The Norms and Networks Sanitation Study in India in Tamil Nadu, India

NCT04269824 | Completed

• 1 other identifier: 833854
• Study Type: interventional
• Target: 22,700
• Locations: 1 country
• Sites: 1

Brief Summary

The objective of this research is to evaluate the impact of a multi-level behavior change intervention designed to promote toilet construction, exclusive toilet use and maintenance in peri-urban communities of Tamil Nadu. The intervention leverages two years of formative research and reflects a norms and network-centric approach that will employ dynamic information dissemination to signal others' sanitation practices while also addressing other barriers to the adoption of improved sanitation practices. The study will determine whether those who received the interventions had significant improvements in toilet usage compared to those who did not. Qualitative research will help assess exposure and reactions to the intervention in these communities.

Conditions

Behavior, Social; Norms, Social

Keywords

Sanitation; Norms; Toilet Use; Toilet Ownership

Outcome Measures

Primary Outcomes (1)

• Change in exclusive toilet usage rate

  Exclusive toilet use is measured using self reported use of toilet every time for defecation in the past 2 days. It will be assessed via household survey conducted by trained enumerators and respondents.

  Measured 12 months after intervention

Secondary Outcomes (4)

• Change in Empirical expectations (beliefs of what other's do) regarding toilet ownership, use and maintenance

  Measured 12 months after intervention

• Change in the proportion of households with improved sanitation facilities

  Measured 12 months after intervention

• Change in normative expectations (beliefs of what other think you should do) regarding toilet ownership, use and maintenance

  Measured 12 months after intervention

• Change in the usable toilet facilities rates

  Measured 12 months after intervention

Other Outcomes (1)

• Change in diarrhea prevalence in children under 5 years

  Measured 12 months after intervention

Study Arms (2)

Intervention Group

EXPERIMENTAL

Residents of the peri-urban ward randomized to this group will receive the norm and network-centric intervention package that includes individual, household, group and community-level interventions. No hardware will be provided. Behavior change components will focus on shifting empirical expectations of improved sanitation behaviors in their wards as well as building capacity to achieve toilet construction and behavioral goals.

Behavioral: Behavioral intervention package

Control Group

NO INTERVENTION

Residents of these wards will not receive any intervention. They may be exposed to other WASH interventions promoted by the government and/or other parties independent of this study.

Interventions

Behavioral intervention package BEHAVIORAL

Community mobilization and commitment events * Update factual beliefs * Establish public commitment * Update empirical expectations about toilet use Audio announcements - Disseminate norms-related messages regarding toilet use and ownership Group level \- Facilitated sex-segregated group meetings to share information and action knowledge through increased social connections Network-level social media messages - Transmit norms-related messages, and testimonials of adopters through influential social network members Household-level Counseling visits * Update empirical expectations of improved sanitation behaviors in their community * Motivate improved sanitation practices * Build capacity to achieve exclusive toilet use Stickers/decals \- Signal adoption of promoted behaviors to community members Individual-level * Update empirical expectations of improved behaviors among similar others * Set goals, track progress and maintain improved behavior

Intervention Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Site: Peri-urban wards with 60% or less toilet coverage from selected town panchayats in Tamil Nadu.
• Participants
• Randomly selected residents of eligible wards above 18 years of age.
• All households in the intervention wards will receive the LENNS intervention.

You may not qualify if:

• Site: Slum wards as they will not be representative of our population of interest.
• Wards that were included in the piloting of the intervention package.
• Wards enrolled in any water, sanitation or hygiene intervention other than the national program, Swachh Bharat Mission (SBM)
• Participants:
• Persons who were reported or deemed cognitively unable to participate in the study and respond to the surveys will be excluded
• Household members who confirm that they will not reside continuously at that address in the upcoming year
• Specific household members who do not reside at that residency continuously.

Sponsors & Collaborators

• University of Pennsylvania: lead

Study Sites (1)

Swasti

Bangalore, India

Location

Related Publications (1)

• Ashraf S, Bicchieri C, Delea MG, Das U, Chauhan K, Kuang J, Shpenev A, Thulin E. Norms and Social Network-Centric Behavior Change Intervention (Nam Nalavazhvu) for Improved Toilet Usage in Peri-Urban Communities of Tamil Nadu: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc. 2021 May 3;10(5):e24407. doi: 10.2196/24407.

  PMID: 33938805 DERIVED

MeSH Terms

Conditions

Social Behavior

Condition Hierarchy (Ancestors)

Behavior

Study Officials

• Cristina Bicchieri, PhD

  University of Pennsylvania

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 5, 2020
• First Posted: February 17, 2020
• Study Start: January 5, 2020
• Primary Completion: September 5, 2021
• Study Completion: October 22, 2021
• Last Updated: November 26, 2021

Record last verified: 2021-11

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, ANALYTIC CODE
• Time Frame: The data will be available after the completion of the RCT and will be open access.
• Access Criteria: Open access with an application form

Locations

IN (1)