Contextual and psychological factors influencing open defecation free status: an exploratory qualitative study in rural South Western Uganda

Moses Ntaro; Judith Owokuhaisa; John Bosco Isunju; Edgar Mulogo; John C Ssempebwa

doi:10.1186/s12889-022-12759-z

Contextual and psychological factors influencing open defecation free status: an exploratory qualitative study in rural South Western Uganda

BMC Public Health. 2022 Mar 1;22(1):414. doi: 10.1186/s12889-022-12759-z.

Authors

Moses Ntaro¹, Judith Owokuhaisa², John Bosco Isunju³, Edgar Mulogo², John C Ssempebwa³

Affiliations

¹ Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda. ntaro2001@gmail.com.
² Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
³ Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda.

Abstract

Introduction: Achieving the Open defecation free (ODF) status remains a major challenge in Uganda, yet it contributes significantly to child health improvement. Literature on social, cultural and behavioral aspects that influence the ODF status in rural Uganda is limited. The study therefore, explored perceived factors influencing the ODF status in rural South Western Uganda.

Methods: An exploratory study employing qualitative techniques and based on deductive analysis between month December 2020 and January 2021 was conducted. Seven Focus Group Discussions (FGDs and three Key Informant Interviews (KIs) were conducted in Kabale District, southwestern Uganda. Focus Group Discussion participants were mothers and fathers having children of 2 years and below while KIIs included local community leaders and health extension workers. Data was analyzed using a categorization matrix derived from the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model which is comprised of contextual and psychological factors. Text was further categorized into high and low statements for attainment of ODF status.

Results: The contextual factors influencing the Open Defecation Free status behavior included; farming activities far from home, financial constraints, rainy seasons, collapsible soft soils, and alcohol use. Psychological factors influencing ODF status included; perceived health risk for typhoid disease, low perceived severity for lack of ODF components, negative attitude of less value attached to ODF components, and a feeling of time wastage practicing ODF status behavior. The perception that the community has the ability to attain the ODF status was high. Although, the capability to maintain ODF was low when it comes to replacement of ODF component if stolen or destroyed.

Conclusion: Open Defecation Free status is influenced by contextual and psychological factors. Therefore, it's crucial for sanitation promotors to always identify such context specific factors in order to design sanitation and hygiene promotion interventions to address the ODF free status related challenges.

Keywords: Behavior; Contextual; Open defecation (OD); Open defecation free (ODF); Psychological; RANAS factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Defecation*
Humans
Rural Population
Sanitation / methods
Toilet Facilities*
Uganda

Grants and funding

D43 TW011632/TW/FIC NIH HHS/United States