Department for Disease Control, London School of Hygiene & Tropical Medicine, London, England, United Kingdom.
Department of Economics, University of Dar es Salaam, Dar es Salaam, Tanzania.
PLoS One. 2019 Aug 23;14(8):e0221445. doi: 10.1371/journal.pone.0221445. eCollection 2019.
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.
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.
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.
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.
全球在如何设计和实施干预措施以改善环境卫生方面存在知识差距。这项形成性研究为随后重新设计坦桑尼亚农村地区政府主导的全国环境卫生运动提供了见解。
采用以行为为中心的设计方法来调查建造、改善和使用厕所的决定因素。在坦桑尼亚两个地区的 55 户家庭中使用了各种新颖且互动的研究工具。对结果进行分析，以阐明变革理论，然后为干预措施设计提供信息。
参与者重视多年来的辛勤工作、创业精神和改善生活。他们想要更好的厕所，但并不急于迅速采取行动。改善厕所的一个常见情感动机是保护儿童免受疾病侵害（养育），但这不足以推动快速变革。对传统厕所的厌恶意味着它们建在远离房屋的地方：一种“眼不见心不烦”的态度。其他强大的动机包括改善生活条件的愿望（创造），以及成为现代坦桑尼亚人（地位），尽管没有“炫耀”。建设成本和水资源短缺是主要的障碍。获得关于实际成本的信息、支持获取材料以及参观其他更好的厕所是改善厕所的常见原因。
由此产生的变革理论建议干预措施应该用一个关于厕所的新颖对话来让人们感到惊讶，将厕所作为获得地位的一种手段，并引入一种“现在就行动”的紧迫感。它应该表明适度的改进将带来更好的生活。应该放大对劣质厕所的厌恶和恐惧情绪，并通过推广变革性的厕所改进和改善对现代厕所产品的获取来减轻障碍。这项研究深入了解了坦桑尼亚农村的环境卫生行为，为创造性的干预措施设计提供了重要的见解。
