Understanding cultural beliefs and practices is important to effectively influence sanitation and hygiene behaviours in rural India

Use of local perspectives towards SDG 6

Universal, affordable and sustainable access to water, sanitation, and hygiene (referred to by the acronym WASH) is a key public health issue within international development, and is the focus of Sustainable Development Goal 6: Ensure availability and sustainable management of water and sanitation for all [Source: UN.org).

The development of effective WASH interventions is dependent on a comprehensive understanding of relevant contextual factors. These factors must be incorporated into the design and adaptation of WASH interventions, as well as the assessment of their outcomes. 

The research used a community-based participatory research (CBPR) approach, applying knowledge-sharing techniques to develop a localized, culturally relevant, and therefore more effective WASH intervention.  

Using this approach, Gold-Watts was able to i) develop an in-depth understanding of the contextual setting of the rural community of Thirumalaikodi Tamil Nadu in India, to contribute to and document the processes of cultural adaptation of an existing intervention (the Project SHINE, Sanitation and Hygiene Innovation in Education), and ii) understand how health promotion interventions can be adapted and scaled. 

Engaging youth through the arts

The first of three sub-studies engaged youth participants using the arts to reveal students’ perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours. Using photovoice, whereby participants are provided with cameras to document and share their experiences, the youngsters revealed that several social factors influence their sanitation and hygiene-related behaviours.

How do adolescent girls experience their first period and menstruation?

Adolescent girls expressed through interviews how they experienced their first periods (menarche) and thereafter menstruation in the second element of this research. The girls also discussed how their experiences connect to the sociocultural context, and how they manage menstruation within these boundaries. The interviews revealed that menstruation is linked to stigma and various taboos in this sociocultural context.

Taboos surrounding diarrhea

Whilst the association between poor sanitation/hygiene and various diseases (e.g. diarrheal disease, parasitic infections, and urogenital infections) is well-documented, evidence regarding the effectiveness of WASH interventions is still mixed. So how are water, sanitation, and hygiene measures being taken up and sustained in practice? To answer this question, students discussed cultural representations and perceptions of diarrheal illness using the Bristol Stool Form Scale, a visual chart classifying human stools into seven categories. They also kept ‘stool diaries’ and completed surveys. The study found that, like menstruation, diarrhea is linked to stigma and taboos.

The three studies found several important implications for the translation and tailoring of a Project SHINE adaptation in India, and demonstrate the role of formative research and community engagement within the development and adaptation of health promotion interventions. 

The findings revealed that social and gender norms influence health outcomes. Moreover, cultural and religious attitudes, beliefs, and practices are linked to sanitation and hygiene-related behaviours.

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Anise Gold-Watts will defend her thesis ‘Translating SHINE: Application of community-based participatory research approaches to the cultural adaptation of a school-based water, sanitation, and hygiene intervention’ on 24 June 2020. See the event web page for details and how to attend.