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Evidence Based Designing of a Communication Campaign for Enhancing Use of Point of Use (PoU) Water Disinfectants in Urban Slums of Dharavi, Mumbai, India

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Background: Dharavi is the largest slum in Asia, with a population of over one million people and a population density of 17,000 people per square kilometre. Extreme overcrowding, unhygienic dwelling practices and lack of basic amenities like clean drinking water and sanitation characterize this area. Clean drinking water, and sanitation services and improved hygiene behaviours by caregivers, are most critical in improved child survival outcomes. While means to prevent diarrhea through improved water quality, and improved hygiene advantageously impact the whole family, yet 68 percent of Indian households do not treat water by any means.1 The prevalence of water borne diseases is fuelled by low use of PoU water treatment products in community. In project site at Dharavi, samples of drinking water tested with microbiological water test field kits (H2S kits which indicate bacterial contamination within 48 hours) indicated that almost 43 percent of stored drinking water samples, collected from households, were not fit to drink4. Based on this need assessment, PSI initiated intervention in Dharavi, with a purpose to promote PoU water disinfectant and prevent diarrhoea and related water borne diseases. The project implements an integrated behavior change communication (BCC) approach with an aim to motivate the caregivers for adoption of hygienic practices, particularly safe storage and handling of drinking water, hand washing and the importance of point-of-use water disinfection.

The paper examines the segments of the caregivers consistently using water treatment products to treat drinking water. Moreover the paper investigates predictors for increased use of PoU water treatment products which supported design and prioritization of a communication campaign.

Methods: A cross-sectional survey was conducted caregivers of children under 10 years of age in selected slum communities of Dharavi in May 2009. Stratified two stage cluster sampling was done wherein slum cluster comprised the strata and localities were defined as the primary sampling units (PSU). The desired sample size (800) was calculated for project to allow comparison over time between independent samples: significance level was set at 0.05 and power was set at 80 percent. The respondents were selected from a house listing frame wherein age of child and caregiver were screening criteria. The number of interviews was proportionately allocated to each locality. The baseline survey identified key predictors of PoU water treatment. Logistic regression was used to examine relationships between the behaviour determinants and current use of PoU water treatment products. Determinants related to behaviour of interest were classified according to framework of opportunity, ability and motivation.

Result: Almost all caregivers (98 percent) reported to know that contaminated drinking water can cause diarrhea and 75 percent of all the caregivers knew that water can be contaminated by microbes. Despite high levels of knowledge on contamination of water and its effect, only 9 percent of the caregivers knew of benefits of chlorine for water treatment. Findings indicated that 35 percent of the target audience reported to have heard of water treatment tablet or solution and 8 percent reported to have ever used such products. Further, 5 percent of the respondent reported having ever purchased any water purification solution/tablet. Altogether 4 percent respondents reported to currently purchase and use such products on recurrent basis. Perceived availability of PoU water treatment products (odds ratio=2.36; CI=1.90 – 2.82), knowledge about benefits of chlorine based PoU water treatment products (odds ratio=4.32; CI=3.36 – 5.28) and intention to use such product (odds ratio=2.90; CI=2.18 – 3.62) were found to be strongly associated with current use. Subsequently, these predictors were prioritized to guide the design and planning process of program intervention.

Discussion: The results available from baseline research were used for designing the communication campaign. The behavior change communication strategy is based on diagnostic research to understand the behavioral determinants that shape the present behavior. Selecting the type of behavior change communication intervention depends prioritizing the determinants. It is expected that the process of prioritizing determinants will help program managers to use evidence to guide the design and planning process of program intervention.

Based on the Complexity Relationship and scope (CRS) analysis, program implementers prioritized two predictors viz. knowledge of benefits of PoU water treatment and perceived availability of the product. The communication theme focused on improving knowledge of care-givers about the benefits of treating drinking water with chlorine based water disinfectants and perceptions about availability of the products and point of access for the same. The program adopted a strategy of making the product available through non traditional outlets like grocery store, beetle leaf shop etc. to increase its access among the target audience and making it available at an outlet near to the household.
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Keywords: Behaviour Change; Chlorine-based water disinfectant; Diarrhoeal diseases; Evidence-based; Point-of-Use; Segmentation

Document Type: Research Article

Publication date: 2011-01-01

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