The Norms and Networks Sanitation Study in India in Tamil Nadu, India

NCT ID: NCT04269824

Last Updated: 2021-11-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

22700 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-01-05

Study Completion Date

2021-10-22

Brief Summary

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The objective of this research is to evaluate the impact of a multi-level behavior change intervention designed to promote toilet construction, exclusive toilet use and maintenance in peri-urban communities of Tamil Nadu. The intervention leverages two years of formative research and reflects a norms and network-centric approach that will employ dynamic information dissemination to signal others' sanitation practices while also addressing other barriers to the adoption of improved sanitation practices. The study will determine whether those who received the interventions had significant improvements in toilet usage compared to those who did not. Qualitative research will help assess exposure and reactions to the intervention in these communities.

Detailed Description

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The objective of this research is to evaluate the impact of a multi-level behavior change intervention designed to promote toilet construction, exclusive toilet use and maintenance in peri-urban communities of Tamil Nadu. The intervention leverages two years of formative research and reflects a norms and network-centric approach that will employ dynamic information dissemination to signal others' sanitation practices while also addressing other barriers to the adoption of improved sanitation practices. The study will determine whether those who received the interventions had significant improvements in toilet usage compared to those who did not.

For this cluster-randomized trial, communities will be engaged in two rounds of surveys to assess toilet ownership, toilet usage practices of their family members and include additional questions about beliefs, norms and other factors influencing toilet use. Investigators will also conduct a process evaluation to monitor change from baseline to endline and identify successful pathways of or bottle-necks to the adoption of improved sanitation behaviors. These indicators will include fidelity indicators to assess the quality of intervention delivery, level of community participation, behavioral antecedents, contextual changes in community and household conditions that may facilitate improved behavioral adoption and/or outcomes (e.g., exclusive toilet use). They will also conduct qualitative research using observations and semi-structured interviews with respondents and stakeholders to assess exposure and reactions to the intervention. They will also assess spillover in the control wards using mixed-method assessment tools.

Conditions

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Behavior, Social Norms, Social

Keywords

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Sanitation Norms Toilet Use Toilet Ownership

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Intervention Group

Residents of the peri-urban ward randomized to this group will receive the norm and network-centric intervention package that includes individual, household, group and community-level interventions. No hardware will be provided. Behavior change components will focus on shifting empirical expectations of improved sanitation behaviors in their wards as well as building capacity to achieve toilet construction and behavioral goals.

Group Type EXPERIMENTAL

Behavioral intervention package

Intervention Type BEHAVIORAL

Community mobilization and commitment events

* Update factual beliefs
* Establish public commitment
* Update empirical expectations about toilet use

Audio announcements - Disseminate norms-related messages regarding toilet use and ownership

Group level

\- Facilitated sex-segregated group meetings to share information and action knowledge through increased social connections

Network-level social media messages - Transmit norms-related messages, and testimonials of adopters through influential social network members

Household-level Counseling visits

* Update empirical expectations of improved sanitation behaviors in their community
* Motivate improved sanitation practices
* Build capacity to achieve exclusive toilet use

Stickers/decals

\- Signal adoption of promoted behaviors to community members

Individual-level

* Update empirical expectations of improved behaviors among similar others
* Set goals, track progress and maintain improved behavior

Control Group

Residents of these wards will not receive any intervention. They may be exposed to other WASH interventions promoted by the government and/or other parties independent of this study.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Behavioral intervention package

Community mobilization and commitment events

* Update factual beliefs
* Establish public commitment
* Update empirical expectations about toilet use

Audio announcements - Disseminate norms-related messages regarding toilet use and ownership

Group level

\- Facilitated sex-segregated group meetings to share information and action knowledge through increased social connections

Network-level social media messages - Transmit norms-related messages, and testimonials of adopters through influential social network members

Household-level Counseling visits

* Update empirical expectations of improved sanitation behaviors in their community
* Motivate improved sanitation practices
* Build capacity to achieve exclusive toilet use

Stickers/decals

\- Signal adoption of promoted behaviors to community members

Individual-level

* Update empirical expectations of improved behaviors among similar others
* Set goals, track progress and maintain improved behavior

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Site: Peri-urban wards with 60% or less toilet coverage from selected town panchayats in Tamil Nadu.

Participants

* Randomly selected residents of eligible wards above 18 years of age.
* All households in the intervention wards will receive the LENNS intervention.

Exclusion Criteria

* Site: Slum wards as they will not be representative of our population of interest.
* Wards that were included in the piloting of the intervention package.
* Wards enrolled in any water, sanitation or hygiene intervention other than the national program, Swachh Bharat Mission (SBM)

Participants:

* Persons who were reported or deemed cognitively unable to participate in the study and respond to the surveys will be excluded
* Household members who confirm that they will not reside continuously at that address in the upcoming year
* Specific household members who do not reside at that residency continuously.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Pennsylvania

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Cristina Bicchieri, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Locations

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Swasti

Bangalore, , India

Site Status

Countries

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India

References

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Ashraf S, Bicchieri C, Delea MG, Das U, Chauhan K, Kuang J, Shpenev A, Thulin E. Norms and Social Network-Centric Behavior Change Intervention (Nam Nalavazhvu) for Improved Toilet Usage in Peri-Urban Communities of Tamil Nadu: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc. 2021 May 3;10(5):e24407. doi: 10.2196/24407.

Reference Type DERIVED
PMID: 33938805 (View on PubMed)

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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833854

Identifier Type: -

Identifier Source: org_study_id