An Integrative Review of Community Health Volunteer-Led Training to Improve Water, Sanitation, and Hygiene Practices...

Water, sanitation, and hygiene (WASH) are foundational determinants of public health and community development. Globally, approximately 2.3 billion people still lack access to safe drinking water and sanitation services. These disparities are most pronounced in low- and middle-income countries such as Haiti, and regions affected by conflict, political instability, or fragile health infrastructure.

An integrative review was conducted to evaluate the best practices in community health volunteers' training on WASH practice outcomes in underserved communities.

A literature search was performed, including articles published between 2015 to 2025 in PubMed, CINAHL, and Embase. Whittemore and Knafl's method of integrative review was employed to ensure a rigorous approach for the review, and the Johns Hopkins Nursing Evidence-Based Practice appraisal tool was used for quality and grading. Nine studies were included in the review that involved CHV training interventions in underserved populations. Results were synthesized and interpreted using the COM-B behavioral change framework.

Four themes were identified across the literature, which included (1) behavioral change, (2) knowledge and capability, (3) confidence and motivation, and (4) community engagement and opportunity, to promote successful community volunteer-led WASH training programs. Knowledge improved in most studies, but behavioral change was inconsistent. Given that the COM-B model supports that only one of the domains need to change to elicit behavior change, findings in this study suggest that building knowledge/capacity, or promoting opportunity, or encouraging motivation alone can be powerful.

Recommendations from the literature support the implementation of community volunteer-led WASH training programs to improve overall knowledge and confidence among those engaged in WASH efforts. The recommendations are applicable to the context of WASH practices in Haiti, which remains sparse, especially in rural areas. Community-engaged research plays an integral role in how communities can embrace the behavior change necessary to achieve long-term improvements in hygiene and sanitation.