Abera, Kumie (PhD)Teshome, Gebre (PhD)Fikralem, Mezgebu2021-09-132023-11-282021-09-132023-11-282018-06http://etd.aau.edu.et/handle/12345678/27856Background: Inadequate sanitation is one of the leading causes of disease in least developed countries. Objective: The general objective of the current study wass to determine the psychosocial, technological and contextual factors associated with the adoption and consistent use of sanitation facilitates in rural Becho district of Ethiopia. Methods: A mix method design cross sectional study was conducted that employed quantitative and qualitative data collection techniques. Quantitative data was collected using a structured questionnaire. Eight rural Kebele (clusters) were selected randomly from the total of 21 kebele in the district. Then every sixth households in the selected clusters were selected to be interviewed using systematic random sampling technique. A total of 1047 household heads (650 male) interviewed, and latrines were inspected. Data were entered using Epi info version 3.5.4 and analysis was conducted using SPSS version 20. Logistic regression analysis was used to assess associations between outcome variables with potential determinants. Statistically significant results with p-value are less than 0.05 were reported. The qualitative data was collected using in-depth interviews and Focus Group Discussions (FGD) to explore beliefs, contextual and technologulcal factors influencing the adoption, sustainability and consistent use of sanitation facilities at multiple levels. The socio-ecological model was employed for the design of the study and for the analysis of data. A total of 10 in-depth interviews were held, and 8 FGDs were undertaken with 75 participants. The FGDs and IDIs were tape-recorded, verbatim transcribed and translated into English. The analysis was supported using Nvivo version 10 software. Results: Overall, 73% of participants owned some kind of latrine, while only 1.5% of participants used improved latrine. The percentage of households that used shared latrine, unimproved or practiced open defecation were 2.2%, 69.3%, and 27%, respectively. Among latrine owners, 79% reported using a latrine consistently, 48% of children's stool disposed in latrine. Only 11% of the observed latrines had handwashing facilities within 10 paces of distance. Among the psychosocial factors, attitude [(AOR 1.88: (95%CI: 1.4-2.5)]; and injunctive norm [(AOR 6.18; (95%CI: 4.46-10.44)] were significantly associated with latrine ownership. Among the demographic factors, households with family size of more than 6 compared to small size families [(AOR 1.43: (95% CI 1.01-1.97)]; households having a child attending school compared to those who did not have [(AOR = 1.88; (95% CI 1.17-3.02)] and, household head having high school education [(AOR 1.98: (95% CI: 1.34-2.87)] were more likely to be latrine owners. With respect to exposure to communication about sanitation (the cues to action), households that had a family member who took part in CLTSH triggering were 3.0 times more likely to be latrine owners than those who did not participate in CLTSH triggering (95% CI 1.92-4.78. Results from adjusted logistic regression analysis of potential predictors of consistent latrine use showed that having positive attitude [(AOR 7.00: (95% CI: 4.55-10.55)]; ownership of a latrine that had superstructure [(AOR 2.3 (95%CI: I1.47-3.48)]; cleanliness of a latrine [(AOR 1.69 (95%CI: 1.00-3.00)]; and latrines that had a protected door [(AOR 1.94 (95%CI: 1.10-3.48)] were significantly associated with consistent latrine use. The qualitative study revealed that latrine ownership was influenced by multi-level ecological barriers. The barriers to sustained adoption and use of sanitation facilities were categorized into 1)individual level (past latrine experience, perception of less health threat to unhygienic child faeces disposal, lack of knowledge and demand to improved latrine), 2) household level (unable to pay the cost of a latrine, lack of space and, absence of physically strong family member), 3) community level (lack of access to public latrine, lack of shared rules against open defecation, lack of financial access for the poor) and, 4) societal level factors (flooding, soil condition and lack of appropriate sanitation technology that can adopt the environment, lack of promotion and demand creation for improved latrine, and the lack of strong leadership at the local level). Conclusions and recommendations: The very limited access to improved latrine needs ctirtical attention. Attitude and perceived social norm were the psychosocial predictors of latrine ownership, which suggests normative and persuasive behaviour change approach are relevant. Sanitation facilities were valued not only for health benefit, but also for providing protection, privacy, and dignity, which needs consideration by policy makers and sanitation programmers. It is critical to increase access to environmentally feasible, affordable and safe toilet options. Multiple level barriers to sustained adoption of sanitation facilities indicating the need to consider interventions that address multi-dimensional and multi-level factors concurrently. Interventional research recommended to investigate the effectiveness of the suggested normative and persuasive approaches in changing behaviour to increasing latrine adoption and use.en-USlatrine ownershipconsistent latrine usepsychosocial factorstechnological factorscontextualsocio-ecological analysisruralEthiopiaThesis