TY - JOUR
T1 - Norms and Social Network–Centric Behavior Change Intervention (Nam Nalavazhvu) for Improved Toilet Usage in Peri-Urban Communities of Tamil Nadu
T2 - Protocol for a Cluster-Randomized Controlled Trial
AU - Ashraf, Sania
AU - Bicchieri, Cristina
AU - Delea, Maryann Greene
AU - Das, Upasak
AU - Chauhan, Kavita
AU - Kuang, Jinyi
AU - Shpenev, Alex
AU - Thulin, Erik
N1 - Funding Information:
We sincerely acknowledge the substantial insights and efforts of Krishnan Jeyaganesh, Rajesh Kanna, Johnson Thangaraj, Raja Rethinam, and the experienced team implementing this study at Swasti, Catalyst Management Services. New Concepts, Delhi helped us design our sociobehavioral change communication materials following multiple rounds of field tests. We are also grateful for the time of our outreach workers and the respondents who provided feedback during the development of the intervention activities and messages. This manuscript has been released as a preprint in medRxiv. This study is funded by the Bill and Melinda Gates Foundation (grant no. OPP1157257). The funder did not have a role in the study design, data collection, management, analyses, or content in any forthcoming publications based on the data collected in this study.
Publisher Copyright:
© 2021 JMIR Research Protocols. All rights reserved.
PY - 2021/5/3
Y1 - 2021/5/3
N2 - Background: Inconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norm-centric behavior change interventions to increase toilet use in low-income settings. Objective: The objective of this paper is to detail the rationale and design of an ex ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norm-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India. Methods: Following formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for "our well-being"). The multilevel intervention aims to improve toilet usage by shifting empirical expectations or beliefs about other relevant people's sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to own, consistently use, and maintain their toilets. This trial includes 76 wards in the Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining served as counterfactuals. Results: We enrolled wards and conducted a baseline survey among randomly selected individuals in all 76 wards. The 1-year behavior change intervention is currently ongoing. At the endline, we will collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, and well-being outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We are also conducting a process evaluation to understand the extent to which the intervention was implemented as designed, given the special pandemic context. Conclusions: Findings from this trial will inform norm-centric behavior change strategies to improve exclusive toilet usage.
AB - Background: Inconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norm-centric behavior change interventions to increase toilet use in low-income settings. Objective: The objective of this paper is to detail the rationale and design of an ex ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norm-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India. Methods: Following formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for "our well-being"). The multilevel intervention aims to improve toilet usage by shifting empirical expectations or beliefs about other relevant people's sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to own, consistently use, and maintain their toilets. This trial includes 76 wards in the Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining served as counterfactuals. Results: We enrolled wards and conducted a baseline survey among randomly selected individuals in all 76 wards. The 1-year behavior change intervention is currently ongoing. At the endline, we will collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, and well-being outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We are also conducting a process evaluation to understand the extent to which the intervention was implemented as designed, given the special pandemic context. Conclusions: Findings from this trial will inform norm-centric behavior change strategies to improve exclusive toilet usage.
KW - Behavior change
KW - Sanitation
KW - Social norms
KW - Toilet
U2 - 10.2196/24407
DO - 10.2196/24407
M3 - Article
SN - 1929-0748
VL - 10
JO - JMIR research protocols
JF - JMIR research protocols
IS - 5
M1 - e24407
ER -
