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Table 1 Categorization matrix

From: Contextual and psychological factors influencing open defecation free status: an exploratory qualitative study in rural South Western Uganda

RANAS model categories RANAS model sub categories Description of the codes Quotes
High statement for attaining ODF Low statement for attaining ODF
Risk factors perceived health risks Diseases associated with individuals not living in an ODF environment “Typhoid is the commonest but the problem with people in this village, when they feel ill, they just go to clinic and ask for drugs...without testing to know which disease they are suffering from.” (FGD, participant)  
Perceived vulnerability Children were perceived as the ones most affected by the ODF status   “We normally get cholera in children though they try and provide treatment but its common among children.” (FGD, participant)
“For the old people, it’s not common for them to get diarrhea and when one gets it, he just thinks it’s what he has eaten or drank…. most say that maybe they have taken poor quality porridge or food and the stomach reacted like that” (FGD, participant)
Perceived severity Low perceived severity if you live in a household without the ODF status   “...most people are aware that malaria leads to death, most people slept under mosquito net but they don’t know the diseases which they get from toilet can kill them. They just get worms, go for medication and they become Okay..” (FGD, participant)
“...if we had got someone dying after visiting latrine and leaving without covering, we should be covering them [using latrine covers to control flies] but we had never got such case in our area” (FGD, participant)
Factual knowledge Knowledge on oral fecal transmission “It’s [diarrhea] caused by flies because when we are neighbors, they fly from one household to another. So that is why you find like 4 families in one village, their children are having diarrhea. Even the old people may be having diarrhea but they cannot disclose it.” (FGD, participant). “...no one can say that the child got diarrhea because of dirtiness [feacal contamination]. They just say the child has got a stomach reaction [abdominal upset].” (FGD, participant)
Knowledge of ODF components   “…So they don’t know the importance of those covers [pit latrine covers for flies control].” (FGD, participant)
“People don’t wash hands because they don’t know the outcomes of it….. If they are aware that they can get diseases, I think they should be washing their hands.” (FGD, participant)
Attitude factors Positives and negatives: Costs/benefits for ODF behaviour less importance attached to ODF components such as handwashing facility and latrine cover   “Lack of seriousness is caused by the value attached to it [handwashing facility]. People thinking it’s a small thing and keep postponing doing it…” (FGD, participant)
“...Even those who put the water jerricans for handwashing, many of them it’s like a decoration, washing is less…” When people hear that VHTs are coming, it’s when they use them but most of the time, those latrine covers are always in the corner [inside pit latrine’s floor corner].” (FGD, participant)
Wastage of resources put into attaining ODF status   “...in this village, people have that feeling of wastage of time to have a clean household (ODF).”
“..like apiece [a piece of soap] of 1000, there is one who calculates that the soap which he can keep putting at the latrine it can be spoiling my money...” (KII, participant)
Economic benefits attached to living in ODF environment “For sure such homes [homes with ODF components] don’t spend much due to sickness [faecal related diseases] and they end up developing but those who normally spent on these diseases [faeacal related] may end up in poverty.” (FGD, participant)
“.....you save on the money and the time that you will be spending on the hospital, so you have time to do other things….” (FGD, participant)
 
Health benefits attached to an ODF environment “….you are protecting your health and that of your family members. Secondary, they cannot get such diseases that are caused by dirtiness…..” (FGD, participant)  
Affective aspect Peaceful feeling when living in an ODF household “…you feel having peace and your family cannot get disease” (FGD, participant)  
Proud for having living in an ODF household “..I found that I was one of those having a washing point…..... So that makes you feel comfortable in the heart and when people are passing around, you feel proud and even happy.” (FGD, participant)  
Norm factors descriptive norm (perceptions of ODF status by others)
Injunctive norm (perceptions of ODF approved by important others).
Individuals living in households with ODF status were perceived to be more educated “They see that family [with ODF behaviour] as educated and they know what they are doing.” (FGD, participant)  
Individuals practicing ODF behavior such as handwashing after visiting latrine where perceived to be wasting time on less important things   “...neighbors may think you are wasting time because they are spending some time without getting sick and they see you trying to put everything [handwashing facilities, latrine with latrine cover]] in place, they say you are wasting time.” (FGD, participant)
“...Some take you to be a fool that what you are doing is nothing and yet you are doing cleanliness.” (FGD, participant)
Individuals demonstrating ODF behavior were perceived to show off/proud   “People think it’s because he is rich. Others say you are proud.” (FGD, participant)
“They see you as a pretender. Another person may choose to pick the jerrycan and throw it away simply because they look at that person as a pretender...a behavior of washing hands after visiting a latrine. It doesn’t look normal to many.” (FGD, participant)
Approval of ODF households by important others such as religious leaders “...when those people [important others] come to your home and find you are clean, they sit comfortably and even if you offer them food or a drink, they feel free to take it..” (FGD, participant)  
Ability factors Confidence to maintain ODF High confidence “Most of the things can be done because we use our own hands to put them in place….... Even you may find you have like 3 to 6 jerrycans at home which are normally scattered in the compound not broken and you fail to put water in it and put it at the latrine. So we have the capacity to put such things in place..” (FGD, participant)  
Low confidence   “When we talk of capacity [to have ODF components], me I see may be having soap, you cannot fail to have soap for washing or bathing and you get one to put on the toilet…” (FGD, participant)
Action knowledge for ODF items eg. latrine items and tippytape High action knowledge “..people used to make latrine covers from banana fibers instead of timber because they knew how to do them…..So things are possible….they are knowledgeable”.  
Materials for ODF components “..the resources [items] are very available. Because Kabale is blessed with enough trees. So, one can’t use that as excuse for not building a latrine…. toilet covers can be made locally. And they know that they have the resources to construct them.” (KII, participant)  
Self-regulation factors capability to plan and self-monitor including managing contradictory goals and distractions Discouragement related to loss or destruction of an ODF component   “...but they kept stealing the soap. I got discouraged and leave them.” (FGD, participant)
Commitment to replacing destroyed or missing ODF components such as handwashing facility “I keep replacing it because I know its importance”  
Contextual factors Social context Farming activities away from home where there are no latrines   “...I may be having my latrine here and wanted to go and cut my trees up the hill there. So, when I go to cut them and I am spending the whole day there, do you think I can come to defecate and go back? I just defecate there because you cannot put toilet in every bush”. (FGD, participant)
“.. When we go digging, we tend to use the gardens for our defecation.” (FGD, participant)
  low-household income level   “It also depends on the income of someone. I cannot fail to have one [piece of soap] for bathing or washing clothes and buy the one to put on the latrine..... So, I think if there is a possibility of an alternative like detergents that dissolve in water and is given by government to people, this can help everyone to comply.” (FGD, participant)
  Ash use replacing latrine covers for controlling flies   “..Bakiga are intelligent, when the latrine start smelling and flies come out, they pour ash inside and the smell goes even the flies.” (FGD, participant)
  Gender roles which lead men to be less involved in ensuring that their households are ODF   “For us Bakiga, we believe that a man is the head of the family and depending on our responsibilities, when am home with my wife, I tell her to clean up the place…....according to Bakiga culture, such responsibilities [removing children feaces from compound] belong to wives and in most cases, they are the ones to take care of the children”. (FGD, participant)
“The man digs [pit latrine hole] it after he builds it when he finishes it, issues of water [hand washing water] and the rest are for the woman; you find the woman saying that you leave these things for me”. (KII participant)
  community by-laws “...when leaders pass around and find for example a person with no latrine or its not clean, they fine you” (FGD, participant)
“...The ones [latrines] we find full, we put them down and give you the deadline for putting up another one and on top of that, they fine you with shs. 20,000/= [approximately USD 6]”. (FGD, participant)
“The laws at village level were there but with time, those laws lost value...”. (FGD, participant)
“...These days we are somehow helped by the VHTs, but even if they get you and take you to prison, even those who take you, they find you home by the time they return meaning, the laws are not strengthen and the penalties are not there”. (FGD, participant)
“...Even if you arrest someone like now for not having a toilet, he would be home again in a few minutes as the politicians will say that you are spoiling their votes.” (KII, participant)
  Information access “...a person who is sensitized there is how he can slightly change, you find that he is not like the other one because there is when I come with the health people, they come and say that let us go and inspect [household sanitation inspection], when they do the inspection, you find before the end of the month you find that there is a difference, you find that there is something that has changed [towards attaining ODF components].” (KII, participant) “We are not informed and that’s why most don’t wash hands after visiting latrine. In case we have leaders to educate us, like they blow whistle [calling community gathering], gather people and tell them what they are supposed to do, I think they can do ....” (FGD, participant)
“...I met a man from those hills who found a jerrycan of water and soap [handwashing facility] at the toilet and asked me the importance of them. He was not informed of its importance, so others fail to do them because they are not aware of them or are not taught.” (FGD, participant)
  Shared latrines “Since we have nearby households in this area of Mushenyi like less than 10 m apart or even less and since we coordinate with each other, toilets are not locked and one can use for the neighbor…” “..you find an extended homestead with about 4 households all using the same latrine. So, at times it may happen when its dirty [soiled] and none is willing to clean it. All end up abandoning it.” (FGD, participant)
  Physical context Water access   “...someone from up the hill fetches water from valley and as I talk is still in the garden up to 4:00 pm. From there he will come with one jerrycan to fetch water which is to be used for drinking and cooking then after goes back to fetch for bathing. So, it becomes hard for this person to get like 3 l [water] to put it the small jerrycan on the latrine...” (FGD, Participant)
  Temporary latrines   “When you are leaving in a place where there are ants in low areas or in places which are soft and you build with wood which they normally use here, latrines reach time and fall....” (FGD, participant)
“...when it’s at night, I cannot also move to look for toilet for fear that it might fall on me when no one knows. So, I also defecate on the roadside.” (FGD, participant)
  Rainy seasons   “In this area we are living in is water logged place and in rainy season, some latrines fall down and it take some time to be reconstructed, may be after when the rainy season is over. So, during that period, even if they say they have toilets but they are not in good conditions.” (FGD, participant)
  Small land size   “...you might find someone had a small plot and after construction of a house, there is nowhere to put the latrine.” (FGD, participant)
  Soft collapsible soils   “...I was telling you about our soils on the mountains, a person can be staying on the mountain, he builds his good latrine after 1 year when the rain comes it washes everything away….this year, the latrines that have fallen are not below 50 and all of them fell within 2 months.” (KII, participant)
  Personal context Young children contributing to failure open defecation practice   “In our village….., the child defecates wherever they are, either in the house or compound and its up to parents/ caretakers….3 years and below, they defecate wherever they are. So, when you are a dirty person, you find feces everywhere in the house, veranda, compound etc. or you find [children feaces] for 3 or 4 days still there”. (FGD, participant)
  Alcohol abuse contributing to open defecation   “... drunkards who defecate in gardens and along the road because they have no time to look for toilet and they use [defecate] wherever they see and go.” (FGD, participant)
  Vulnerable individual such as older persons unable to put in place the ODF components   “…widows are the ones who have no latrines.” (FGD, participant)
“...aged ladies who cannot afford to have such things [latrine, handwashing facility, latrine covers] and cannot get someone to build them toilets.” (FGD, participant)