Unravelling context: a formative photovoice study of Indian youth perspectives of sanitation and hygiene practices
Water, sanitation, and hygiene are issues of substantial public health importance. Community-based participatory research approaches such as photovoice can help explore and identify determinants that influence sanitation and hygiene-related behaviours. This study aimed to use photovoice as part of the formative research process to increase understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours in Thirumalaikodi, India. First, a school was recruited using convenience sampling; next, 10 participants were purposively selected to participate in an information meeting, seven photo discussion sessions, and one wrap-up session over a three-week period. In each photo discussion session, participant groups selected one ‘trigger’ photograph, and through a structured discussion using SHOWED mnemonic questions (a series of questions that ask participants to describe and reflect upon a chosen photograph), generated a new understanding of issues related to water, sanitation, and hygiene. All sessions were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyse photo discussion session text. Findings revealed that factors such as social structure, education, and culture influence behaviours that determine the sanitary conditions of an individual’s private and public spaces. Furthermore, participants described how descriptive norms generated practices (e.g. littering) that were reinforced and maintained by limited access to waste management systems, attitudinal indifference, and generational beliefs. Findings yielded an in-depth understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours. This study also contributes to the advancement of participatory applications in formative research and intervention adaptation processes.
Intervention mapping as a framework for planning the implementation of urine diversion toilets and Ecosan education in a community school in Kavre, Nepal
Use of human excreta as fertilizer is not a new concept. However, with the use of the modern water-flush toilet, human excreta becomes mixed with water and causes environmental pollution. To reemphasize the nutritional value of human urine in the field, a urine diversion toilet was constructed in a community school situated in Kavre, Nepal. The purpose of establishing the urine diversion toilet is to improve hygiene outcomes through promoting proper sanitation and transforming the school community’s regular practice and attitudes towards urine as a resource. To ensure effective implementation of the urine diversion toilets, intervention mapping was used as a guiding framework. The aim of this paper is to document how the urine diversion toilet was planned and implemented in the school and how the urine diversion toilet was connected with the curriculum to address concerns regarding water, sanitation, and hygiene with a focus on sustainability through intervention mapping. This study highlights the benefits of intervention mapping as a systematic and step-by-step process for the planning and implementation of the urine diversion toilet. This study also highlights the benefits of connecting urine diversion toilets with school gardening, and engaging with local government and other stakeholders about the value of the approach.