The Disgust Box: a novel approach to illustrate water contamination with feces

Inadequate drinking water, sanitation, and hand hygiene are responsible for approximately 800,000 deaths per year in low- and middle-income countries. We evaluated the benefits of a behavior change communication method to motivate water treatment practices in urban low income communities in Dhaka, Bangladesh. To motivate people to chlorinate their water we used a device called the 'Disgust Box'. This box provides a vivid demonstration of how piped water is contaminated with feces. Most of the respondents were able to recall the Disgust Box demonstration at both 4-month and 1-year follow-up qualitative assessments. At 4 months, the majority of participants stated that they still felt disgusted by the demonstration and mentioned it as a motivator for water chlorination. However, after one year, despite being able to recall the demonstration, disgust was no longer mentioned as a motivator to chlorinate water. The Disgust Box has the potential to be an effective communication method and is more likely to work if it is part of an intervention that includes repeated presentations and a more attractive water treatment option.