3 figueroa
TRANSCRIPT
-
7/29/2019 3 Figueroa
1/22
The HealthCommunication
Partnership
October 2, 2007
End-of-Project Meeting
Understanding BehaviorChange for Safe Water:Psychosocial factors inPakistan
-
7/29/2019 3 Figueroa
2/22
Advancing Health Communication, Saving Lives
USAIDs Global Development Alliance
Safe Drinking Water Alliance
-
7/29/2019 3 Figueroa
3/22
Advancing Health Communication, Saving Lives
Poor water qualitycontinues to be a majorhealth threat.
Diarrhea alone kills about5 000 people, every day,most of them youngchildren.
Most of this problem, theresult of unsafe water,poor sanitation andhygiene.
Why should we care about
water treatment behavior?
-
7/29/2019 3 Figueroa
4/22
Advancing Health Communication, Saving Lives
Water Fields Flies Hands
Feces
Food
Family
Handwashing
Flush Latrine and Toilets
Traditional Latrine
Transmission barriers
Washing & Covering
Purification & Storage
Adapted from EHP, 1999. Preventing Child
Diarrhea Disease, Options for Action.
Fecal-Oral Transmission Cycle
-
7/29/2019 3 Figueroa
5/22
Advancing Health Communication, Saving Lives
Improvedwater source and safe
water
1.1 billion people lack
access to improvedwater
sources Recontamination due to
transportation and storage
Treatment at the
household level, about 2x
as effective as treatment
at the sourceWHO, 2007; Clasen, 2005
-
7/29/2019 3 Figueroa
6/22
Advancing Health Communication, Saving Lives
POU water treatment technologies
Boiling Filters
Chlorination Chlorination and
flocculation
Solar disinfection,
Others (UV light)
-
7/29/2019 3 Figueroa
7/22Advancing Health Communication, Saving Lives
Water treatment not asustained practice for
people that need it most
-
7/29/2019 3 Figueroa
8/22Advancing Health Communication, Saving Lives
Findings of literature review on
water treatment interventions
Focus on technology not the consumer
Main message in the last 50 years:
contaminated water causes diarrhea
Mothers believe diarrhea due to:
teething, growing up, eating raw or green
fruit, cold-hot foods, evil eye.
Some see a benefit (cleans the bowels)
Diarrhea prevention, not a clear
benefit for mothers!
-
7/29/2019 3 Figueroa
9/22Advancing Health Communication, Saving Lives
Reasons why people treated water
(boiled) in Peru in 1955
They were ill, and the norm was that ill people
drink boiled water,
They considered themselves of higher status, They had empathy with the health promoter,
An authority a trusted source recommended
them to boil water
The 2-year intervention promoting
boiling to prevent diarrhea failed!Wellin, 1955
-
7/29/2019 3 Figueroa
10/22
Advancing Health Communication, Saving Lives
A predictive model of communication & change:Influence of psychosocial factors on behavior
Knowledge
Attitudes
Self-Image
Perceived
Risk
Self-
EfficacyNorms
Emotions
SocialSupport &
Influence
Personal
Advocacy
BEHAVIOR
Impliessimultaneous
effect of all
influences.
Implies
communication
can affect all
influences.
-
7/29/2019 3 Figueroa
11/22
Advancing Health Communication, Saving Lives
Qualitative researchidentified psychosocialfactors in the province
of Sindh, Pakistan Household survey with
1,500 women who hadchildren under 12;
economic strata C-E
Field Work in 2005
-
7/29/2019 3 Figueroa
12/22
Advancing Health Communication, Saving Lives
1. Attitudes toward water treatment
2. Knowledge of water treatment methods
3. Social influence: Talked to husband, husband supports, talked
to others, others have recommended, has
advocated to others
4. Perceived norms
Relatives or friends treating water at home
Four Psychosocial factors
investigated. Sindh, 2005
-
7/29/2019 3 Figueroa
13/22
Advancing Health Communication, Saving Lives
1. Water that looks clear is good for drinking*
2. Piped water needs to be treated.
3. I only trust the water that I have treatedmyself.
4. Sweet tasting water is good for drinking*
5. Good health comes from God and not fromwhat people do to keep healthy*
Five positive attitudes toward water
treatment
*Inverted items. 5-point scale of level of agreement. N =
1,500 women. Attitude score: k = 5; Cronbach alpha = 0.60
-
7/29/2019 3 Figueroa
14/22
Advancing Health Communication, Saving Lives
Percent treating water by level of
positive attitudes. Sindh, 2005
6
15
46
67
23
0
20
40
60
80
1-1.5 1.5-2.5 2.5-3.5 3.5-5 Overall
Four Attitude levels (scale 1-5)
Percentage
K=5 items; N = 1,500
-
7/29/2019 3 Figueroa
15/22
Advancing Health Communication, Saving Lives
0
15 1523
32 37 36 35 37
0
20
40
60
80
None 1 2 3 4 5 6 7 8
Methods known (spontaneous and aided)
Percentage
Survey investigated 8 methods: boiling, chlorine, PUR,
Dettol, cloth filter, other filter, alum, solar, N = 1,500
Percent treating water by number
of methods known. Sindh, 2005
-
7/29/2019 3 Figueroa
16/22
Advancing Health Communication, Saving Lives
Percent treating water by level of
social influence. Sindh, 2005
9
34 35
62 6063
23
0
20
40
60
80
None 1 2 3 4 5 6
Six levels of social influence
Percentage
K=6 items; Cronbach alpha = 0.87; N = 1,500
-
7/29/2019 3 Figueroa
17/22
Advancing Health Communication, Saving Lives
Percent treating water by level of
perceived norm. Sindh, 2005
14
65
86
0
20
40
60
80
100
None About half or Less More than half,
Almost all
Three levels of social norms
Percentage
Cronbach alpha = 0.94; N = 1,500
-
7/29/2019 3 Figueroa
18/22
Advancing Health Communication, Saving Lives
0
20
40
60
80
0 1 2 3 4
Knowledge Attitude Soc Influence Social norm
Number and Type of Psychosocial Factors
Percent
1.67.7
17.2
35.2
65.6
Percent treating water by type and number of
psychosocial index. Sindh, 2005
-
7/29/2019 3 Figueroa
19/22
Advancing Health Communication, Saving Lives
Regression of treating water at home on
psychosocial factors and selected control
variables
Variable Odds ratio
Psychosocial factors (0-4) 1.23***
Dirty latrine (0-4, 4 dirtiest) 0.70***
Piped water % 3.01***
Surface water (river, pond) % 2.47***
Perceived water quality (1-5, 5 very good) 0.75***
Store water at household % 1.48*
Number of women in household 1.38*
Other control variables include: sociodemographic (age, education, religion), number of children in
household, spouses occupation, participation in community groups, access to media, household hygiene
(soap in handwashing area, dirty household), type of latrine, time to collect water. N=1,500, Chi2 (p,.001)
*** (p
-
7/29/2019 3 Figueroa
20/22
Advancing Health Communication, Saving Lives
Conclusions
Psychosocial factors strongly associatedwith water treatment in Sindh, Pakistan
Design communication programs that
promote these factors rather than focusingon diarrhea alone
Positive attitudes, better predictors of
water treatment than negative attitudes Preferred attributes of water should also be
used to promote water treatment.
-
7/29/2019 3 Figueroa
21/22
Advancing Health Communication, Saving Lives
Promotion Strategy for Pakistan
Healthy and well
nourished children
Take responsibility You can trust water
you have treated
yourself
You can find the timeto treat your familys
water
Safe water promoted with positive attitudes
-
7/29/2019 3 Figueroa
22/22
Advancing Health Communication, Saving Lives
Another promotion approach :
Sweet tasting
Shiny and clear Safe
Natural
Affordable Easy to use
Safe water promoted with preferred attributes:
http://upload.wikimedia.org/wikipedia/commons/9/92/Cotopaxi_and_ruminahui.jpg