Sustained adoption of water, sanitation and hygiene interventions: systematic review

Abstract

Abstractobjective To understand factors that influence sustained adoption of water, sanitation and hygiene (WASH) technologies or behaviours.methods Systematic review of the current literature. Articles were gathered from databases of peerreviewed articles and grey literature, and screened for relevance. After exclusion, we created a descriptive map of 148 articles and analysed in-depth 44 articles that had an explicit focus on promoting or evaluating sustained adoption or programme sustainability. Twenty-two of these articles met our definition of measuring sustained adoption.results Definitions of sustained adoption varied widely and were often inadequate, making comparison of sustained adoption across studies difficult. The time frame for measurements of sustained adoption is frequently inadequate for examination of longer-term behaviour change.conclusions Ideally, an evaluation should specify the project period and describe the context surrounding adoption, make measurements at multiple time points, diversify measurement methods and describe and measure a range of factors affecting sustained adoption. Additional consideration needs to be given to developing behaviour change models that emphasise factors related to sustained adoption, and how they differ from those related to initial adoption.

Acceptability and Feasibility of Sharing a Soapy Water System for Handwashing in a Low-Income Urban Community in Dhaka, Bangladesh: A Qualitative Study

“… 12 , 15 Therefore, the promotion of soapy water as a hand cleansing agent with 1.5-L bottles as a dispenser was low-cost, acceptable, and feasible for handwashing in low-income urban communities, and has the potential for sustained adoption. 23 This mirrors the findings of a study conducted in rural Bangladesh. 18 In addition, a trial among low-income urban communities in Dhaka found soapy water was equally effective as bar soap in removing indicator organisms from hands and more effective than water alone.…”

“…Therefore, this innovation has the potential to increase handwashing with soap as part of large-scale national promotions. Important areas for future research include lowering the cost of behavior change promotion potentially by using mass media, identifying systematic definitions of sustained adoption and methodology to rigorously evaluate water and sanitation interventions, 23 and evaluating sustainability and sustained behavioral impact of such interventions.…”

“… 17 However, we lack data on feasibility, convenience, and sustained use of sharing soapy water bottles in these low-income urban households where shared handwashing sites are the norm. This article examines the acceptability and feasibility of sharing the soapy water system as a cleaning agent and dispenser in a low-income neighborhood in Dhaka, Bangladesh, drawing on data from a qualitative assessment conducted during a pilot handwashing intervention, 17 from a systematic review on sustained adoption of Water, Sanitation, and Hygiene (WASH) behaviors 23 we conducted, and other relevant literature we reviewed on promotion of water, sanitation, and hygiene. 17 , 18 , 21 , 24 – 35 …”

Household Water Treatment and Cholera Control

“…A recent review found the sustainability of WASH interventions is frequently inadequately evaluated [ 32 ]. One study evaluated the sustainability of an existing development HWT with chlorine program that expanded after the Haiti earthquake and cholera outbreak [ 33 ].…”

Water, sanitation and hygiene (WASH) behaviour change research: why an analysis of contingencies of reinforcement is needed

“…A systematic review of WASH behavioural models concluded that existing approaches have overemphasised hypothetical psychological variables and should instead focus on aspects of the physical and natural environment, as well as on technological features (Dreibelbis et al 2013). However, in a more recent systematic review, psychological factors were considered key for the maintenance of WASH behaviour change, alongside technological and contextual factors (Martin et al 2018). In fact, in another review it was reported that sociopsychological variables explained 62% of safe water drinking behaviours, while contextual factors were said to contribute little by way of explanation (Lilje and Mosler 2018).…”