The role of psychological factors in predicting latrine ownership and consistent latrine use in rural Ethiopia: a cross-sectional study

Abstract

BackgroundInadequate sanitation is one of the leading causes of disease in poor and middle-income countries.ObjectiveThe objective of the study was to identify the psychological factors that predict latrine ownership and consistent latrine use in the rural Becho district of central Ethiopia.MethodA quantitative, cross-sectional, community based study was conducted. A total of 1047 heads of household were interviewed using a structured questionnaire. Ownership of latrine and consistent latrine use constituted the outcome variable of the study. Data were entered using Epi Info version 3.5.4 and were analyzed using SPSS version 20.ResultsOf the 1047 households, 73% owned a traditional pit latrine. Among the psychological factors, attitude (AOR 1.70; 95% CI 1.21–2.37) and injunctive norm (AOR 6.18; 95% CI 4.46–10.44) were positively and significantly associated with latrine ownership. Among the demographic factors, having a family size of more than six (AOR = 1.43; 95% CI 1.01–1.97, having a child attending school (AOR = 1.88; 95% CI 1.17–3.02), and having a high school education (AOR = 1.98; 95% CI 1.34–2.87) were significantly associated with latrine ownership. With respect to exposure to communication about sanitation (the cues to action), households that had a family member who took part in Community Led Total Sanitation and Hygiene (CLTSH) triggering were three times more likely to be latrine owners than those who did not participate in CLTSH triggering (95% CI 1.92–4.78.) Results from adjusted logistic regression analysis of potential predictors of consistent latrine use showed that having a positive attitude (AOR 7.00; 95% CI 4.55–10.55), owning of a latrine that had superstructure (AOR 2.3 95% CI 1.47–3.48), having a clean latrine (AOR 1.69 95% CI 1.00–3.00), and having a latrine with a protected door (AOR 1.94; 95% CI 1.10–3.48) were significantly associated with consistent latrine use.ConclusionThe study findings showed that attitude and injunctive norm are the psychological predictors of latrine ownership, and consistent latrine use was associated with attitude, cleanliness of the latrine, and its privacy. Hence, sanitation intervention needs to focus on changing societal norms, attitudes, and the promotion of latrine quality.

Factors Associated with Levels of Latrine Completion and Consequent Latrine Use in Northern Ghana

“…The factors influencing latrine construction and use are broadly classified into demographic and socio-economic factors, knowledge and attitudes, and social influence [13,15,19,20,35,36]. Although we did not find significant differences between household size, age, marital status or literacy rates among respondents across the levels of latrine completion, other research works have reported the influence of these factors on latrine construction and use [36,37,38].…”

“…Households would more likely switch from open defecation to latrine use if latrines protect their privacy. Existing literature on CLTS indicates that convenience, comfort, and health benefits are recurring reasons for latrine use [19,20]. Similarly, a study on rural sanitation showed that privacy and safety are the major reasons for latrine construction and use among women [35].…”

“…However, we found in this study that households with the highest incomes were at the lowest level of latrine construction (Table 2). It has also been suggested that, despite the impact of income on latrine construction, other contextual factors drive latrine construction decisions [16,19,20,37].…”

“…However, though risk perception may evoke precautionary measures [44], it is not a determinant of preventive health behaviours [45]. The adoption of healthy behaviours is dependent upon the social process triggered by CLTS [20], social norms [13,19], social networks, and social capital [15,36]. For example, one qualitative study conducted in Benin found prestige to be the main motivation for latrine construction, which had little to do with health risk [46].…”

“…To understand latrine completion and use decisions among households, we used the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model of behaviour change [18] as a conceptual guide. The RANAS model underscores the importance of psychosocial factors in determining households’ sanitation behaviours [13,19,20,21,22]. The risk factors represent a person’s understanding of the health risk of open defecation, the person’s perceived perception of his or her risk of contracting diarrhoea, and his or her perception of the severity of diarrhoea and its consequences.…”