Promotion of Toilet Construction and Usage in Rural Tamil Nadu: A Mixed-Methods Evaluation Study

ABSTRACT

Background: Open defecation is the leading cause for malnutrition and diarrhoeal deaths in low- and middle-income countries. The negative public health impacts of open defecation could be neutralized by toilet usage. However, the usage of improved sanitation facilities is unsatisfactory in rural India. Objectives: The study was carried out to find the psycho?social barriers among households for not having toilets and for not using the owned toilets and to develop and find out the effect of Behaviour Change Communication (BCC) strategy on toilet construction and usage. Methods: A community?based Embedded Experimental Mixed Methods study was undertaken in the four field practice villages of Urban Health Training Centre, Villupuram. For baseline and end?line surveys, 422 independent sample households who were not having or not using the toilets were selected by Simple Random Sampling. After IEC clearance, interviews and direct observation of the toilets were undertaken. Context?specific multi?faceted BCC strategy was employed through community participation. The data were analyzed in SPSS software. Chi?square test was used to determine the significance of difference and effect size was calculated to estimate the size of the difference between the baseline and end-line data. Results: Toilet ownership and utilization improved by 21.3% and 23.3% points, respectively. There was a significant reduction in households’ perceived psychosocial barriers in toilet adoption. Conclusion: Our intervention demonstrated considerable improvements in both toilet construction and usage surpassing the psycho-social barriers. Future sanitation promotion interventions should focus more on community participation and the key messages should be reinforced multiple times using different channels.