Behaviour change interventions to improve household sanitation and hygiene practices in urban settings: A systematic...

Behaviour change interventions have the potential to improve sanitation and hygiene practices in urban settings. However, evidence on which behaviour change interventions have successfully improved sanitation and hygiene practices in urban settings is unclear.

We performed electronic searches across five databases and one grey literature database to identify relevant studies published between January 1, 1990 and November 20, 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.

After de-duplication, 8249 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, used as a proxy measure for handwashing. There is limited evidence on food hygiene practices. Most behavioural outcomes were measured between 6 and 12 months after intervention implementation, which may undermine the sustainability of behaviour change interventions.

Despite overall mixed behavioural effects on sanitation and hygiene practices, behaviour change interventions can improve certain behaviours 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.