Behavior change research on point-of-use water treatment interventions in developing countries: A review of the literature

Six point-of-use water treatment technologies (i.e., purification at the location where water is consumed) have proven effective in preventing diarrhea in developing countries. However, widespread adoption and sustained use has not occurred, suggesting that implementation strategies have not motivated behavior change. We conducted a literature review to determine if behavior change research has been done on point-of-use water treatment interventions, if behavioral theories have been used, and if the application of behavioral theories has resulted in improved acceptance of point-of-use water treatment interventions. Using 22 key words, we searched peer-reviewed literature for articles from 1950 through December 2008 from OVID Medline, CINAHL, and PsycINFO. We included English language, peer-reviewed studies that evaluated the impact of behavioral interventions on adoption or use of evidence-based point-of-use water treatment technologies in developing countries. Of 1,226 papers identified, 17 met the inclusion criteria. Four (24%) papers incorporated a behavioral theory in the intervention design and evaluation; 7 (41%) applied a behavioral theory only in the evaluation design or interpretation of results; and 6 (35%) focused on behavior change but did not mention a behavioral theory. Data collection was quantitative in 13 (76%), qualitative in 1 (6%), and mixed quantitative-qualitative in 3 (18%) studies. Eleven (65%) studies had objective outcome measures. Seven (41%) papers with baseline data documented an increase in point-of-use water treatment. Despite the health benefits of point-of-use water treatment interventions, we found limited behavioral research on factors influencing adoption or scaled-up, sustained use. More behavioral theory-based research is necessary to understand the barriers and motivators for adopting point-of-use water treatment interventions.