What works in urban WASH promotion around the world? A review of behavior change approaches for water, sanitation & hygiene in urban environments

Summary:

Rapid urbanization in the global south is accompanied by growth of informal settlements. Insufficient infrastructure and services in these environments contribute to higher risk of exposure to water, sanitation, and hygiene (WASH)-related diseases. To inform the design of urban WASH social and behavior change communication (SBCC) for these populations, we reviewed documented examples of relevant programs. This systematic review included both grey and peer-reviewed literature. After multiple stages of screening, consolidation, and snowballing, we identified 91 urban WASH SBCC interventions documented in 104 peer-reviewed and grey literature documents. These interventions used SBCC approaches to change handwashing, safe water, food hygiene, safe fecal disposal, and vector control behaviors in urban settings. Intervention data was extracted from identified documents and analyzed. Interventions were not evenly distributed by region; South Asia and Eastern and Southern Africa were most represented. Handwashing was found to be the most frequently promoted WASH behavior. Few identified interventions reported using a behavioral theory or framework to inform their design. Programs relied heavily on interpersonal health education over other SBCC approaches. The evidence for promoting handwashing using interpersonal health education in urban areas is abundant and strong. There is substantial evidence for promoting safe water behaviors through interpersonal health education in urban areas. There is substantial evidence for effective community-based approaches to promote vector control in urban areas. Evidence supporting the uptake of behaviors related to food hygiene, and sanitation related to the safe disposal of feces in urban areas is limited. Disclaimer: The author is expressing a personal point of view here. The opinions stated in this text should not be regarded as the official position of Switzerland or of the Swiss Federal Department of Foreign Affairs.

Background/Objectives

Rapid urbanization in the global south is accompanied by growth of informal settlements. Insufficient infrastructure and services in these environments contribute to higher risk of exposure to water, sanitation, and hygiene (WASH)-related diseases among residents. To inform the design of urban WASH social and behavior change communication (SBCC) for these populations, we reviewed documented examples of relevant programs. While WASH has been promoted extensively for decades in rural areas of the global south, to our knowledge efforts to promote these behaviors in urban settings are fewer and less documented.

Description Of Intervention And/or Methods/Design

This systematic review included both grey and peer-reviewed literature. After multiple stages of screening, consolidation, and snowballing, we identified 91 urban WASH SBCC interventions documented in 104 peer-reviewed and grey literature documents. These interventions used SBCC approaches to change handwashing, safe water, food hygiene, safe fecal disposal, and vector control behaviors in urban settings. SBCC approaches included were interpersonal health education, health communication, social marketing, community-based approaches, and advocacy.

Results/Lessons Learned

Intervention data was extracted from identified documents and analyzed. Interventions were not evenly distributed by region; South Asia and Eastern and Southern Africa were the most represented. Handwashing was the most frequently promoted WASH behavior in urban contexts as found in identified literature. Few identified interventions reported using behavioral theory or framework to inform their design. Programs relied heavily on interpersonal health education over other approaches. Women and girls were rarely consulted in the design of programs. The evidence for promoting handwashing using interpersonal health education in urban areas is abundant and strong. There is substantial evidence for promoting safe water behaviors through interpersonal health education in urban areas. There is substantial evidence for effective community-based approaches to promote vector control in urban areas. Evidence supporting the uptake of behaviors related to food hygiene, and sanitation related to the safe disposal of feces in urban areas is limited.

Discussion/Implications For The Field

Urban WASH programs could benefit from the uptake of SBCC best practices in the design stage (application of theory, gender integration, formative research, etc.), and a broadened approach that incorporates approaches beyond the interpersonal and integrates multiple WASH behaviors rather than focusing so narrowly on handwashing. Several interventions with promising results should be replicated and tested further. As the global population becomes more urbanized and SBCC interventions in cities become more common, the examples identified in this review could serve as a foundation for future SBCC interventions in similar settings and inform urban-focused WASH SBCC strategies.

Abstract submitted by: 

Claire Slesinski - The Drexel Urban Health Collaborative

Cierra Bryant - The Drexel Urban Health Collaborative

Michael Gnilo -  UNICEF

Julia Stricker

Ana Diez Roux - The Drexel Urban Health Collaborative

Alex Ezeh - The Drexel Urban Health Collaborative