Sanitation and Collective Efficacy in Rural Cambodia: The Value Added of Qualitative Formative Work for the Contextualization of Measurement Tools

Abstract

Community-level action may be required to achieve the levels of sanitation uptake necessary for health gains. Evidence suggests that collective action is influenced by collective efficacy (CE)—a group’s belief in its abilities to organize and execute action to achieve common goals. The extent to which it is necessary to fully contextualize existing CE measurement tools, in order to conduct meaningful assessments of the factors influencing CE perceptions, is not well understood. This study examines the value added of contextualizing an existing CE measurement tool using qualitative formative research. We employed a modified grounded theory approach to develop a contextualized CE framework based on qualitative data from rural Cambodian villages. The resulting framework included sub-constructs that were pertinent for the rural Cambodian context for which an existing, hypothesized framework did not account: perceived risks/benefits, action knowledge, shared needs/benefits, and external accountability. Complex confirmatory factor analyses indicated that contextualized models fit the data better than hypothesized models for women and men. This study demonstrates that inductive, qualitative research allows community-derived factors to enhance existing tools for context-specific CE measurement. Additional research is needed to determine which CE factors transcend contexts and could, thus, form the foundation of a general CE measurement tool.

Assessment of water, hygiene, and sanitation practice and associated factors among Bihari refugee camp in Bangladesh: A cross‐sectional study

“…Numerous These circumstances may lead to the presence of below-standard facilities, limited availability of clean water, and poor provision of hygiene products. 29 A study in urban slums in India found that inadequate water supply and poor sanitation facilities were major contributors to poor health outcomes, with high rates of diarrhoea and other waterborne diseases. 27 In rural Cambodia a study was conducted which found that lack of access to safe water and sanitation facilities led to poor hygiene practices and contributed to high rates of waterborne diseases and other health problems.…”

“…Low‐income communities may encounter challenges in terms of financial accessibility and sustainability when it comes to procuring and upkeeping adequate WASH infrastructure. These circumstances may lead to the presence of below‐standard facilities, limited availability of clean water, and poor provision of hygiene products 29 …”

“…27 In rural Cambodia a study was conducted which found that lack of access to safe water and sanitation facilities led to poor hygiene practices and contributed to high rates of waterborne diseases and other health problems. 29 These studies highlight the challenges faced by populations in different contexts related to WASH practices, and emphasize the need for effective interventions to improve access to clean water, sanitation facilities, and hygiene promotion programs. There is a need to improve access to safe and clean water, increase the availability of private toilet facilities, and address the challenges associated with multiple people using the same toilet.…”

Community Perceptions of a Multilevel Sanitation Behavior Change Intervention in Rural Odisha, India

“…Community-level interventions that call upon the broader community to take action may be needed to truly eliminate, or at least reduce, fecal contamination in the environment. New research has demonstrated the need to assess two critical assumptions before implementing a community-level public health intervention based on collective action: (1) target participants believe their community is capable of taking collective action and (2) participants agree that the proposed collective action is an appropriate response to their common interests [57]. Our findings show that these assumptions may not have been met before the Sundara Grama intervention was implemented and, as a result, may have contributed to the limited impacts the trial found on latrine use.…”

“…Delea, et al (2018) have devised a scale to measure perceptions of collective efficacy, which includes factors like social disorder, social response, common values, social capital, social equity, community attachment, and agency, as potentially influential to the uptake of WASH behaviors [59,60]. Such a measure could help WASH program planners to better design, target, and evaluate their community-based interventions, although the measure may require adaptation to the local culture [57].…”