Abstract

Using toilets is a simple way to prevent diarrhea, yet no validated tool exists to measure this habit. This study aimed to develop and validate instruments for measuring latrine use consistency. This questionnaire was adapted from the risk, attitude, norm, ability, and self-regulation (RANAS) framework developed in India and modified for Indonesia. It was evaluated by three experts using the content validity index (CVI). The face validity index (FVI) was pilot-tested on 40 community respondents. Variables measured included behavior, habits, intentions to use toilets, knowledge, attitudes, norms, abilities, and self-regulation. Question items with relevance and clarity scores of item CVI above 0.80 were considered valid and appropriate. Item scoring 0.70–0.79 required revisions, while scores below 0.70 led to deletion. The relevance and clarity assessment results for behavioral, intention, knowledge, norm, and attitude to use toilet questions yielded a scale CVI of more than 0.80, indicating that all items were valid and reliable. However, the habits, abilities, and self-regulation variables had varying I-CVI scores, indicating a need to revise or remove certain items. A culturally adapted and validated RANAS-based instrument is reliable for measuring latrine use behavior in Indonesia.

References

1. World Health Organization. Safe water, better health. Geneva: World Health Organization; 2019.

2. Wolf J, Johnston RB, Ambelu A, et al. Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: A global analysis for selected adverse health outcomes. Lancet. 2023; 401 (10393): 2060–2071. DOI: 10.1016/S0140-6736(23)00458-0.

3. Gozali SI, Astutik E, Ismail WI. Environmental sanitation and diarrhea in children ages 12 - 59 months in Pojok Village, Bojonegoro, Indonesia. J Berk Epidemiol. 2023; 11 (2): 120–127. DOI: 10.20473/jbe.V11I22023.120-127.

4. Musa SS, Ezie KN, Scott GY, et al. The challenges of addressing the cholera outbreak in Cameroon. Public Heal Pract (Oxf). 2022; 4: 100295. DOI: 10.1016/j.puhip.2022.100295.

5. Mara D. The elimination of open defecation and its adverse health effects: A moral imperative for governments and development professionals. J Water Sanit Hyg Dev. 2017; 7 (1): 1–12. DOI: 10.2166/washdev.2017.027.

6. Freeman MC, Garn JV, Sclar GD, et al. The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis. Int J Hyg Environ Health. 2017; 220 (6): 928–949. DOI: 10.1016/j.ijheh.2017.05.007.

7. Merid MW, Alem AZ, Chilot D, et al. Impact of access to improved water and sanitation on diarrhea reduction among rural under-five children in low and middle-income countries: A propensity score matched analysis. Trop Med Health. 2023; 51: 36 . DOI: 10.1186/s41182-023-00525-9.

8. Bauza V, Ye W, Liao J, et al. Interventions to improve sanitation for preventing diarrhoea. Cochrane Database Syst Rev. 2023; 1 (1): CD013328. DOI: 10.1002/14651858.CD013328.pub2.

9. World Health Organization and United Nations Children’s Fund. Progress on household drinking water, sanitation and hygiene 2000-2022: Special focus on gender. World Health Organization, United Nations Children’s Fund; 2023.

10. Yulyani V, Febriani CA, Shaharudin MS, et al. Patterns and determinants of open defecation among urban people. Kesmas. 2021; 16 (1): 45–50. DOI: 10.21109/kesmas.v16i1.3295.

11. Hirai M, Kelsey A, Mattson K, et al. Determinants of toilet ownership among rural households in six eastern districts of Indonesia. J Water Sanit Hyg Dev. 2018; 8 (3): 533–545. DOI: 10.2166/washdev.2018.010.

12. Paladiang R, Haryanto J, Has EMM. Determinan perilaku buang air besar sembarangan (BABS) di Desa Kiritana Kecamatan Kambera. Indones J Community Health Nurs. 2020; 5 (1): 33. DOI: 10.20473/ijchn.v5i1.17545.

13. Lopez VK, Berrocal VJ, Angulo BC, et al. Determinants of latrine use behavior: The psychosocial proxies of individual-level defecation practices in rural coastal Ecuador. Am J Trop Med Hyg. 2019; 100 (3): 733–741. DOI: 10.4269/ajtmh.18-0144.

14. Gauri V, Rahman T, Sen IK. Shifting social norms to reduce open defecation in rural India. Behav Public Policy. 2023; 7 (2): 266–290.

15. Jacob S, Natrajan B, Ajay TG. ‘Why don’t they use the toilet built for them?’: Explaining toilet use in Chhattisgarh, Central India. Contrib Indian Sociol. 2021; 55 (1): 89–115. DOI: 10.1177/0069966720972565.

16. Sari AFK, Azizah R, Jalaludin J, et al. A review of open defecation (OD) in Indonesia and the control with logic model. Malaysian J Med Heal Sci. 2022; 18 (2): 157–165.

17. Yolanda K, Katmawanti S, Hapsari A, et al. Literature review: Predisposing, enabling and reinforcing factors that influence community open defecation behavior in Indonesia. In: Proceedings of the International Conference on Sports Science and Health (ICSSH 2022). Atlantis Press International; 2022. p. 88–120. DOI: 10.2991/978-94-6463-072-5_11.

18. Vyas S, Srivastav N, Mary D, et al. Measuring open defecation in India using survey questions: Evidence from a randomised survey experiment. BMJ Open. 2019; 9 (9): e030152. DOI: 10.1136/bmjopen-2019-030152.

19. Jain A, Wagner A, Snell-Rood C, et al. Understanding open defecation in the age of Swachh Bharat Abhiyan: Agency, accountability, and anger in rural Bihar. Int J Environ Res Public Health. 2020; 17 (4): 1384. DOI: 10.3390/ijerph17041384.

20. Friedrich M, Balasundaram T, Muralidharan A, et al. Increasing latrine use in rural Karnataka, India using the risks, attitudes, norms, abilities, and self-regulation approach: A cluster-randomized controlled trial. Sci Total Environ. 2020: 707: 135366. DOI: 10.1016/j.scitotenv.2019.135366.

21. Harter M, Mosch S, Mosler HJ. How does community-led total sanitation (CLTS) affect latrine ownership? A quantitative case study from Mozambique. BMC Public Health. 2018; 18 (1): 387. DOI: 10.1186/s12889-018-5287-y.

22. Tumwebaze IK, Mosler HJ. Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums. Soc Sci Med. 2015; 147: 72–79. DOI: 10.1016/j.socscimed.2015.10.059.

23. Golla EB, Gelgelu TB, Adane MD, et al. Latrine utilization and associated factors among rural households in Southwest Ethiopia: Risk, attitude, norms, ability, and self-regulation behavioral model. Environ Health Insights. 2023; 17: 11786302231163956. DOI: 10.1177/11786302231163956.

24. Roebianto A, Savitri SI, Suciyana A, et al. Content validity: Definition and procedure of content validation in psychological research. Test Psychom Method Appl Psychol. 2023; 30: 5-18. DOI: 10.4473/TPM30.1.1.

25. Abdullah L, Jusoh Z. Validating content of sentence variety checklist for ESL writing. Int J Acad Res Progress Educ Dev. 2017; 6 (3): 81–91. DOI: 10.6007/IJARPED/v6-i3/3164.

26. Yusoff MSB. ABC of content validation and content validity index calculation. Educ Med J. 2019; 11 (2): 49–54. DOI: 10.21315/eimj2019.11.2.6.

27. Said NAM, Bujang SM, Buang NA, et al. Critical thinking transfer practice instrument: A content validity calculation steps based on expert panel evaluation. Educ Med J. 2022; 14 (3): 61–74. DOI: 10.21315/eimj2022.14.3.5.

28. Alemu F, Kumie A, Medhin G, et al. The role of psychological factors in predicting latrine ownership and consistent latrine use in rural Ethiopia: A cross-sectional study. BMC Public Health. 2018; 18: 229. DOI: 10.1186/s12889-018-5143-0.

29. Ersche KD, Lim TV, Ward LHE, et al. Creature of habit: A self-report measure of habitual routines and automatic tendencies in everyday life. Pers Individ Dif. 2017; 116: 73–85. DOI: 10.1016/j.paid.2017.04.024.

30. Persada SF, Miraja BA, Prasetya P, et al. Understanding Indonesian citizen’s intentions to take personal protective measures and follow a stay-at-home order to limit the spread of COVID-19. Humanit Soc Sci Rev. 2020; 8 (5): 158–168. DOI: 10.18510/hssr.2020.8515.

31. Setyoadi S, Kartika AW, Hayati YS, et al. Community empowerment program to increase individual empowerment of cadres in stunting prevention. J Aisyah J Ilmu Kesehat. 2023; 8 (2): 1097–1104. DOI: 10.30604/jika.v8i3.2069.

32. Wagiono F, Shaddiq S, Junaidy J, et al. Community habits in floating houses (lanting) in utilizing the river as an shower, wash, and toilet (MCK) facility in the S. Parman down area neighborhood 01 Hamlet XVII Palangka Raya. JED J Etika Demokr. 2022; 7 (1): 109–121. DOI: 10.26618/jed.v7i1.6770.

Share

COinS