The role of social identity in stopping open defecation A cluster-randomized trial on CLTS in Ghana Miriam Harter, Nadja Contzen, Hans-Joachim Mosler & Jennifer Inauen
Collaborations Funding through Bill and Melinda Gates Foundation Partners: USAID, Global Communities Special thanks to Alberto Wilde, Dominic K. Dapaah, Abdulai Baba Seidu, Eva Seumer, Seraina Huder, Nicole Frank, Sebastian Mosch, Saskia Engel, Vica Tomberge, Innocent K. Tumwebaze, Maximilian Schneider, Alexander Mewes
Sanitation campaign Community-Led Total Sanitation (CLTS) Goal: collective action Expected outcome: high latrine coverages to protect public health In the end: People decide together how they will create a clean and hygienic environment that benefits everyone 29.10.2018 UNC 2018 Miriam Harter 3
Latrine coverage in community Latrine coverage CLTS is effective in changing behaviour Results from Ghana 1.0 0.8 0.6 0.4 Latrine coverage Before in CLTS intervention After communities CLTS 80% 68% 60% 40% 0.2 0.0 20% 10% 5% 2% 00% 20 40 60 80 100 120 Communities Control arm Intervention arms - Intervention communities showed an 66% increase in latrine coverage on average - Coverages range from 0-100% 29.10.2018 UNC 2018 Miriam Harter 4
Information behavior change techniques Risk factors Behavior A Persuasive behavior change techniques CLTS Norm behavior change techniques psychosocial factors Attitude factors Norm factors Intention Use Habit Stopping open defecation RANAS model of behaviour change (Mosler, 2012) Infrastructural, skill & ability behavior change techniques Planning & relapse prevention behavior change techniques Social context Social context Physical context Personal context Ability factors Self-regulation factors Behavior B Intention Use Habit 1. Is CLTS successful in ending open defecation? 2. Is CLTS more successful in communities with more positive social preconditions? Social context Physical context Personal context 29.10.2018 UNC 2018 Miriam Harter 5
Social identity Tajfel (1978, p. 63) defines social identity as that part of an individual s self-concept which derives from her knowledge of her membership of a social group, together with the emotional significance attached to that membership. Exemplary items (based on Cameron (2004)): How much do you agree or disagree with the following statements: I have a lot in common with other community members. In general, I m glad to be a member of this community. 29.10.2018 UNC 2018 Miriam Harter 6
The concept of social identification in CLTS CLTS creates a new social norm: stop open defecation People with strong social identification rather follow this new social norm Because they want to be approved and accepted by fellow community members 29.10.2018 UNC 2018 Miriam Harter 7
Research design Ghana Intervention design and implementation July-Dec 2016 Qualitative presurvey Baseline survey First follow-up survey One year followup survey Dec 2015 Feb-April 2016 Feb-April 2017 Feb-April 2018 Face-to-face interviews with structured questionnaires Self- reported data and short observations (spot-checks) 29.10.2018 UNC 2018 Miriam Harter 8
Sample Northern Region of Ghana Two districts 3216 households 132 communities 57.4% male Average age: 44 years 29.10.2018 UNC 2018 Miriam Harter 9
OPEN DEFECATION RATE IN COMMUNITIES Results CLTS effects on open defecation 100% 80% 60% 40% 20% 0% Control arm 97% 90% BASELINE SURVEY Intervention arms 89% 81% FIRST FOLLOW-UP (4-6 MONTHS) 88% 46% LONG-TERM FOLLOW- UP (ONE YEAR) 29.10.2018 UNC 2018 Miriam Harter 10
Results CLTS effect depending on social identity 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 55% weak social identity * 39% strong social identity intervention arms 84% weak social identity * 92% strong social identity control arms In intervention communities: Open defecation is lower with stronger social identification In control communities: Open defecation is higher with stronger social identification This effect was only found at community level and not at individual level. * Significant on 0.01 level, Generalized equation estimation model 29.10.2018 UNC 2018 Miriam Harter 11
Conclusions CLTS is effective in changing people s behavior and stop open defecation It is more effective in communities where people strongly feel and appreciate to be part of the community People rather follow the new social norm if they feel strongly identified People follow the norm: open defecation (control) or latrine use (intervention) That means: focus on social preconditions is a promising approach for improving community-based interventions, such as CLTS assess social identity and where needed strengthen it before CLTS e.g., by enabling interaction of community members 29.10.2018 UNC 2018 Miriam Harter 12
The role of social identity in stopping open defecation Miriam Harter, Nadja Contzen, Jennifer Inauen Contact: Miriam Harter miriam.harter@eawag.ch 29.10.2018 UNC 2018 Miriam Harter 13
Correlation of latrine coverage and open defecation In Ghana: 97% of those owning a completed latrine, also use it. 29.10.2018 UNC 2018 Miriam Harter 14