Behavior change in Water, Sanitation and Hygiene (WASH) promotion programs: a review of reviews to identify evidence gaps

Article type
Year
Authors
Van Remoortel H1, Govender T2, Lutje V3, Vandeveegaete A1, Young T4, De Buck E1
1Belgian Red Cross, Flanders, Belgium
2Division of Community Health, Stellenbosch University, Cape Town, South Africa
3Cochrane Infectious Diseases Group, Liverpool School of Tropical Medicine, Liverpool, UK
4Centre for Evidence-Based Healthcare, Stellenbosch University, Cape Town, South Africa
Abstract
Background: There are various approaches to promote WASH interventions (e.g. hand washing, toilet use, water supply). A systematic review (SR) on the effectiveness of these approaches to promote WASH behavior change is relevant to guide policy makers to formulate effective WASH programs.

Objectives: In preparation for a new SR (funded by 3ie (International Initiative for Impact Evaluation) and WSSCC (Water Supply and Sanitation Collaborative Council)), we mapped existing SRs that investigated the EFFECTIVENESS or IMPLEMENTATION aspects of WASH promotion programs on behavior change.

Methods: We searched seven biomedical/social sciences databases and eight relevant websites (for grey literature) to identify SRs about the EFFECTIVENESS or IMPLEMENTATION aspects of WASH promotion programs on behavior change in low- and middle-income countries. Study selection, data extraction and quality appraisal (via ROBIS tool) were performed by two reviewers independently. We constructed an evidence map to identify current gaps in the literature.

Results: We screened 3775 results from database searches and 199 from the grey literature and we included six SRs (five about EFFECTIVENESS and one about IMPLEMENTATION). The risk of bias ranged from low (four SRs) to high (two SRs). We found inconsistent results in terms of the EFFECTIVENESS of WASH promotion programs on behavior change outcomes (i.e. uptake/adherence, five SRs). Evidence from one SR indicated that WASH promotion programs are effective to improve behavioral mediators (i.e. knowledge, skills and attitude). One SR concluded that promotion (via personal contact with a health promoter) is an important IMPLEMENTATION factor for a sustained WASH behavior. The evidence gap map showed a lack of SRs investigating both the EFFECTIVENESS and IMPLEMENTATION aspects of various WASH promotion programs on behavior change.

Conclusions: Mapping evidence gaps, based on a review of reviews, will inform researchers about potentially relevant future SRs within the WASH domain and behavior change. We specifically used this information to fine-tune the scope of our own mixed-methods SR, which will be published in 2017.