A Qualitative Assessment of Mothers’ Perceptions and Behaviors in Response to an Intervention Designed to Encourage Safe Child Feces Disposal Practices in Odisha, India Open Access
Williams, Rebekah (Spring 2019)
Abstract
Background:
A critical but often neglected aspect of sanitation is the lack of consistent, proper disposal of child feces. When not safely disposed, child feces can become a source of exposure for enteric disease, potentially leading to impaired growth in children. Reasons for not properly handling child feces include the belief that child feces pose low risk, a lack of understanding of the pathogenic risks, a lack of access to diapers, potties and/or cleaning supplies, and a lack of knowledge about safe disposal practices. As most children under the age of five are dependent on mothers and/or caregivers for their defecation practices, they are key for sustained behavior change in this age cohort. However, there is a need to assess how mothers perceive external influences and personal motivations around child feces disposal management (CFM).
A cluster-randomized controlled trial was conducted in Odisha, India to evaluate the effectiveness of a multi-level intervention that aimed to increase latrine use among latrine-owning households. An aspect of the multi-level intervention was a Mothers Group, targeting mothers of children under age five to increase knowledge safe child feces disposal behaviors and provide safe disposal tools (potties/scoops). This study aimed to qualitatively assess mothers and caregivers attitudes and perceptions of child feces disposal management after attending the Mothers Group.
Methods: Qualitative data collection was carried out in six villages. Twenty-four in-depth interviews (IDIs) were conducted in three villages that received the Mother’s Group intervention to assess their opinions of the intervention activities, including the messages and hardware delivered. Four focus group discussions (FGDs) were conducted in three villages that did not receive the intervention to understand feces disposal practices broadly and potential spillover of information from neighboring intervention villages. Inductive coding was used to guide the development of codes and thematic analysis was used to explore the dimensions of emerging patterns and variations.
Results: Results found that women’s narratives provide a deeper understanding of the sociocultural context of child feces management, especially in regards to perceptions of family networks and perspectives of risk. Findings indicated that women’s household responsibilities and restrictions in their movements outside the home were barriers that prevented them directly experiencing the sanitation intervention. Mothers-in-laws and grandmothers commonly attended the intervention instead of mothers with children under the age of five, the target demographic. Among women that did experience the Mother’s Group there was variation in how they implemented the safe disposal tools related to child comfort using of the tool, perceptions of the training process, and access to a functional latrine.
Conclusions: These findings demonstrate that future interventions should be purposive in building trust with elder female gatekeepers, in order to accommodate the movement restrictions of younger mothers. These findings also indicate that the design of the tool may need to shift to better meet the needs of both mother (ease of cleaning) and child (comfort during use). We intend that these findings encourage further research and discourse on CFM solutions that benefit the well-being of both mother and child.
Table of Contents
Table of Contents
Acknowledgements........................................................................................................................ 4
Chapter 1: Introduction.............................................................................................................. 6
Chapter 2: Literature Review...................................................................................................... 9
The State of Sanitation in India.......................................................................................... 9
Safe Disposal of Child Feces – Perspectives from Low and High-Income Countries..... 12
The Role of Mothers and Caregivers................................................................................ 15
Sanitation Challenges in Odisha, India............................................................................. 17
Intervention Design & Theoretical Framework................................................................ 17
Chapter 3: Student Contribution............................................................................................. 21
Chapter 4: Manuscript............................................................................................................... 26
Chapter 5: Public Health Implications.................................................................................... 57
Appendices................................................................................................................................... 61
Appendix 1: In-Depth Interview Guide: English Translation........................................... 61
Appendix 2: Focus Group Discussion Interview Guide: English Translation.................. 66
Appendix 3: Demographic Questionnaire IDI.................................................................. 70
Appendix 4: Demographic Questionnaire FGD............................................................... 72
Appendix 5: IDI Consent Form: English Translation....................................................... 76
Appendix 6: FGD Consent Form: English Translation.................................................... 77
References................................................................................................................................... 79
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