National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Acton, Australia.
Swiss Tropical and Public Health Institute, Associate Institute of University of Basel, Allschwil, Switzerland.
PLoS Negl Trop Dis. 2022 Sep 12;16(9):e0010702. doi: 10.1371/journal.pntd.0010702. eCollection 2022 Sep.
Inadequate access to water, sanitation, and hygiene (WASH) is an environmental risk factor for poor health outcomes globally, particularly for children in low- and middle-income countries (LMIC). Despite technological advancements, many interventions aimed at improving WASH access return less than optimal results on long term impact, efficacy and sustainability. Research focus in the 'WASH sector' has recently expanded from investigating 'which interventions work' to 'how they are best implemented'. The 'acceptability' of an intervention is a key component of implementation that can influence initial uptake and sustained use. Acceptability assessments are increasingly common for health interventions in clinical settings. A broad scale assessment of how acceptability has been measured in the WASH sector, however, has not yet been conducted.
METHODS/PRINCIPAL FINDINGS: We conducted a systematic literature review of intervention studies published between 1990 and 2021 that evaluated the acceptability of WASH interventions in LMIC settings. Using an implementation science approach, focused outcomes included how acceptability was measured and defined, and the timing of acceptability assessment. We conducted quality assessment for all included studies using the Cochrane Risk of Bias tool for randomised studies, and the Newcastle-Ottawa Scale for non-randomised studies. Of the 1238 records; 36 studies were included for the analysis, 22 of which were non-randomized interventions and 16 randomized or cluster-randomized trials. We found that among the 36 studies, four explicitly defined their acceptability measure, and six used a behavioural framework to inform their acceptability study design. There were few acceptability evaluations in schools and healthcare facilities. While all studies reported measuring WASH acceptability, the measures were often not comparable or described.
As focus in WASH research shifts towards implementation, a consistent approach to including, defining, and measuring acceptability is needed.
在全球范围内，水、环境卫生和个人卫生（WASH）获取不足是健康状况不佳的环境风险因素，尤其是在中低收入国家（LMIC）的儿童中。尽管技术有所进步，但许多旨在改善 WASH 获取的干预措施在长期影响、效果和可持续性方面的效果都不尽如人意。“WASH 领域”的研究重点最近已从调查“哪些干预措施有效”扩展到“如何最佳实施”。干预措施的“可接受性”是实施的关键组成部分，它会影响初始采用和持续使用。在临床环境中，健康干预措施的可接受性评估越来越普遍。然而，尚未对 WASH 部门中可接受性的衡量标准进行广泛评估。
方法/主要发现：我们对 1990 年至 2021 年间发表的评估 LMIC 环境中 WASH 干预措施可接受性的干预研究进行了系统的文献回顾。使用实施科学方法，重点关注的结果包括如何衡量和定义可接受性以及可接受性评估的时间。我们使用 Cochrane 随机研究偏倚工具和纽卡斯尔-渥太华量表对所有纳入的研究进行了质量评估。在 1238 条记录中；有 36 项研究被纳入分析，其中 22 项是非随机干预措施，16 项是随机或整群随机试验。我们发现，在 36 项研究中，有四项明确定义了他们的可接受性衡量标准，有六项研究使用行为框架来为他们的可接受性研究设计提供信息。在学校和医疗机构中很少进行可接受性评估。虽然所有研究都报告了 WASH 可接受性的衡量，但这些衡量标准往往不可比或未说明。
随着 WASH 研究重点转向实施，需要采用一致的方法来纳入、定义和衡量可接受性。
