BRISTOL STOOL CHART VALIDATION STUDY Público

Abstract

Background: In the evaluation of Water, Sanitation, and Hygiene (WASH) intervention
studies, researchers rely on mothers-report, a subjective outcome measure on whether
their child has had diarrhea. Since this method is subjective there is a need for a more
objective outcome measure. We are proposing the use of the Bristol Stool Chart (BSC).
This is a scale of seven stool types that includes images and descriptions. The chart was
developed and validated in Bristol, England to evaluate adult patients with irritable bowel
syndrome but it has not been used as an outcome measure for WASH research in
developing countries. Objective: This study assessed whether the chart can be used as an
outcome measure instead of the alternative, mothers-report. Methods: Mixed methods
approach was used, using 99 surveys and 5 in-depth interviews. We assessed the ability
of the mother to use the tool by asking mothers to rate their child's most recent stool and
fake stool models on the chart. We measured the association between mothers' ability to
use the chart and mother/child characteristics. Mother's ratings of three fake stools
measured inter-rater reliability. In-depth individual interviews were used to understand
mothers' perceptions of children's stools and stool types on the chart. Results: Mothers
were able to rate the stools of children who were younger than three years old and still
breastfeeding. In addition mothers were able to rate their children's stools who had come
to the clinic for varied ailments. Specifically mothers were able to rate all the diarrhea
cases on the chart as softer to watery stools, although the cases were very few. Mothers
were able to consistently identify the three fake stools on the chart, establishing inter-
rater reliability. Through in-depth interviews we learned that there are different types of
diarrhea in this community and that the chart is well understood. Discussion: The chart
can be used for children younger than three years old, weaned or those with diarrhea.
Conclusion: In field settings the BSC can be used with mothers-report, this study has
shown that it works well for certain children.

Table of Contents

List of tables ...................................................................................1

Literature review...............................................................................2

--Diarrhea burden..............................................................................2

--Causes of Diarrhea .........................................................................2

--WASH interventions........................................................................3

--Bristol stool chart (BSC) .................................................................5

----BSC as an outcome measure.........................................................6

----Pictorial superiority effect.............................................................7

----Methodology for validating studies..................................................8

Manuscript.....................................................................................10

--Astract.......................................................................................10

--Introduction.................................................................................11

--Methods......................................................................................13

--Study design................................................................................14

--Analysis.......................................................................................21

--Results........................................................................................22

----Qualitative results.......................................................................34

Discussion.......................................................................................41

Conclusion......................................................................................48

References ....................................................................................50

Appendices.....................................................................................53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Sciences
Palabra Clave	Bristol Stool Chart Developing Sanitation Hygiene Water
Committee Chair / Thesis Advisor	Null, Clair, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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