This study assesses the impact of a behaviour change intervention using the risks, attitudes, norms, abilities and self-regulation (RANAS) approach for improving latrine use in the context of India’s Swattch Bharat Mission (SBM) sanitation campaign.
In India, 52.1 per cent of the rural population practises open defecation. The explicit SBM agenda is to make India open defecation free by 2 October 2019. The study aims to generate evidence on the impact of a behaviour change intervention using RANAS approach on increasing latrine use in Raichur district in Karnataka.
- Do the interventions increase latrine use of households?
- What are the mechanisms and behavioural factors that influence the impact of the interventions?
- Does the interventions increase safe disposal of child faeces?
This evaluation assesses the impact of four intervention strategies implemented over eight weeks in each intervention village:
- Community meetings to discuss the benefits of latrine use, the costs of open defecation and to create personal norms for latrine use by linking latrine use to pride and leadership.
- Household visit including encouragement for public commitment through a family photo, instruction poster for correct latrine use and cleaning, morning routine planning and reminder stickers on tumblers used for anal cleansing.
Follow-up communication through mobile phones, including a pictorial SMS reminder to be sent early in the morning and one phone call to individually discuss encountered barriers to latrine use and strategies to overcome them.
Parents meetings in Anganwadi Centres for promotion of safe handling of child faeces by creating awareness of risks and disgust associated with unsafe disposal, linking safe disposal to happy children and mothers, and prompting mothers to agree on a behavioural contract.
Theory of change
The RANAS model provides the theoretical core to the project’s theory of change. The model assumes that behaviour change is achieved through changing psychosocial factors, which steer targeted behaviour.
This study uses a stratified cluster-randomised controlled trial to evaluate the developed behaviour change interventions, where households are the units of observation. Additionally, process monitoring of the campaign was carried out by collecting qualitative data on the perception of the interventions.
In both the treatment and control arms, latrine use and safe disposal of child faeces increased by more than 15% and 30%, respectively. The study finds that external factors had a strong influence on the project outcomes. Intensive government activities to promote and monitor latrine use were revealed by qualitative data collection and the findings suggest that these substantially impacted latrine use and safe disposal of child faeces. Further, the intervention triggered statistically significant increase in latrine use by 5%. Spot-check observations corroborated these results.
Here are key recommendations for programme managers, policymakers, donors and researchers:
- Latrine use behaviour change to be positioned as an important component of the Open Defecation Free sustainability agenda at all levels (from district to the national level). Behaviours change strategies to be positioned to promote latrine use behaviours, as well as to sustain latrine use behaviours over time in both open defecation declared districts and those that are yet to be declared. Further, sustained behaviour requires all community members.
- Effective behaviour change strategies and activities, such as household visits and community meetings should be incorporated into ongoing SBM campaigns.
- Key behaviour change messages must be reinforced multiple times using different activities (that address different drivers)
- Cultural and contextual sensitivities related to latrine use (e.g., overt and public display of campaign materials in households, water availability) must be taken into consideration and addressed to implement a successful behaviour change intervention.
The study suggests influencing policy at the district, national and international levels through the following actions:
- The findings from the impact evaluation have been shared with the Raichur District Collector’s office. They are keen to scale up the approach to the entire district.
- Findings have been disseminated to other development partners working on sanitation in India, who have the potential to inform the sanitation policy at state and national levels.
- Findings will be shared with WaterAid at the global level to inform sanitation policy influencing in other countries (e.g., Nigeria).