Table 2 Summary of drivers and barriers to key IYCF and WASH behaviors based on formative research
From: Designing integrated interventions to improve nutrition and WASH behaviors in Kenya
Key behavior | Barriers | Drivers |
|---|---|---|
Infant and young child feeding | ▪ Belief that eating specific food when pregnant will result in a too large baby (maternal nutrition) ▪ Lack of time to breastfeed, prepare complementary foods multiple times per day, practice responsive feeding ▪ Belief that covering hot food will degrade quality | ▪ Caregiver and family member awareness of critical foods during pregnancy and lactation (maternal nutrition. ▪ Knowledge of breastfeeding benefits for CU2 (EBF) ▪ Access to and knowledge of drying racks through community strategy (food hygiene) |
Household water treatment | ▪ Limited access to water ▪ Unacceptability of chemical treatment taste and smell ▪ Access to chemicals inconsistent at health facilities; cost barrier if purchased outside of health facility ▪ Perceived lack of time to collect firewood to boil water | ▪ Knowledge of multiple water treatment techniques, including: adding alum, boiling, straining, letting water settle, and treatment with chemicals (PUR & Waterguard). ▪ Perceived importance of cleaning water storage containers |
Handwashing with soap at critical times | ▪ Limited access to water and soap. ▪ Handwashing with soap is not a perceived social norm. ▪ Concern that soap or water at handwashing station will be consumed by animals, stolen, ruined/damaged by children ▪ Perceived lack of time to fill handwashing stations daily | ▪ Convenience of handwashing station (handwashing station near latrine, access to soap) ▪ Disgust of feces or dirt on hands ▪ Caregiver knowledge of when to wash own hands |
Latrine use | ▪ Lack of household latrines ▪ Latrine building challenge because of soil, affordability of materials, and limited skilled workers ▪ Public urination and defecation is socially acceptable. ▪ Low acceptability of latrines due to smell, cleanliness, safety, ownership, and distance from compound | ▪ Privacy during urination and defecation, particularly of women ▪ Disgust related to the sight and smell of feces Perceived fear of catching diseases (e.g. typhoid, cholera) |
Safe child feces disposal | ▪ Lack of household latrines ▪ Lower perceived risk of disease associated with child feces ▪ Perceived lack of time for caretakers to supervise children (do not know where/when child defecates) | ▪ Disgust related to the sight and smell of feces, presence of flies associated with feces in the compound ▪ Caretakers train children to defecate in designated location |
Promoting clean play environment | ▪ Uncontained compound animals result in presence of animal feces ▪ Lack of commonly understood definition for “protected play environment” ▪ Social acceptability of children freely playing around the compound, uncontained | ▪ Social norm of child playing under caregiver supervision ▪ Social norms of keeping a clean compound and the habit of sweeping driven by feelings of disgust |
Deworming | ▪ Inconsistent information about dose frequency being given to caregivers by health workers ▪ Belief that the costs outweigh the benefits of taking the medication ▪ Religion forbidding the use of medication | ▪ Caregivers perceived outcomes as positive for people that took de-worming medication. ▪ Knowledge is spread to community by community health volunteers and community health facility workers about de-worming medication. |