The role of water- and health-related local community knowledge and perceptions in decision-making

The role of water- and health-related local community knowledge and perceptions in decision-making

Health-related knowledge and perceptions are important determinants of health behaviours and behaviour change. What someone knows, thinks or feels will motivate or hinder their intention or hesitancy to implement a certain behaviour, i.e. the application of protective health measures. A perceived potential risk to our health and well-being can influence our health-promoting and/or health-seeking behaviour. Below are a few examples of studies conducted in this area.

Risk perceptions motivate water - and health-related behaviour

Our recent review shows that risk and behaviour studies on water and health have been reporting information from different countries belonging to different income groups around the globe, conducted in various settings and contexts, among different target populations, from various disciplinary angles, using different methods.

Prominent topics in the literature mainly relate to drinking water sources and water safety, disease prevention, health seeking behaviour, variations and changes in perception and behaviour over space, geography, socioeconomic differences and time.

Moreover, the cultural context plays a major role in how we perceive risk and whether we adapt our behaviour to reduce related adverse outcomes.

Click here to read the study “Do health risk perceptions motivate water - and health-related behaviour? A systematic literature review."

Wetland use, disease exposure and improved health-based wetland management

This study assessed knowledge, perceptions and behaviours towards infectious disease exposure in East African wetlands and evaluated whether the perceived risks reflect the actual risk factors. Data were collected from 400 community members, including farmers, nomadic pastoralists and service sector workers, based on cross-sectional surveys and in-depth interviews.

The study showed that the level of risk perception regarding disease exposure was high and understood as being driven by users' physical contact with water during wetland use, characteristics of pathogens and vectors of disease, both in domestic and occupational environments.

Risk factors mostly associated with diseases in wetlands included limited access to basic water supply, sanitation and poor (environmental) hygiene (WASH) (typhoid fever, diarrhoeal diseases, schistosomiasis), agricultural irrigation (malaria), proximity to livestock (trachoma), use of agrochemicals (skin and eye diseases), seasonal flooding (malaria, typhoid fever) and droughts (trachoma).

Different user groups, i.e. farmers versus nomadic pastoralists, perceived the use-related risks differently and different (occupational) risks were attributed to different groups. The study showed that perceptions reflect actual risks and challenges, underpinning the vital role of wetland users as key informants to inform health-promoting wetland management.

Click here to read the study "Health risk perceptions and local knowledge of water-related infectious disease exposure among Kenyan wetland communities”.

Integrating school book knowledge into interventions

Schools, depending on their access to and quality of WASH and the implementation of healthy hygiene behaviours, can be critical for the control and spread of many infectious diseases. Schools provide opportunities for pupils to learn about the importance of hygiene and WASH-related practice and build healthy habits and skills, with beneficial medium- and long-term consequences, particularly in low- and middle-income countries.

WASH services alone are often not sufficient and need to be combined with educational programmes. International organisations frequently roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours.

This study analyzed WASH, health promotion and disease prevention education in primary school science text book content and explored how such knowledge and school books are integrated into WASH education interventions in schools.

Click here to read the study “Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: disconnect, integration or opportunities?”

Improving monitoring and water point functionality

This study examines the patterns, trends, and factors associated with functional community water points and identifies potential areas of improvement in terms of practitioner response to functionality and functionality monitoring. Based on insights from cross-sectional surveys rolled out in 73 communities in rural Ethiopia, it found that the majority of communities had functional water points and a WASH committee.

Community members suggested that the key factors for water point sustainability were improving water quality and water pressure, reducing water collection time, and speeding up repair times. Taking community leaders’ ‘priority lists’ into consideration offers sustainable opportunities for demand-driven, adaptive and targeted design and implementation of rural water supply programs, which, if they include the grassroots level as key informants and actors of change, can succeed.

Click here to read the study “Improving monitoring and water point functionality in rural Ethiopia”

Improving access to public drinking water and toilets for people experiencing homelessness

To make sure that access to public drinking water and toilets improves for people experiencing homelessness, involving them is key. This study, which involved 45 individuals experiencing homelessness in Bonn, Germany, identified solutions based on in-depth interviews, participatory mapping, arts-based research, and group discussion.

Suggestions included adapting existing infrastructure, opening up existing but inaccessible infrastructure, and constructing multifunctional WASH kiosks with integrated showers, toilets, sinks, and vending machines for hygiene materials.

A very easy-to-implement idea was the development and use of an artificial coin, similar to the ones used for shopping carts in supermarkets, for those in need of public-for-pay toilets free of charge. Overall, proactive, long-term sustainable solutions were preferred over reactive short-time options.

Click here to ready the study "A question of human dignity”. Identifying solutions to improve WASH for people experiencing homelessness. A case study from Germany”.

Preparing schools for future pandemics

Post-COVID-19, schools urgently need to enhance infection control and prevention (IPC) measures, including WASH, to prepare for future outbreaks. This study from Brazil describes WASH solutions outlined in policies released at the federal, state, and capital city levels during the COVID-19 pandemic for the safe reopening of schools and discusses their potential to enhance schools' capacity to remain operational during a new outbreak.

The analysis of 66 public policies revealed that solutions were discussed in the light of the principles of human rights and the human rights to water and sanitation, international guidelines for WASH and IPC in schools and the Sphere minimum standards for humanitarian aid. While suggested solutions have the potential to provide a cleaner and safer learning environment, it is essential to exercise caution when implementing these measures and adapt them to the specific circumstances of each school.

Click here to ready the study "Preparing schools for future pandemics: Insights on Water, Sanitation and Hygiene solutions from the Brazilian School Reopening Policies."

Conclusions and recommendations

Local community knowledge and perceptions are vital for water and health governance in terms of policy, raising awareness, education and behaviour change.

To make such studies even more relevant to effective public health planning and health messaging, future research needs to increasingly focus on early culturally sensitive interventions and changes in perceptions and behaviours over time. Interventions should integrate the 'voice' of the community and other relevant stakeholders and thereby facilitate transdisciplinary approaches at different stages of program management (planning, monitoring, and evaluation). This would help close the knowledge-to-action gap and improve policy, programming, practice, and service delivery.