Theory-driven formative research to inform the design of a national sanitation campaign in Tanzania.
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INTRODUCTION: There are gaps in global understanding about how to design and implement interventions to improve sanitation. This formative study provided insights for the subsequent redesign of a government-led national sanitation campaign targeting rural populations in Tanzania. METHODS: The Behaviour Centred Design approach was used to investigate the determinants of toilet building, improvement and use. Varied, novel, and interactive research tools were employed in fifty-five households in two regions of rural Tanzania. Results were analysed to articulate a Theory of Change, which then informed intervention design. RESULTS: Participants valued hard work, enterprise, and improving their lives over many years. They wanted better toilets but felt no urgency to act quickly. A common emotional motivator for improving toilets was to protect children from disease (Nurture) but this was insufficient to drive rapid change. Disgust with traditional toilets meant they were built at a distance from the house: an 'out of sight, out of mind' attitude. Other powerful motives included the desire to improve living conditions (Create), and to become a modern Tanzanian (Status), albeit without 'showing off'. Construction costs and water scarcity were the main stated barriers. Receiving information about realistic costs, support accessing materials, and visiting better latrines elsewhere were commonly reported reasons for improving latrines. CONCLUSIONS: The resulting Theory of Change recommended that the intervention should surprise people with a novel conversation about toilets, promote toilets as a means of conferring status, and introduce a perceived urgency to 'act now'. It should suggest that modest improvements would lead to a better life. Feelings of disgust and fear with poor quality toilets should be amplified, and barriers lessened through promoting transformational toilet improvements, and improving access to modern toilet products. This research provided considerable insight into sanitation behaviours in rural Tanzania, which informed creative intervention design.
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Women have faced difficulties accessing government subsidies or loans large enough for latrine construction and reported willingness to make financial sacrifices, like paying higher rent or accepting a lower wage job, to gain toilet access; in India, even women with economic and decision-making power could not build latrines without land ownership.
“Women have faced difficulties accessing government subsidies [125, 135] or loans large enough for latrine construction [131] and reported willingness to make financial sacrifices, like paying higher rent [191] or accepting a lower wage job, [174,217] to gain toilet access.In India, even women with economic and decision-making power could not build latrines without land ownership [124,187,190].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [131]
Rural Indian women were often responsible for assisting others, including children, adolescent girls, and elderly family members, with sanitation needs.
“and were often responsible for assisting others, including children, adolescent girls, and elderly family members, with sanitation needs [62,131,135,184,190].”
From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [131]
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- Authors
- Czerniewska, A., Muangi, W. C., Aunger, R., Massa, K., & Curtis, V.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- University of Dar es Salaam (TZ)
- Ministry of Health, Community Development, Gender, Elderly and Children (TZ)
- Corresponding author
- Czerniewska, Alexandra
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-08-23
- Volume
- 14
- Issue
- 8
- Pages
- e0221445
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6707585
- OpenAlex
- W2969601510
- Cited by
- 25
- References
- 47
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 7 · 2020: 4 · 2019: 1
- FWCI
- 3.42
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Department for International Development, UK Government (DFID 7540)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- sanitation, latrine construction, theory of change, sanitation behavior, disgust, status motives, construction costs, water scarcity, intervention design, Tanzania
- MeSH terms
- Adult, Aged, Behavior, Culture, Family Characteristics, Female, Humans, Male, Middle Aged, Motivation, Sanitation, Tanzania, Qualitative Research, Young Adult
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