Evaluating the effectiveness of a community-based hygiene promotion program in santa clara, El Salvador

BACKGROUND: Due to the lack of adequate hygiene, potable water and sanitation, diarrheal disease still poses a substantial threat to human health in developing communities. While there have been considerable advances in the WASH sector, there is still a lack of evidence on theory-based program models for hygiene behavior change. This research study aimed to advance knowledge around hygiene behavior change strategies through the evaluation of a two-year community-based hygiene promotion pilot program implemented in rural Santa Clara, El Salvador by local health promoters.

METHODS: This study used a community-level quasi-experimental pretest-posttest design with repeated follow ups (2008-2010) to determine whether the hygiene promotion program achieved changes in hygiene knowledge and behavior. One community received the intervention while the other served as a comparison. Interviewer-administered surveys were collected from a representative sample using community-based participatory methods. Thirteen measures of hygiene knowledge and behavior for water, sanitation, personal, domestic and food hygiene were constructed using a hygiene cluster framework and were tested for reliability. ANOVA, one-way ANOVA with posthoc analysis using Tukey's HSD for multiple comparisons and linear regression were used.

RESULTS/DISCUSSION: Hygiene knowledge and behaviors related to sanitation and food hygiene increased more in the intervention than in the comparison community. Study results suggest that limited improvements in water and domestic hygiene may be related to an inadequate enabling environment for behavior change, with water source and availability of mechanisms for adequate trash disposal playing a role in this process. Recommendations for public health practice and research are also offered.