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General

Study Overview

Title:

Effect of a behaviour change and hardware intervention on safe child feces management practices in rural Odisha, India: a cluster-randomized controlled trial

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-61d2b60449ba1

Initial Registration Date:

01/03/2022

Last Update Date:

11/26/2021

Study Status:

Ongoing

Location(s):

India

Abstract:

While child feces are likely a significant source of fecal exposure, the latest National Family Health Survey (2015-2016) reported only 36% of Indian households safely dispose of their child’s feces into a latrine, with the State of Odisha having the lowest rate at 13%. Emory University conducted an evaluation of a community-based water and sanitation infrastructure program, implemented by the Odisha-based NGO Gram Vikas, and found that while the program led to substantial increases in latrine coverage and use, the practice of safe disposal of child feces continued to be a challenge. Research is needed to better understand what works and what doesn’t when it comes to influencing caregivers to adopt safe child feces management (CFM) practices that can reduce household fecal exposure and ultimately improve health.

The primary aim of this study is to conduct a cluster-randomized trial to evaluate an evidence-based and theoretically informed behavioral intervention aimed at increasing safe CFM practices among caregivers of children less than 5. The key behaviors of interest are safe disposal of child feces into the household latrine and teaching young children how to use the latrine on their own so they establish the habit of latrine use rather than going for open defecation. Emory University and Gram Vikas joined together to collaborate on this study with Emory University as the research partner and Gram Vikas as the implementing partner.

Registration Citation:

Sclar, G.D., Bauza, V., Mosler, H.-J., and Clasen, T. 2021. Effect of a behaviour change and hardware intervention on safe child feces management practices in rural Odisha, India: a cluster-randomized controlled trial. Registry for International Development for Impact Evaluations (RIDIE). 

Categories:

Water and Sanitation

Additional Keywords:

child feces, safe disposal, toilet training, behavior change, RANAS, latrine mat

Secondary ID Number(s):

This trial is registered at ISRCTN: ISRCTN15831099

Principal Investigator(s)

Name of First PI:

Thomas F. Clasen

Affiliation:

Emory University

Name of Second PI:

Hans-Joachim Mosler

Affiliation:

RanasMosler

Study Sponsor

Name:

Bill and Melinda Gates Foundation

Study Sponsor Location:

United States

Research Partner

Name of Partner Institution:

Xavier University Bhubaneswar

Type of Organization:

Research institute/University

Location:

India

Intervention

Intervention Overview

Intervention:

The CFM (child feces management) intervention includes six behavior change strategies (i.e. program activities), which consist of small group meetings and household visits that employ specific behavior change techniques (BCTs). The objective of the intervention is to motivate caregivers and their houseolds to adopt the practice of safe child feces disposal into a latrine and to teach their children how to use a latrine for defecation when the child is developmentally ready. The target participant for the strategies are primary caregivers, typically mothers, of children <5 years. However, in some of the strategies other household members, such as fathers and grandmothers, are also engaged to foster a supportive household environment towards the new CFM behaviors. A team of mobilizers with the NGO Gram Vikas implemented the activities across the 37 trial intervention villages. Due to the nature of the intervention, participant blinding was not possible. The intervention starts with an opening meeting that uses risk, attitude, and norm BCTs and also includes distribution of CFM hardware as an ability BCT. The intervention then shifts to alternating household visits and caregiver group meetings, which primarily use ability and self-regulation BCTs. The final strategy is a closing celebratory meeting that uses norm BCTs. Throughout the intervention, caregivers receive behavioral messaging on how to safely manage their child’s feces based on their child’s current developmental stage. Caregivers will also receive messaging on what to do as their child grows, such as transitioning from safe disposal to latrine training. Additional details on each program activity can be found in the attached pre-analysis plan.

Theory of Change:

The overall theory of change for the intervention is that the six behavior change strategies and hardware will lead to a change in caregivers' mindsets. Specifically, the intervention will change caregivers' RANAS behavioral factors (risks, attitudes, norms, abilities, and self-regultion; Mosler, 2012) related to safe disposal and child toilet training. Caregivers will perceive unsafe disposal and child open defecation as practices that pose a risk to health; caregivers will perceive the practices of safe disposal and child toilet training to have many benefits and few costs; caregivers will perceive others in their household expect them to do these practices; caregivers will have confidence in their ability to do the practices, even in the face of barriers; and caregivers will hold strong commitment and intention towards the practices. We also theorize that some of the intervention components will bolster social support among household members so that caregivers perceive others in their household will help them with adopting these new praactices and are not overburdened. We also theorize that the hardware will improve caregivers' ability and attitude perceptions towards the practices (i.e. strengthen self-confidence in ability to do the practices and foster positive attitudinal perceptions such as viewing the practices as easy to do and requiring little time).

Multiple Treatment Arms Evaluated?

No

Implementing Agency

Name of Organization:

Gram Vikas

Type of Organization:

NGO (local)/Community Based Organization/Other civil society organization

Program Funder

Name of Organization:

USAID

Type of Organization:

Public Sector, e.g. Government Agency or Ministry

Intervention Timing

Intervention or Program Started at time of Registration?

Yes

Start Date:

12/10/2020

End Date:

04/06/2021

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Randomized control trial

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

Please refer to the attached pre-analysis plan for details of the methodological approach.

Outcomes (Endpoints):

The primary outcome is a binary measure of safe disposal of child feces, as defined by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP). The updated JMP definition describes safe disposal as encompassing two distinct behaviors based on the last time the child defecated: (1) caregiver put/rinsed the child’s feces into the toilet/latrine or (2) child used the toilet/latrine (JMP, 2018).

In secondary analyses, we will separately examine the two behaviours that comprise “safe disposal.” We will examine these behaviors —child latrine use and caregiver disposal in latrine —using the following metrics:

Child latrine use is a binary measure where a “1” is assigned if the child defecated in the latrine the last time they defecated and a “0” is assigned if the child defecated anywhere else.

Caregiver disposal in latrine is a binary measure where a “1” is assigned if the caregiver safely disposed of the child’s feces into the latrine the last time the child defecated and a “0” is assigned if the caregiver disposed of the child’s feces anywhere else. (*This outcome is examined only among those caregivers whose child did not use the latrine the last time they defecated)

Other secondary analyses will also examine:

• behavioral factors related to child latrine training and caregiver disposal in latrine
• different CFM practices along the “child feces exposure pathway”
• latrine use among household members >= 6 years old
• visibility of feces in the household compound

Unit of Analysis:

Children <5 years old (at the time of the intervention)

Hypotheses:

Main research question (RQ1):

H1: The prevalence of safe disposal among children that reside in intervention villages will be significantly higher compared to children that reside in control villages.

Secondary research question (RQ2):

H2a: The prevalence of caregiver disposal in latrine among children that reside in intervention villages will be significantly higher compared to children that reside in control villages.

H2b: The prevalence of child latrine use among children that reside in intervention villages will be significantly higher compared to children that reside in control villages.

Unit of Intervention or Assignment:

Village

Number of Clusters in Sample:

74 villages

Number of Individuals in Sample:

We estimated 9 eligible households (i.e. household with a child <5 years old and a latrine) in each of the 74 villages, for an expected number of about 670 individual observations.

Size of Treatment, Control, or Comparison Subsamples:

37 villages were randomly assigned to the intervention arm and 37 were randomly assigned to the control arm

Supplementary Files

Analysis Plan:

CFM_preanalysisplan_3ieRIDIE_26NOV2021.docx

Other Documents:

Data

Outcomes Data

Description:

The dataset is a household survey administered to the primary caregiver of the child <5 years old (if the primary caregiver was not available then a secondary caregiver was asked to participate). The survey covered the following topics: caregiver and household demographics, child feces management practices, RANAS behavioral factors, received social support related to child feces management, and household water and sanitation facilities (including observational spot-check at the end).

Data Already Collected?

Yes

Data Previously Used?

No

Data Access:

Not restricted - access with no requirements or minimal requirements (e.g. web registration)

Data Obtained by the Study Researchers?

Yes

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

No

Study Materials

Upload Study Materials:

Registration Category

Registration Category:

Prospective, Category 3: Data for measuring impacts have been obtained/collected by the research team but analysis for this evaluation has not started

Completion

Completion Overview

Intervention Completion Date:

Data Collection Completion Date:

Unit of Analysis:

Clusters in Final Sample:

Total Observations in Final Sample:

Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:

Preliminary Report URL:

Summary of Findings:

Paper:

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

Survey Instrument Links or Contact:

Program Files:

Program Files Links or Contact:

External Link:

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: