1. 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

2. 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),
McFarlane, C. (2008). Sanitation in Mumbai's informal settlements: State,‘slum’, and infrastructure. Environment and planning A, 40(1),
Introduction – Methods – Results – Conclusion

3. 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

4. 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

5. 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

6. 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

7. 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),
Introduction – Methods – Intervention – Evaluation – Conclusion

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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