Barriers and Drivers to Adoption and Use of a Household ... · PDF fileHousehold Ultraviolet...
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Barriers and Drivers to Adoption and Use of a Household Ultraviolet Water Disinfection System: A Randomized Stepped Wedge Trial in Rural Mexico
Fermin ReygadasEnergy and Resources Group, UC Berkeley
UC Berkeley Collaborators:Joshua Gruber, Division of EpidemiologyJack Colford, Division of Epidemiology
Kara Nelson, Civil and Environmental EngineeringIsha Ray, Energy and Resources Group
(Tovar, R. et al. 2005; Reygadas, F. et al. 2007; Photo Credit: Moreno, E. & Fundacion Cantaro Azul)
‐ Operates at fast flow rate of 5 liters / minute‐ Easy to use and does not change taste of water‐ Requires electricity, clear water, and safe storage
Mesita Azul: Water Disinfection at the Household Level
Baffle homogenizes flow
15W UV lamp
Research Questions:
• What levels of adoption and use can be achieved with ultraviolet disinfection at the household level?
• Can small changes in the levels of convenience of household water treatment programs lead to significant increases in adoption and use outcomes?
Great Barriers Small Hassles
(Impact Eval of MA: Gruber, J. et al. 2013; Behavioral Econ: Bertrand, M. et al. 2006; Images: CAWST)
Research Design:Stepped‐Wedge Cluster Randomized Trial
Clusters Baseline Step 1 Step 2 Step 3 Step 4 Step 5 Step 6
1‐4 0 0 0 0 0 0 0
5‐8 0 0 0 0 0 0 0
9‐12 0 0 0 0 0 0 0
13‐16 0 0 0 0 0 0 0
17‐20 0 0 0 0 0 0 0
21‐24 0 0 0 0 0 0 0
Before Intervention
After Intervention
0 = Observation
X = Intervention
X
X
X
X
X
X
Developed Compliance Framework that Maps Key HWT Outcomes:
Adoption of Safe Water Practice
Knowledge of Safe Water Practice
Access to Safe Water
Habit of Safe Water Practice
Exclusive Use of Safe Water
Disaggregated Key Outcomes:
Adoption of Safe Water PracticeAcquisition
Acq. Agreement
Knowledge of Safe Water PracticeProcurement
Consumption
Access to Safe WaterProcurement
Consumption
Habit of Safe Water PracticeProcurement
Consumption
Exclusive Use of Safe WaterProcurement
Consumption
HH vs. Community
Adapted Compliance Framework to the Mesita Azul Program:
Adoption of Safe Water PracticeAcquisition Mesita Azul (MA) was installed in household
Acq. Agreement Paid contribution in full
Knowledge of Safe Water PracticeProcurement Operator has minimum basic knowledge and skills in using MA
Consumption Interviewee differentiates treated and safely stored sources from others
Access to Safe WaterProcurement MA is present at accessible location and in working condition
Consumption Water treated with MA and safely stored (SS) is present at time of visit
Habit of Safe Water PracticeProcurement Uses MA to treat water at least once every five days
Consumption MA‐SS is most common source & Last glass served from MA+SS
Exclusive Use of Safe WaterProcurement Not documented
Consumption Has only consumed water from MA‐SS in past 7 days
HH vs. Community Not documented
Acquired Procuring Consuming Procuring Consuming Procuring Consuming Consuming
Adoption Knowledge Access Habit Exclusive
Can small changes lead to significant increases in compliance?
Tested Basic vs. Enhanced Programs
Clusters Baseline Step 1 Step 2 Step 3 Step 4 Step 5 Step 6
1‐4 0 0 0 0 0 0 0
5‐8 0 0 0 0 0 0 0
9‐12 0 0 0 0 0 0 0
13‐16 0 0 0 0 0 0 0
17‐20 0 0 0 0 0 0 0
21‐24 0 0 0 0 0 0 0
Before Intervention
After Intervention
0 = Observation
XB = Basic ProgramXE = Enhanced Program
XBXE
XBXE
XBXE
XBXE
XBXE
XBXE
Barriers Basic Program Enhanced Program
Information Regional water quality results Individual water quality results
Economic Six month system guarantee Satisfaction guarantee (money back)
OperatorBehavior
Train 1 person per household Train 2 people per household
ConsumerBehavior
1 safe storage container 2 safe storage containers
HabitFormation
Follow up every 6 months Follow up within 1 month
Adoption and Use Barriers
Compliance and Cost‐Effectiveness Results
** => p<0.05* => p<0.1
Results indicate that investing in minor program components that reduce behavior barriers can improve adoption, use, and cost‐effectiveness outcomes.
Outcome Metric Basic Enhanced Adj. RiskDifference
Adoption 70% 81% 7% *
Habit of Consumption 34% 47% 8% **
Adoption ($/hh) $112 $127 +$15
Habit of Consumption ($/hh) $226 $219 ‐ $ 7
Acquired Procuring Consuming Procuring Consuming Procuring Consuming Consuming
Adoption Knowledge Access Habit Exclusive
Acquired Procuring Consuming Procuring Consuming Procuring Consuming Consuming
Adoption Knowledge Access Habit Exclusive
Acquired Procuring Consuming Procuring Consuming Procuring Consuming Consuming
Adoption Knowledge Access Habit Exclusive
Conclusions:
• The Mesita Azul program significantly increased the habit of consuming treated and safely‐stored water
• Small improvements in convenience can lead to statistically significant increases in compliance (while improvements last)
• Using a comprehensive compliance framework that combines impact evaluation with formative research can help us better understand barriers and drivers to safe water practices
Barriers and Drivers to Adoption and Use of a Household Ultraviolet Water Disinfection System: A Randomized Control Stepped Wedge Trial in
Baja California Sur, Mexico
Fermin ReygadasEnergy and Resources Group, UC Berkeley
Water and Health Conference, UNCOctober 15th, 2013
Acknowledgments: Ian B, Cintia L, Hector C, and Saul H, at Fundacion Cantaro Azul, MexicoSustainable Products and Solutions Program, UC Berkeley Consejo Nacional de Ciencia y Tecnología, MexicoBlum Center for Developing Economies, UC Berkeley
Acquired Procuring Consuming Procuring Consuming Procuring Consuming Consuming
Adoption Knowledge Access Habit Exclusive
UV Disinfection
• Effective in inactivating pathogens• Efficient• High flow rates• Does not impact taste• No disinfection byproducts
• No residual disinfection• Requires electricity• Does not remove physical or
chemical contaminants• Water absorbance lowers dose
Advantages Drawbacks
Procuring Consuming Procuring Consuming Procuring Consuming Consuming
Adoption Knowledge Access Habit Exclusive
Procuring Consuming Procuring Consuming Procuring Consuming Consuming
Adoption Knowledge Access Habit Exclusive
Developed Compliance Framework with Summative & Formative Goals:
Adoption of Safe Water Practiceo Acquisitiono Compliance
Knowledge of Safe Water Practiceo Procuremento Consumption
Access to Safe Watero Procuremento Consumption
Habit of Safe Water Practiceo Procuremento Consumption
Exclusive Use of Safe Watero Procuremento Consumptiono HH vs. Community
Compliance Framework to Assess Summative & Formative Goals:
Adoption of Safe Water PracticeAcquisition
Compliance
Knowledge of Safe Water PracticeProcurement
Consumption
Access to Safe WaterProcurement
Consumption
Habit of Safe Water PracticeProcurement
Consumption
Exclusive Use of Safe Water
Procurement
Consumption
HH vs. Community
Compliance Framework to Assess Summative & Formative Goals:
Adoption of Safe Water PracticeAcquisition
Compliance
Knowledge of Safe Water PracticeProcurement
Consumption
Access to Safe WaterProcurement
Consumption
Habit of Safe Water PracticeProcurement
Consumption
Exclusive Use of Safe Water
Procurement
Consumption
HH vs. Community