Assessing barriers to WASH behavior change in high-fidelity Andilaye intervention communities in Amhara, Ethiopia Open Access

Braccio, Christina (Spring 2019)

Permanent URL:


Background: Water, sanitation and hygiene (WASH) behavior change is notoriously difficult to sustain long-term after intervention implementation, and behavioral slippage – reverting back to pre-intervention behaviors – is common. Community-led total sanitation and hygiene (CLTSH) is a behavior change approach currently used in Ethiopia to improve rural sanitation and hygiene practices; however, the program lacks long-term behavioral maintenance activities. The Andilaye project, currently being conducted by Emory University, is an attempt to implement strategies to facilitate behavioral maintenance and prevent behavioral slippage, addressing some of the gaps in the CLTSH approach.


Objective: To conduct a qualitative process evaluation to qualify the barriers to behavioral uptake that remained after the first year of Andilaye intervention implementation in households with high behavioral adoption in communities with high intervention fidelity.


Methods: In-depth interviews were conducted with eight high behavior change uptake female caregivers across two high fidelity kebeles. Four focus groups were held across the same two high fidelity kebeles among high behavior change uptake and low behavior uptake change female caregivers. Observational surveys of the homes of high behavior change uptake female caregivers were also conducted.


Results: Most respondents (85.7%) reported that lack of time as a barrier to behavior change. More than half of all respondents (57.1%) reported financial constraints, lack of availability of construction materials and soap as their biggest barriers to behavior change.


Conclusion: The findings of this study corroborate previous studies on barriers to behavior change in the CLTSH model. Noticeably, more barriers were reported in the kebele farther from a paved road and with lower education levels. Residents from the kebele located on the paved road reported a lack of time to dedicate to hygiene practices as their only barrier to behavior change. It can be inferred that behavior change may be more successful in communities with greater infrastructure and access to resources.

Table of Contents

Chapter 1: Literature Review

               Introduction                                                                                                                                                                7

WASH Behavior Change Approaches                                                                                                                7

Community-Led Total Sanitation                                                                                                                       8

Behavioral Slippage and Barriers to Sustained Behavior Change                                                           9

Andilaye Intervention and Approach to Behavior Change Implementation                                   11

Aims and Objectives                                                                                                                                              14

Chapter 2: Manuscript

Abstract                                                                                                                                                                      15

Introduction                                                                                                                                                              16

Methods                                                                                                                                                                    18

Results                                                                                                                                                                        23

Discussion                                                                                                                                                                  29

Chapter 3: Conclusions, Recommendations

Conclusions                                                                                                                                                              32

Key Recommendations                                                                                                                                        33

Chapter 4: References

               References                                                                                                                                                                34

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Last modified

Primary PDF

Supplemental Files