Adapting a water, sanitation, and hygiene picture-based curriculum in the Dominican Republic.

Water, sanitation, and hygiene issues present barriers to health in rural Dominican Republic. Limited access to adequate water, sanitation, and hygiene accompanies a prevalence of water, sanitation, and hygiene-related diseases. To address these issues, an education and behavior change program using community health clubs has been adapted for areas at greatest risk of water, sanitation, and hygiene disease transmission. To support this initiative, a protocol was created to evaluate 147 images from a community health clubs toolkit for Dominican agricultural communities, or bateyes, to determine image comprehension and cultural appropriateness, as well as the demographic variables associated with visual literacy. A total of 112 interviews were completed across seven bateyes located near the city of La Romana; 60 images were determined to require additional adaptation. Further analyses demonstrated that age and education were significantly associated with greater visual literacy. These results reinforce that educational visual aids require testing for cultural appropriateness and that future work should be conducted to investigate factors that contribute to visual literacy.