The Impact of Enhanced, Demand-side Sanitation and Hygiene Promotion on Sustained Behavior Change and Health in Ethiopia

Study Overview
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Brief Summary
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This study is a two-year evaluation investigating the impacts of an enhanced, demand-side sanitation and hygiene intervention on sustainable adoption of improved water, sanitation, and hygiene (WASH) practices and mental well-being.

Detailed Description
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This study utilizes a cluster randomized, controlled trial design to examine the impacts of an enhanced, demand-side sanitation and hygiene intervention on behavior change and health in Amhara, Ethiopia. The study will test hypotheses set out in the investigation team's theory of change through the measurement and evaluation of process indicators, intermediate and shorter-term behavioral outcomes, and longer-term behavioral and health impacts, including mental well-being. The study aims to: (1) identify ways in which WASH-related behavior change components preventive for neglected tropical diseases (NTDs) can be mainstreamed into the government-led Health Extension Program; (2) document the effectiveness of an enhanced demand-side sanitation and hygiene intervention; (3) investigate whether changes in personal hygiene, sanitation, and water behaviors are sustained; (4) document the cost-effectiveness of integrated WASH-related NTD-preventive behavior change promotion; and (5) assess whether collective efficacy and water security modify intervention effectiveness.

Official Title
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The Impact of Enhanced, Demand-side Sanitation and Hygiene Promotion on Sustained Behavior Change and Health in Ethiopia

Conditions
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Sustained Behavior Change, Mental Well-being

Intervention / Treatment
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* Behavioral: Enhanced demand-side sanitation, hygiene
* Behavioral: Standard of care


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Households residing in kebeles in select woredas of Amhara National Regional State Households with at least one adult (18 years of age or older) who provides consent to serve as the survey respondent Households with at least one child aged 1-9 years (at baseline) living in the household and consenting to enrollment in the study, including study staff observation of children, specifically their faces and hands Exclusion criteria: Households that refuse to provide consent to enroll in the study or have one adult consent to serve as the survey respondent Households that are repeatedly vacant or do not have an appropriate member of the household home to serve as the household's respondent (capable adult 18 years or older) after three attempts within the course of one day (for study enrollment and baseline) Households that do not have a household member aged 0-5 years of age (at baseline) living in the household

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Enhanced demand-side sanitation, hygiene<br>The intervention group will receive a package of enhanced, demand-side sanitation and hygiene interventions that are informed by formative research and facilitated by local government and Emory Ethiopia partners. | Behavioral: Enhanced demand-side sanitation, hygiene<br>* The enhanced, demand-side sanitation and hygiene intervention package will be informed by findings from formative research, and will consist of interventions designed to enhance sanitation and hygiene messaging to better facilitate behavior change, and intensify implementation of related community-based interventions via engagement of various delivery modalities.<br>|
| Active Comparator: Standard of care<br>The comparison group will receive the current standard of care, including potential implementation of government-led policies and programs. | Behavioral: Standard of care<br>* The comparison group will receive the current standard of care, including potential implementation of government-led policies and programs.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sustainability of WASH-related behaviours, including NTD-preventive WASH behavior measures | Sustainability of WASH-related behaviors, as measured through changes in the proportion of individuals and households practicing targeted improved NTD-preventive WASH behaviors. | Endline (Up to two years) | 
| Mental well-being measures | Mental well-being, as measured through the changes in mental well-being scale scores | Up to two years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shorter-term behavioral outcome measures | Proportion of households with improved or shared, but otherwise improved household latrine and washing facilities that are functional and available for use; proportion of households using functional latrines and washing facilities; proportion of households with all members exclusively using a latrine for defecation purposes; proportion of households disposing of child feces in an improved latrine; proportion of households with all children in the household with a clean face and hands. | Up to two years | 
| Intermediate behaviour change antecedent measures | Proportion of households with improved knowledge regarding the implications of improved WASH practices; proportion of households that indicate positive attitudes, perceptions toward improved sanitation and good hygiene practices; change in normative beliefs and behaviors related to open defecation, exclusive latrine use for defecation, and personal hygiene practices. | Up to two years | 
| Water insecurity measures | Water insecurity, as measured through changes in water insecurity scale scores | Up to two years | 
| Sanitation insecurity measures | Sanitation insecurity, as measured through changes in sanitation insecurity scale scores | Up to two years | 
| Collective efficacy measures | Collective efficacy, as measured through changes in collective efficacy scale scores | Up to two years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sanitation, Hygiene, Public Health, Behavior change, Neglected tropical diseases, Demand-side sanitation and hygiene, Mental well-being, Water insecurity, Sanitation insecurity, Collective efficacy