Community-based health promoters as change agents: Culturally-appropriate strategies for hygiene behavior modification in a rural salvadoran setting

BACKGROUND: Informed by Everett Rogers' Diffusion of Innovations (DOI) theory, this study examined the role of community-based health promoters as change agents for improved hygiene behavior adoption in a two-year hygiene promotion intervention that took place in a rural Salvadoran community setting.

METHODS: We conducted three focus groups and six semi-structured individual interviews to gain a fuller perspective of the health promoter's role in hygiene behavior modification. We used a grounded theory approach to examine the social processes behind hygiene behavior adoption to elaborate on the role of health promoters in these processes. More specifically, we explored household decision-making dynamics and perceived attributes of recommended hygiene practices. Free-listing was used to identify attributes about the health promoters with regards to how these attributes influenced reception of promotion messages.

RESULTS/DISCUSSION: Findings suggest that program successes may be attributed to the community-based approach and intervention delivery by local, culturally appropriate health promoters, who played a vital role in community members' acceptance of hygiene messages. Health promoter characteristics identified as important to hygiene behavior change included: amabilidad (kindness), respeto (respect), confianza (trust), homophily, effort, and credibility. The ama de casa, or female homemaker, emerged as a key player in the hygiene behavior adoption process. Community social networks, desired obedience to authority, and dedication to community priorities emerged as key factors in hygiene behavior change. This study offers a deeper understanding of the way in which this theoretical approach and intervention strategy can be applied in a culturally and linguistically appropriate manner.