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Table 2 Theoretical models of WASH and WASH-related behaviours included in the systematic review

From: The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings


Behaviour or outcome of focus

Included determinants

Environmental Health Project et al. 2004 [1]

Diarrheal prevention

Access to hardware: water supply systems, improved sanitation, household technologies

Hygiene promotion: communication, social mobilization, community participation, social marketing, advocacy

Enabling environment: policy improvement, institutional strengthening, community organization, financing, partnerships

Rainey and Harding, 2005 [28]

Household water treatment (SODIS)

Application of the Health Belief Model, including:

Individual perceptions: perceived severity and perceived susceptibility to disease (diarrhoea)

Modifying factors: demographic variables, socio-economic variables, structural variables; perceived threat of disease; cues to action

Likelihood of Action: perceived benefits of taking action minus perceived barriers, perceived efficacy of action and ability to complete it, likelihood of taking action

Jenkins and Scott, 2007 [32]


Preference (motivation): dissatisfaction with current practices, awareness of options

Intention: priority of change among competing goals, absence of permanent constraints to acquiring sanitation

Choice: absence of temporary constraints to acquiring sanitation

Curtis et al. 2009 (elaborated in Curtis et al. 2011) [34, 35]

Handwashing with soap

Planning: teaching children manners

Motivation: disgust, norms, conform, nurture

Habit: train children, tips to train oneself

Social norms

Physical facilities: cues, costs

Biological signs of contamination

Devine, 2009 / Coombes and Devine, 2010 [39, 67]

Handwashing (FOAM) and Sanitation (SaniFOAM)

Opportunity: access / availability, product attributes, social norms (FOAM), sanction/enforcement (SaniFOAM)

Ability: knowledge, social support (FOAM), skills and self-efficacy, roles and decisions, affordability (SaniFOAM)

Motivations: beliefs and attitudes, outcome expectations, threat, intention (FOAM), values, emotional/physical/social drivers competing priorities, willingness-to-pay (SaniFOAM)

Figueroa and Kincaid, 2010 [37]

Household water treatment and storage

Individual: knowledge / skills, attitudes, perceived risk and severity, subjective norms, self-image, emotional response, self-efficacy, empathy & trust, social influence, personal advocacy

Household: time allocation, family support, resources, decision making

Community: value for water quality, leadership, action, resources, cohesion

Environmental/context: burden of disease, WASH technologies, community infrastructure, socio-demographic infrastructure, income inequality

Wood et al. 2011 [31]

Household water treatment (filters)

Awareness: Perceived need, awareness of products, assess value of products and relevance to lives

Action: trial / initial use, sustained use

Maintenance: purchase, sustained use

Mosler, 2012 [36]

WASH practices (general)

Risk factors: perceived vulnerability, perceived severity, factual knowledge

Attitude factors: Instrumental beliefs, affective beliefs

Normative Factors: descriptive, injunctive, and personal norm

Ability Factors: Action knowledge, self-efficacy, maintenance efficacy, recovery efficacy

Self-Regulation Factors: action control / planning, coping planning, remembering, commitment