene and Traditional Medicine

A Community-Based Program Promotes Sanitation

Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low‐ and middle‐income countries: An evidence and gap map of effectiveness studies

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