What factors affect sustained adoption of safe water, hygiene and sanitation technologies?

Safe water, sanitation and hygiene (WASH) behaviours, such as treating drinking water, washing hands at key times or using a latrine rather than defecating in open spaces, are cornerstones of building strong, healthy communities and reducing mortality due to diarrhoea and other preventable diseases. Many studies have shown the health benefits of WASH, and factors that affect initial adoption of short-term WASH use. Few have assessed the determinants of long-term, sustained WASH practice.

Drawing on a full systematic review, this systematic review summary by Kristyna Hulland,Nina Martin, Robert Dreibelbis, Julia DeBruicker Valliant and Peter Winch reviews the evidence on factors that motivate sustained adoption of WASH technologies.

This report by Hulland et al. is a summary of the full systematic review and is designed to be useful to policymakers and practitioners. The full review and all of its appendices are available through the EPPI-Centre website.

Systematic Review findings

• The authors found that individual psychosocial factors, such as perceived benefit and self-efficacy, as well as interpersonal factors like social norms, strongly affect continued WASH behaviours. 
• Age and gender were strong determinants of continued WASH practice, particularly in latrine use and handwashing practice. 
• An individual’s broader context was also found to be highly influential. 
• Cost and durability were the two most important factors related to technology. 
• Influential programme factors associated with sustainability include frequent, personal contact with a health promoter and sustained accountability. Personal follow-up in conjunction with other measures like mass media advertisements or group meetings may further increase sustained adoption.

Implications for research and, policy and practice

• More emphasis needs to be placed on defining sustainability and translating these definitions into metrics and programme elements that can be used to implement, evaluate and further the discussion on sustained WASH adoption
• Programmes and technologies need to be designed to be supportive and flexible to motivators of both initial and long-term WASH practice. 
• Funding mechanisms need to emphasise the importance of routine monitoring and evaluation, and be willing to invest in longer-term behaviour maintenance. 
• Policies and regulations need to be established at the governmental and intergovernmental levels that support the right to safe water, hygiene and improved sanitation for all people globally.