Vaparshun Improving Toilet Use in Rural India
Condition: Behavior
Study type: Interventional

Summary: 
      Vaparshun intervention aimed to inspire the target audience to use a toilet. It aimed to
      revalue their toilets by recognizing that they provide benefits associated with the motives
      of hoard, create, convenience (comfort) and affiliation, and provide a reward pathway for
      transitioning to a new toilet use routine.
    

Detailed description: 
      Our intervention consists of four different streams of activity. The outcome is that family
      members and men improve and use their contractor-built toilets. The activities are listed
      below.

        1. Create Motive:

           Toilet Makeover: Conduct a lottery and perform makeovers of select government built
           toilets in the village, with the involvement of the community. Demonstrate improvements
           in comfort (light, space, ventilation, latrine chair/handle) and aesthetics (stencil
           painting of door and walls).

           Challenge/Opportunity: Many of the 'contractor' toilets are built with low engagement
           from family members and are uncomfortable to use. People are left with toilets they are
           not proud of or engaged with.

           Insight (from 'makeover' trial): If families invest in creating an attractive toilet
           they are be more likely adopt and use them.

           Inputs: Materials for the physical and aesthetic improvement of a toilet, manuals for
           conducting the community event.

           Outputs: Greater engagement with, and pride in, the toilet after makeover; others in the
           village inspired to conduct their own makeover. Those who use the upgraded toilet find
           it a more comfortable experience than they had expected causing reinforcement learning.

        2. Hoard motive:

           Pit Emptying Demo and Pit Filling Estimation Demo" A community event-based discussion of
           the 'real' aspects related to pit filling/emptying designed to graphically overcome
           their perceptual barriers (e.g., squeezing a watermelon to show how little material
           there is in faeces).

           Challenge/Opportunity: People over-estimate the speed at which a pit fills and are
           uncertain about the emptying process. Therefore they hoard the 'limited' pit space by
           using the toilet only partially.

           Insight from FR: There are gaps between perception and reality which can be addressed.
           For example; water doesn't stay in the pit but seeps into the soil, faeces are composed
           mainly of water, decomposition reduces volume, compost doesn't smell and twin pits can
           be used interchangeably forever.

           Inputs: Films and 'emo-demos' (emotional demonstrations). Outputs: Participants are less
           anxious about pit filling and emptying.

        3. Affiliation/convenience motives:

           Community Motivational Events: Small and large community events such as street plays,
           films, posters and pledging activities to bring alive convenience/comfort motives by
           amplifying problems associated with OD and rewards of using toilets; use of affiliation
           through testimonials films, posters, village maps, etc.

           Challenge/Opportunity: Even if the barriers around pits and toilet comfort are
           addressed, it may still not be enough to motivate men with entrenched habits of OD to
           start using toilets.

           Insights: Convenience/comfort can be a powerful drive for toilet usage. Those who use
           toilets in the village (women, children and elderly) find it is much more convenient and
           therefore do not return to OD. However, men who are non-users may not have experienced
           this and need to be convinced. Affiliation can be another strong drive for toilet usage.
           It is possible to exploit the emerging norms of toilet use and encourage men 'not to be
           left behind'.

           Inputs: Scripts, props, invitations, loud hailers, audio-visual equipment, etc. Outputs:
           Men use toilets because they 'get' how convenient they are, and so as not to be 'left
           behind'.

        4. Transition to a new toilet use This would include testimonial videos of toilet users and
           toilet board of household members who improved their toilets. Providing certificate to
           households who improved their toilets.

      Challenge/Opportunity: Those who use toilets for a specific period tend to stick with the
      habit; however, some people, especially men, do not try out the toilet or find the first
      experience unpleasant.

      Insight: Reward the use of toilets for a specific period so new habits can form.

      Inputs: Stimuli and nudges. Outputs: The entire family, especially men, form the habit of
      using a toilet.

      In addition, village authorities will also be recruited to support delivery of the
      intervention.
    

Intervention name(s): Vaparshun
Intervention type(s): Behavioral
Intervention description(s): Participants in the intervention clusters were encouraged to improve their existing toilets.
Other intervention name(s): 5 Star Toilet Campaign
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study was a cluster-randomised trial with 47 intervention and 47 control clusters, with a baseline and an endline survey conducted in the district of Bhavnagar, Gujarat, India. Briefly, 94 villages were randomised to intervention or control groups. We carried out a household census and from this we selected 10 households with a functional 'government' toilet for a baseline and 30 for follow up at endline using random sampling from the census list for each village. Outcomes were measured as the proportion of households where all members were reported to use the toilet and the overall usage of toilets by individuals, employing a standard questionnaire.
Masking: None (Open Label)
Primary purpose: Other
Keywords: sanitation; toilet; behavior; evaluation