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7/29/2019 3 Figueroa

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The HealthCommunication

Partnership

October 2, 2007

End-of-Project Meeting

Understanding BehaviorChange for Safe Water:Psychosocial factors inPakistan


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Advancing Health Communication, Saving Lives

USAIDs Global Development Alliance

Safe Drinking Water Alliance


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Poor water qualitycontinues to be a majorhealth threat.

Diarrhea alone kills about5 000 people, every day,most of them youngchildren.

Most of this problem, theresult of unsafe water,poor sanitation andhygiene.

Why should we care about

water treatment behavior?


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Water Fields Flies Hands

Feces

Food

Family

Handwashing

Flush Latrine and Toilets

Traditional Latrine

Transmission barriers

Washing & Covering

Purification & Storage

Adapted from EHP, 1999. Preventing Child

Diarrhea Disease, Options for Action.

Fecal-Oral Transmission Cycle


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Improvedwater source and safe

water

1.1 billion people lack

access to improvedwater

sources Recontamination due to

transportation and storage

Treatment at the

household level, about 2x

as effective as treatment

at the sourceWHO, 2007; Clasen, 2005


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POU water treatment technologies

Boiling Filters

Chlorination Chlorination and

flocculation

Solar disinfection,

Others (UV light)


7/22Advancing Health Communication, Saving Lives

Water treatment not asustained practice for

people that need it most



Findings of literature review on

water treatment interventions

Focus on technology not the consumer

Main message in the last 50 years:

contaminated water causes diarrhea

Mothers believe diarrhea due to:

teething, growing up, eating raw or green

fruit, cold-hot foods, evil eye.

Some see a benefit (cleans the bowels)

Diarrhea prevention, not a clear

benefit for mothers!



Reasons why people treated water

(boiled) in Peru in 1955

They were ill, and the norm was that ill people

drink boiled water,

They considered themselves of higher status, They had empathy with the health promoter,

An authority a trusted source recommended

them to boil water

The 2-year intervention promoting

boiling to prevent diarrhea failed!Wellin, 1955


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A predictive model of communication & change:Influence of psychosocial factors on behavior

Knowledge

Attitudes

Self-Image

Perceived

Risk

Self-

EfficacyNorms

Emotions

SocialSupport &

Influence

Personal

Advocacy

BEHAVIOR

Impliessimultaneous

effect of all

influences.

Implies

communication

can affect all

influences.


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Qualitative researchidentified psychosocialfactors in the province

of Sindh, Pakistan Household survey with

1,500 women who hadchildren under 12;

economic strata C-E

Field Work in 2005


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1. Attitudes toward water treatment

2. Knowledge of water treatment methods

3. Social influence: Talked to husband, husband supports, talked

to others, others have recommended, has

advocated to others

4. Perceived norms

Relatives or friends treating water at home

Four Psychosocial factors

investigated. Sindh, 2005


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1. Water that looks clear is good for drinking*

2. Piped water needs to be treated.

3. I only trust the water that I have treatedmyself.

4. Sweet tasting water is good for drinking*

5. Good health comes from God and not fromwhat people do to keep healthy*

Five positive attitudes toward water

treatment

*Inverted items. 5-point scale of level of agreement. N =

1,500 women. Attitude score: k = 5; Cronbach alpha = 0.60


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Percent treating water by level of

positive attitudes. Sindh, 2005

6

15

46

67

23

0

20

40

60

80

1-1.5 1.5-2.5 2.5-3.5 3.5-5 Overall

Four Attitude levels (scale 1-5)

Percentage

K=5 items; N = 1,500


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0

15 1523

32 37 36 35 37

0

20

40

60

80

None 1 2 3 4 5 6 7 8

Methods known (spontaneous and aided)

Percentage

Survey investigated 8 methods: boiling, chlorine, PUR,

Dettol, cloth filter, other filter, alum, solar, N = 1,500

Percent treating water by number

of methods known. Sindh, 2005


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social influence. Sindh, 2005

9

34 35

62 6063

23

0

20

40

60

80

None 1 2 3 4 5 6

Six levels of social influence

Percentage

K=6 items; Cronbach alpha = 0.87; N = 1,500


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perceived norm. Sindh, 2005

14

65

86

0

20

40

60

80

100

None About half or Less More than half,

Almost all

Three levels of social norms

Percentage

Cronbach alpha = 0.94; N = 1,500


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0

20

40

60

80

0 1 2 3 4

Knowledge Attitude Soc Influence Social norm

Number and Type of Psychosocial Factors

Percent

1.67.7

17.2

35.2

65.6

Percent treating water by type and number of

psychosocial index. Sindh, 2005


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Regression of treating water at home on

psychosocial factors and selected control

variables

Variable Odds ratio

Psychosocial factors (0-4) 1.23***

Dirty latrine (0-4, 4 dirtiest) 0.70***

Piped water % 3.01***

Surface water (river, pond) % 2.47***

Perceived water quality (1-5, 5 very good) 0.75***

Store water at household % 1.48*

Number of women in household 1.38*

Other control variables include: sociodemographic (age, education, religion), number of children in

household, spouses occupation, participation in community groups, access to media, household hygiene

(soap in handwashing area, dirty household), type of latrine, time to collect water. N=1,500, Chi2 (p,.001)

*** (p


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Conclusions

Psychosocial factors strongly associatedwith water treatment in Sindh, Pakistan

Design communication programs that

promote these factors rather than focusingon diarrhea alone

Positive attitudes, better predictors of

water treatment than negative attitudes Preferred attributes of water should also be

used to promote water treatment.


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Promotion Strategy for Pakistan

Healthy and well

nourished children

Take responsibility You can trust water

you have treated

yourself

You can find the timeto treat your familys

water

Safe water promoted with positive attitudes


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Another promotion approach :

Sweet tasting

Shiny and clear Safe

Natural

Affordable Easy to use

Safe water promoted with preferred attributes:
http://upload.wikimedia.org/wikipedia/commons/9/92/Cotopaxi_and_ruminahui.jpg

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