Ina Sonego & Hans-Joachim Mosler Improved Latrine Cleanliness through Behavior Change and Changes in Quality of Latrine Construction: A Longitudinal Intervention Study in Rural Burundi Ina Sonego & Hans-Joachim Mosler Environmental and Health Psychology EhPsy

Relevance of latrine cleanliness Important for well-being of users Unhygienic latrines are a risk factor for health Stepping down the sanition ladder Risk of return to open defecation if latrines (e.g. Kwiringira, Atekyereza, Niwagaba, & Günther, 2014 in Uganda; McFarlane, 2008 in India) Behavior change to ensure latrine cleanliness! Kwiringira, J., Atekyereza, P., Niwagaba, B. C., & Günther, I. (2014). Descending the sanitation ladder in urban Uganda. BMC public health, 2014(14), 624-634. McFarlane, C. (2008). Sanitation in Mumbai's informal settlements: State,‘slum’, and infrastructure. Environment and planning A, 40(1), 88-107. Introduction – Methods – Results – Conclusion

Research questions How can we improve latrine cleanliness? What determines latrine cleanliness? Contextual factors? Habitual cleaning behavior? What determines habitual latrine cleaning? Introduction – Methods – Results – Conclusion

Systematic behavior change in water, sanitation and hygiene Systematic behavior change in water, sanitation and hygiene. A practical guide using the RANAS approach Mosler, H.-J., & Contzen, N. (2016). Systematic behavior change in water, sanitation and hygiene. A practical guide using the RANAS approach. Version 1.1. Dübendorf, Switzerland: Eawag. Introduction – Methods – Results – Conclusion

Data collection Face-to-face interviews with primary caregivers Team of local interviewers Structured questionnaire Spot-checks Baseline: 761 households Follow-up: 287 households Introduction – Methods – Intervention – Evaluation – Conclusion

Variables Habitual latrine cleaning Self-report Habit and frequency E.g. how often do you clean the latrine (5 point scale) Psychosocial factors (RANAS) E.g. do you think it is disgusting to use a dirty latrine (5 point scale) Observed latrine cleanliness Spot-check Clean: no dirt, no feces (1) mediocre: some dirt, no feces (0) dirty: feces on floor (-1) Introduction – Methods – Intervention – Evaluation – Conclusion

Sanitary situation revealed by baseline study Most households have latrines Quality of latrines mostly low Cleanliness mediocre Sonego, I. L., & Mosler, H. J. (2014). Why are some latrines cleaner than others? Determining the factors of habitual cleaning behaviour and latrine cleanliness in rural Burundi. Journal of Water, Sanitation and Hygiene for Development, 4(2), 257-267. Introduction – Methods – Intervention – Evaluation – Conclusion

Evidence based Intervention 1 Aim To increase observed latrine cleanliness To increase quality of latrine construction Baseline revealed it would be promising to target Positive emotions Satisfaction with latrine cleanliness Commitment strength Introduction – Methods – Intervention – Evaluation – Conclusion

Evidence based Intervention 2 Household visits by local health promotors Poster and group discussion Promoting positive picture of having a well-built and clean latrine Joy, pride and satisfaction Self-commitment at the end of the visit Target group 4 villages Around 4000 households Introduction – Methods – Intervention – Evaluation – Conclusion

Effect of intervention on observed latrine cleanliness Intervention group N = 198 Control group N = 91 Wilcoxon sign-rank test: increase in intervention group Z = -3.00, p = .003, r = .23. (no significant change in control group Mann-Whitney U-Test: Intervention group is more likely to improve cleanliness compared to control group (U = 6000, z = 2.42, p = .02, r = .15). Introduction – Methods – Intervention – Evaluation – Conclusion

Effects of intervention on quality of latrine construction * *** ** *** *** ** Intervention group increased quality of latrine construction more than control group ** Introduction – Methods – Intervention – Evaluation – Conclusion

Influences on observed latrine cleanliness Higher/better Habitual latrine cleaning leads to latrines being 3.5*** times more likely to increase in cleanliness as well! Lid covering slab hole 7.4* Availability of door 3.3† Material of superstructure 2.8** †p < .1; *p < .05; **p < .005; ***p < .001 Introduction – Methods – Intervention – Evaluation – Conclusion

Influences on habitual latrine cleaning Commitment strength Satisfaction with Cleanliness Personal norm Habitual latrine cleaning .18*** .15*** .17*** Adj. R2 = .46 -.23*** Forgetting N = 287 Introduction – Methods – Intervention – Evaluation – Conclusion

Conclusion Habitual latrine cleaning is the strongest predictor of observed latrine cleanliness People have control over the cleanliness of their latrines Behavior change interventions make sense Further enhancement of latrine cleanliness through better quality of latrine construction Behavior change interventions to increase habitual latrine cleaning should target: Commitment strength Positive emotions regarding latrine cleanliness: joy, pride and satisfaction a clean latrine brings to the whole family! Introduction – Methods – Intervention – Evaluation – Conclusion

Thank you very much for your attention! Gratefully acknowledged are Andrea Stocker, Christoph Häfliger, Christine Oberbeck, Nabil Chemaly, the whole data collectors team, all of the promotors, GIZ Burundi, and of course all of the study participants Side event on behavior change in the WASH sector: A practical guide for systematic behavior change using the RANAS approach: Applications in WASH projects demonstrating its practicability Convened by Eawag, Environmental Social Sciences, Environmental and Health Psychology Friday 10/14, 8:30 – 10:00 AM, Mountain Laurel