Social Science & Medicine, Available online 21 March 2012
Systematic review of behavior change research on point-of-use water treatment interventions in countries categorized as low- to medium-development on the human development index
Amy Parker Fiebelkorn, M.S.N.,M.P.H.a, , , Bobbie Person, M.P.H.,Ph.D.b, Robert E. Quick, M.D.,M.P.H.c, Stephen M. Vindigni, M.D.,M.P.H.d, e, Michael Jhung, M.D.,M.P.H.f, Anna Bowen, M.D.,M.P.H.c, Patricia L. Riley, C.N.M., M.PH., FACNMg, h
a Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, U.S.A
b Office of the Director, National Center for Preparedness, Detection, and Control of Infectious Diseases, CDC, Atlanta, GA, U.S.A
c Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vectorborne and Enteric Diseases, CDC, Atlanta, GA, U.S.A
d Emory University School of Medicine, Atlanta, GA, U.S.A
e Office of the Director, National Center for Environmental Health, CDC, Atlanta, GA, U.S.A
f Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, U.S.A
g Division of Global HIV/AIDS, Center for Global Health, CDC, Atlanta, GA, U.S.A
h Lillian Carter Center for International Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, U.S.A
Point-of-use watertreatment (i.e., water purification at the point of consumption) has proven effective in preventing diarrhea in developing countries. However, widespread adoption has not occurred, suggesting that implementation strategies have not motivated sustained behavior change. We conducted a systematic literature review of published behavioral research on factors influencing adoption of point-of-use watertreatment in countries categorized as low- to medium-development on the United Nations Development Programme Human Development Index.
We used 22 key words to search peer-reviewed literature from 1950-2010 from OVID Medline, CINAHL, and PsycINFO. Twenty-six (1.7%) of 1551 papers met our four inclusion criteria: 1) implemented a point-of-use watertreatment intervention, 2) applied a behavioral intervention, 3) evaluated behavior change as the outcome, and 4) occurred in a low- or medium-development country. We reviewed these 26 publications for detailed descriptions of the watertreatment intervention, theoretical rationales for the behavioral intervention, and descriptions of the evaluation.
In 5 (19%) papers, details of the behavioral intervention were fully specified. Seven (27%) papers reported using a behavioral theory in the design of the intervention and evaluation of its impact. Ten (38%) studies used a comparison or control group; 5 provided detailed descriptions.Seven papers (27%) reported high sustained use of point-of-use watertreatment with rates >50% at the last recorded follow-up.
Despite documented health benefits of point-of-use watertreatment interventions in reducing diarrheal diseases, we found limited peer-reviewed behavioral research on the topic. In addition, we found the existing literature often lacked detailed descriptions of the intervention for replication, seldom described the theoretical and empirical rationale for the implementation and evaluation of the intervention, and often had limitations in the evaluation methodology. The scarcity of papers on behavior change with respect to point-of-use water treatment technologies suggests that this field is underdeveloped.
