Department Environmental Social Sciences

Increasing shared toilet users’ cleaning behavior: the case of urban slums in Kampala, Uganda


Project description

Access to shared toilets is the most common on-site mode of sanitation in urban informal settlements. However, their maintenance depends on users’ appropriate usage and cleaning behavior. A user-driven sanitation (UDS) project in Kampala’s urban slums aimed to increase shared toilet users’ cleaning behavior. Group discussions between users of a shared toilet were applied in combination with public commitment as a behavior change strategy. The strategy increased cleaning behavior by up to 30%.

 

 

Context

In Uganda, around 50 % of the urban population relies on shared sanitation, and this percentage is even higher in Kampala’s slums. However, the management of shared toilets (defined as facilities jointly used by different families, mostly known to each other or sharing a compound house) is poor, and most of these toilets are in an unhygienic condition.

 

Objectives

The overall goal of this research project was to promote the cleaning of shared toilets among their users to ensure good hygiene. Specific objectives included:

  • assessing the cleanliness of shared toilets and the behavioral and social dilemma factors that influence users’ cleaning behavior, and
  • designing, implementing, and evaluating the effectiveness of behavior change strategies in increasing the cleaning behavior of shared toilet users.

Activities

Step 1 & 2: Identify, measure and determine behavioral factors of shared toilet cleaning

  • A baseline survey on shared toilets’ cleanliness and the psychological and social dilemma factors influencing collective cleaning behavior was conducted between December 2012 and January 2013 in three slums. 
  • The survey revealed that attitudes, norms, ability, and self-regulating factors had to be targeted.

Step 3: Select behavior change techniques (BCTs) and design behavior change strategies to increase shared toilet cleaning 

  • Two BCTs were selected, the prompt to talk to others, delivered through group discussions, and written public commitment. 
  • Interventions targeted respondents with dirty toilets, that is, non-frequent cleaners.

Step 4: Implement and evaluate behavior change strategies of shared toilet cleaning

  • The strategies’ effectiveness was assessed through a before-after control trial.
  • They were implemented by Sustainable Sanitation and Water Renewal Systems (SSWARS). 
  • Half of the intervention households received only the group discussions
  • The other half received the group discussions in combination with the written public commitment. 
  • Additional households served as a control group. 
  • A follow-up survey on cleaning behavior and behavioral factors was conducted between August and September 2013

Findings

  • Cleaning behavior in intervention groups increased by up to 30% compared to 8% in the groups with no discussions.
  • Discussions combined with a written public commitment were most effective in increasing the cleaning behavior of shared toilet users.
  • Discussions effectively changed behavior as they increased a number of behavioral factors: others’ approval of cleaning, personal importance of cleaning, feelings (liking to clean), and reduced barriers to cleaning.

Conclusion

Improved sanitation, even of shared toilets, can be achieved through systematic behavior change strategies, specifically a group discussion supplemented with written public commitment. Applying this strategy at a larger scale would change the sanitation situation in developing countries dramatically.

Publications

Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums

Rationale and objective: Access to and use of hygienic shared sanitation facilities is fundamental in reducing the high risk of diseases such as diarrhoea and respiratory infections. We evaluated the effectiveness of group discussions and commitment in improving the cleaning behaviour of shared sanitation users in three urban slums in Kampala, Uganda. The study follows the risk, attitudes, norms, abilities and self-regulation (RANAS) model of behaviour change and some factors of the social dilemma theory.
Methods: A pre-versus post-intervention survey was conducted in three slums of Kampala, Uganda, between December 2012 and September 2013. From the pre-intervention findings, users of dirty sanitation facilities were randomly assigned to discussions, discussions + commitment and control interventions. The interventions were implemented for 3 months with the aim of improving cleaning behaviour. This paper provides an analysis of 119 respondents who belonged to the intervention discussion-only (n = 38), discussions + commitment (n = 41) and the control (no intervention, n = 40) groups.
Results: Compared to the control, discussions and discussions + commitment significantly improved shared toilet users' cleaning behaviour. The rate of improvement was observed through behavioural determinants such as cleaning obligation, cleaning ease, cleaning approval and affective beliefs.
Conclusion: Our study findings show that group discussions and commitment interventions derived from RANAS model of behaviour change are effective in improving the shared sanitation users' cleaning behaviour.
Tumwebaze, I. K.; Mosler, H.-J. (2015) Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums, Social Science and Medicine, 147, 72-79, doi:10.1016/j.socscimed.2015.10.059, Institutional Repository

Shared toilet users' collective cleaning and determinant factors in Kampala slums, Uganda

Background: Dirty shared toilets are a health risk to users in urban slum settlements. For health and non-health benefits among users of shared toilets to be guaranteed, their cleanliness is important. The objective of this study was to investigate the cleanliness situation of shared toilets in Kampala's slums and the psychological and social dilemma factors influencing users' cleaning behaviour and commitment by using the risks, attitudes, norms, ability and self-regulation (RANAS) model and factors derived from the social dilemma theory.
Methods: We conducted a cross-sectional study in three slums of Kampala between December 2012 and January 2013. Data were collected from 424 household respondents that were primarily using shared toilets. Semi-structured questionnaires administered through face-to-face interviews were used in data collection. Linear regression was done for the multivariate analysis to test for the association between respondent cleaning behaviour and a combination of RANAS and social dilemma predictors.
Results. Out of 424 respondents interviewed, 44.3% reported cleaning the shared toilet daily, 34.4% cleaned once or several times a week, 1.4% cleaned every second week, 5.4% cleaned once or several times a month and 14.4% did not participate in cleaning. The main RANAS factors significantly associated with respondents' cleaning behaviour were: attitudinal affective belief associated with cleaning a shared toilet (β = -0.13, P = 0.00) and self-regulating factors, such as coping planning (β = 0.42, P = 0.00), commitment (β = 0.24, P = 0.00), and remembering (β = 0.10, P = 0.01). For social dilemma factors, only the social motive factor was statistically significant (β = 0.15, P = 0.00). The R square for the linear model on factors influencing cleaning behaviour was 0.77 and R square for factors influencing cleaning commitment was 0.70.
Conclusion: The RANAS factors provide a more robust understanding of shared toilet users' cleaning behaviour than social dilemma factors. Self-regulating factors and changing the negative affective cleaning feelings are shown to be very important for interventions to increase shared toilet users' collective participation in their cleaning. In addition to RANAS, social dilemma factors have an important influence on slum residents' commitment to clean their shared toilets.
Tumwebaze, I. K.; Mosler, H.-J. (2014) Shared toilet users' collective cleaning and determinant factors in Kampala slums, Uganda, BMC Public Health, 14, 1260 (19 pp.), doi:10.1186/1471-2458-14-1260, Institutional Repository

Why clean the toilet if others don’t? Using a social dilemma approach to understand users of shared toilets’ collective cleaning behaviour in urban slums: a review

Shared toilets are a common good in urban slums, but need to be maintained and cleaned for users to positively benefit from having access to them. Collective participation of the shared toilet users is required to keep them clean and ensure adequate hygiene. However, users' decisions on whether to participate or not in the cleaning of the shared toilets are a social dilemma. If each of the shared toilets' users decided not to participate in their cleaning, the facilities could end up in a deteriorated unhygienic state and become a health risk to them and to the community at large. In this paper, we provide an overview of the social dilemma approach and highlight how the factors important in the management of social dilemmas can be relevant to understanding the cleaning behaviour of shared toilet users in urban slums.
Tumwebaze, I. K.; Mosler, H.-J. (2014) Why clean the toilet if others don’t? Using a social dilemma approach to understand users of shared toilets’ collective cleaning behaviour in urban slums: a review, Journal of Water Sanitation and Hygiene for Development, 4(3), 359-370, doi:10.2166/washdev.2014.152, Institutional Repository

Determinants of households' cleaning intention for shared toilets: case of 50 slums in Kampala, Uganda

Cleaning shared toilets is important if users are to receive the significant health, social and economic benefits associated with having access to these facilities. However, achieving and maintaining hygienic toilets shared by several user households in urban slums is usually a challenge. This study assesses determinants of households' cleaning intention for shared toilets in Kampala, Uganda. Using a structured questionnaire for the household interviews and an observation checklist, data from 1019 users of shared toilets was collected in 50 randomly selected urban slums. Data analysis showed that most of the shared toilets are unhygienic. Less than a quarter of the shared toilets, for instance, were hygienically clean to users' satisfaction. The main cleaning intention determinants (p-value <.05) included: importance of using a clean toilet, the effort involved in cleaning the toilet, the disgust felt from using a dirty toilet, and cleaning habits. Although it is important to have access to sanitation facilities, emphasis should be placed on how to engage users to ensure that the facilities used are appropriately cleaned and maintained.
Tumwebaze, I. K.; Niwagaba, C. B.; Günther, I.; Mosler, H.-J. (2014) Determinants of households' cleaning intention for shared toilets: case of 50 slums in Kampala, Uganda, Habitat International, 41, 108-113, doi:10.1016/j.habitatint.2013.07.008, Institutional Repository

Sanitation facilities in Kampala slums, Uganda: users' satisfaction and determinant factors

Access to improved sanitation is a key preventive measure against sanitary-related gastro-enteric diseases such as diarrhoea. We assessed the access to sanitation facilities and users' satisfaction in 50 randomly selected slums of Kampala through a cross-sectional survey conducted in 2010. A total of 1500 household respondents were interviewed. Sixty-eight per cent of the respondents used shared toilets, 20% private, 11% public toilets and less than 1% reported using flying toilets or practising open defecation. More than half of the respondents (51.7%) were not satisfied with their sanitation facilities. Determinants for satisfaction with the facilities used included the nature and type of toilet facilities used, their cleanliness, and the number of families sharing them. The study findings showed that slum dwellers had high access to sanitation facilities. However, most of them were shared and majority of the respondents were not satisfied with their facilities, primarily due to cleanliness and over demand.
Tumwebaze, I. K.; Garimoi Orach, C.; Niwagaba, C.; Lüthi, C.; Mosler, H.-J. (2013) Sanitation facilities in Kampala slums, Uganda: users' satisfaction and determinant factors, International Journal of Environmental Health Research, 23(3), 191-204, doi:10.1080/09603123.2012.713095, Institutional Repository