We conducted a systematic review of articles available in PubMed, identified through a combination of search terms associated with water, sanitation, and hygiene practices, with terms related to conceptual frameworks and models, and with names of key behaviour change theories and popular determinants referenced in existing water and sanitation research (see Table 1 ). No date restrictions were placed on our search.
Full citation information, including title, abstract, publication date, and journal name, was reviewed for all articles identified in the search. Articles that potentially included a behaviour change model or explanatory framework related to water, sanitation, and hygiene, were identified for full-text retrieval. From the grey literature, we identified documents that described conceptual models of behaviour change frameworks used by key global health organisations, such as Water and Sanitation Program (WSP) of the World Bank and the United States Agency for International Development (USAID). This included a review of WASH behaviour change approaches published by the Water Supply and Sanitation Collaborative Council [2 ]. Three criteria were used to further screen articles potentially employing behaviour change frameworks: 1) the framework addressed factors affecting WASH behaviours at one or more levels of aggregation (individual, household, community, etc.), 2) the framework drew, either implicitly or explicitly, from existing behavioural theory or presented a new theory/framework to summarize these factors, and 3) the framework related to WASH behaviours practiced in a community or domestic setting, rather than an institution (hospital, clinic) or private sector employer (restaurant, food services). Full texts were reviewed and information on behavioural models extracted. Both published and grey literature documents that did not present an explicit behaviour change model or framework but described itemized, specific behavioural determinants related to water, sanitation, and hygiene were excluded from our systematic review; however, relevant information on specific behavioural determinants was used to inform the development and elaboration of our emergent framework.
Findings from our review informed the development of our initial comprehensive behaviour change framework which guided technology selection and hygiene promotion for on-going formative and pilot research on the intervention content of two large-scale cluster randomized trials to be conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)a. Feedback from these formative and pilot projects was reviewed iteratively with our emergent model, and led to the subsequent organisation of the initial framework into three Dimensions (contextual, psychosocial, technological) and five aggregate Levels (behavioural, individual, interpersonal/household, communal, societal).
The resulting multi-level behaviour change framework – the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM – WASH) was presented at the 2011 Oklahoma University International WaTER Conference, and at participatory workshops and lectures at iccdr,b in Dhaka and Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Feedback from these presentations was noted and incorporated into the framework. The full description of the model is the focus of this publication. IBM – WASH subsequently served to develop a codebook for the analysis and interpretation of qualitative findings from the concurrent formative and pilot research on handwashing, point-of-collection or point-of-use water treatment, and sanitation technologies and behaviours (data not shown). Results from one such analysis are presented in Hulland et al. [23 (link)].
Full citation information, including title, abstract, publication date, and journal name, was reviewed for all articles identified in the search. Articles that potentially included a behaviour change model or explanatory framework related to water, sanitation, and hygiene, were identified for full-text retrieval. From the grey literature, we identified documents that described conceptual models of behaviour change frameworks used by key global health organisations, such as Water and Sanitation Program (WSP) of the World Bank and the United States Agency for International Development (USAID). This included a review of WASH behaviour change approaches published by the Water Supply and Sanitation Collaborative Council [2 ]. Three criteria were used to further screen articles potentially employing behaviour change frameworks: 1) the framework addressed factors affecting WASH behaviours at one or more levels of aggregation (individual, household, community, etc.), 2) the framework drew, either implicitly or explicitly, from existing behavioural theory or presented a new theory/framework to summarize these factors, and 3) the framework related to WASH behaviours practiced in a community or domestic setting, rather than an institution (hospital, clinic) or private sector employer (restaurant, food services). Full texts were reviewed and information on behavioural models extracted. Both published and grey literature documents that did not present an explicit behaviour change model or framework but described itemized, specific behavioural determinants related to water, sanitation, and hygiene were excluded from our systematic review; however, relevant information on specific behavioural determinants was used to inform the development and elaboration of our emergent framework.
Findings from our review informed the development of our initial comprehensive behaviour change framework which guided technology selection and hygiene promotion for on-going formative and pilot research on the intervention content of two large-scale cluster randomized trials to be conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)a. Feedback from these formative and pilot projects was reviewed iteratively with our emergent model, and led to the subsequent organisation of the initial framework into three Dimensions (contextual, psychosocial, technological) and five aggregate Levels (behavioural, individual, interpersonal/household, communal, societal).
The resulting multi-level behaviour change framework – the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM – WASH) was presented at the 2011 Oklahoma University International WaTER Conference, and at participatory workshops and lectures at iccdr,b in Dhaka and Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Feedback from these presentations was noted and incorporated into the framework. The full description of the model is the focus of this publication. IBM – WASH subsequently served to develop a codebook for the analysis and interpretation of qualitative findings from the concurrent formative and pilot research on handwashing, point-of-collection or point-of-use water treatment, and sanitation technologies and behaviours (data not shown). Results from one such analysis are presented in Hulland et al. [23 (link)].
Free full text: Click here
