Assessing the heterogeneity of intervention fidelity in Andilaye Communities Restricted; Files Only

Rakhra, Ashlin (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/qf85nc29n?locale=es
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Abstract

Background

Amhara, Ethiopia is typified by poor WASH coverage and high rates of behavioral slippage following sanitation interventions. To address these challenges, Emory University is conducting a three-year study to develop and test the effectiveness of demand-side sanitation and hygiene interventions on sustained behavior change and health called Andilaye (Amharic for “togetherness”). This thesis will be assessing the heterogeneity of intervention fidelity in Andilaye communities.

Methods

We assessed the effectiveness of sanitation and hygiene interventions on sustained behavior change in Amhara, Ethiopia. We used quarterly monitoring data to monitor process evaluation indicators among caregivers, women’s development army leaders (WDALs) and heath extension workers (HEWs). Half of the enrolled Andilaye households (n=1,589) were randomly selected to be included in the first round of quarterly monitoring data collection. Households not selected for the first round were selected for the second round of quarterly monitoring. All twenty-five intervention kebeles were classified into low, medium or high fidelity based on six criteria. Gaps and challenges resulting in heterogeneity among kebeles were identified in pre-households counseling visit Andilaye components.

Results

We found considerable heterogeneity in delivery among intervention clusters. We found changes in fidelity of the intervention kebeles from the first to second quarter. Significant gaps existed in WDALs ability to recall key Andilaye components and messages, ability to discuss barriers to improvements in behaviors, goal card engagement, and supportive supervision that have created suboptimal fidelity.

Conclusion

Data collected for this sub-analysis were used to iteratively inform program delivery. The key gaps and weaknesses identified in the results were addressed in refresher trainings with both HEWs and WDALs and should be included in endline evaluation. The components of the Andilaye intervention focus on skills and tools to aid in behavioral maintenance for caregivers, through repeated household visits, not just behavior change that can potentially result in behavioral slippage. 

Table of Contents

Abstract..................................................................................................................................... 4

Acknowledgements....................................................................................................................6

Abbreviations and Acronyms.....................................................................................................8

Chapter 1: Comprehensive Review of the Literature .................................................................9

1.1 Introduction.........................................................................................................................9

1.2 Behavior Change and Household Caregiver Visits..............................................................10

1.3 Caregiver Visits within Ethiopia .........................................................................................12

1.4 Andilaye Approach ..............................................................................................................16

1.5 Project Purpose ...................................................................................................................18

Chapter 2: Manuscript...............................................................................................................19

Abstract.................................................................................................................................... 19 Introduction............................................................................................................................. 20 Methods.................................................................................................................................... 22

Results ..................................................................................................................................... 28 Discussion.................................................................................................................................34

Manuscript Appendix ...............................................................................................................40

Manuscript References ........................................................................................................... ..41

Chapter 3: Conclusions, Recommendations and Future Research ........................................... 42

Conclusions ..............................................................................................................................42

Key Recommendations .............................................................................................................43

Gaps addressed by this project ................................................................................................ 44

Thesis References .................................................................................................................... 45 Appendix.................................................................................................................................. 48 

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