Household behaviour change interventions to improve sanitation and hygiene practices in urban settings: a scoping review

Abstract

Introduction: Behaviour change interventions have the potential to improve sanitation and hygiene practices in urban settings. However, the evidence on which behaviour change interventions are effective is unclear. This scoping review assesses the effectiveness of behaviour change interventions on sanitation and hygiene practices in urban settings. Methods: We performed electronic searches across five databases and one grey literature database to identify relevant studies published between 1 January 1990 and 20 November 2023 in English. Eligible study designs included randomised and non-randomised controlled trials with a concurrent control. Studies were eligible for inclusion if they reported a behaviour change intervention for improving sanitation and/or hygiene practices in an urban setting. Individual behaviour change intervention components were mapped to one of nine intervention functions of the capabilities, opportunities, motivations, and behaviour (COM-B) framework. Risk of bias was assessed for each study using an adapted Newcastle-Ottawa scale. Results: After de-duplication, 8,249 documents were screened by abstract and title, with 79 documents retrieved for full-text screening. We included 13 studies ranging from low- to high-quality. The behaviour change interventions had mixed effects on sanitation and hygiene practices in urban settings. Specifically, interventions improved latrine quality but not safe child faeces disposal. Interventions often improved handwashing with soap at key times and sometimes increased the presence of soap and water at the handwashing facility. There is limited evidence on the effect on food hygiene practices. Most study outcomes were measured between 6 and 12 months after intervention implementation, which may undermine the sustainability of behaviour change interventions. Conclusion: Despite mixed effects on sanitation and hygiene outcomes, behaviour change interventions can improve certain practices in urban settings, such as latrine quality improvements and handwashing with soap at the household or compound level. More ambitious behaviour change interventions are needed to reduce disparities in sanitation and hygiene access in urban areas globally.