Trial reportSocial science & medicine (1982)2020
How does Community-Led Total Sanitation (CLTS) promote latrine construction, and can it be improved? A cluster-randomized controlled trial in Ghana.
Trial report in Social science & medicine (1982), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Community-based interventions addressing open defecation in Sub-Saharan Africa: a scoping review.Global health action · 2026Article
- Social, environmental and policy contexts affecting the feasibility and acceptability of improving household flooring for better health in rural Kenya.PLoS neglected tropical diseases · 2026Article
- Effects of an integrated intervention on schistosomiasis prevalence in a rural area of Tanzania.PLoS neglected tropical diseases · 2025Article
- Article
- Water, Sanitation, and Hygiene for Everyone Intervention Study: Protocol for a Controlled Before-and-After Trial.JMIR research protocols · 2025Article
- Risk Perception and Psychosocial Factors Influencing Exposure to Antimicrobial Resistance through Environmental Pathways in Malawi.The American journal of tropical medicine and hygiene · 2025Article
- Evaluating and Enhancing an Educational Intervention to Reduce Smallholder Farmers' Exposure to Pesticides in Uganda Through a Digital, Systematic Approach to Behavior Change: Protocol for a Cluster-Randomized Controlled Trial.JMIR research protocols · 2024Article
- The process, outcomes and context of the sanitation change induced by the Swachh Bharat Mission in rural Jharkhand, India.BMC public health · 2024Article
- Inclusion of persons living with disabilities in a district-wide sanitation programme: A cross-sectional study in rural Malawi.PLOS global public health · 2024Article
- What works in sanitation promotion?Health promotion international · 2023Article
- Contextualized Measurement Scale Adaptation: A 4-Step Tutorial for Health Psychology Research.International journal of environmental research and public health · 2022Article
- Understanding safe water-carrying practices during pregnancy and postpartum: A mixed-methods study in Nepal.Applied psychology. Health and well-being · 2022Review
- Frameworks for mitigating the risk of waterborne diarrheal diseases: A scoping review.PloS one · 2022Article
- Review
- Norms and Social Network-Centric Behavior Change Intervention (Nam Nalavazhvu) for Improved Toilet Usage in Peri-Urban Communities of Tamil Nadu: Protocol for a Cluster-Randomized Controlled Trial.JMIR research protocols · 2021Article
- The role of social identification for achieving an open-defecation free environment: A cluster-randomized, controlled trial of Community-Led Total Sanitation in Ghana.Journal of environmental psychology · 2019Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
rationaleOpen defecation is connected to poor health and child mortality, but billions of people still do not have access to safe sanitation facilities. Community-Led Total Sanitation (CLTS) promotes latrine construction to eradicate open defecation. However, the mechanisms by which CLTS works and how they can be improved remain unknown. The present study is the first to investigate the psychosocial determinants of CLTS in a longitudinal design. Furthermore, we tested whether CLTS can be made more effective by theory- and evidence-based interventions using the risks, attitudes, norms, abilities, and selfregulation (RANAS) model.
methodsA cluster-randomized controlled trial of 3216 households was implemented in rural Ghana. Communities were randomly assigned to classic CLTS, one of three RANAS-based interventions, or to the control arm. Prepost surveys at 6-month follow-up included standardized interviews assessing psychosocial determinants from the RANAS model. Regression analyses and multilevel mediation models were computed to test intervention effects and mechanisms of CLTS.
resultsLatrine coverage increased pre-post by 67.6% in all intervention arms and by 7.9% in the control arm (p < .001). The combination with RANAS-based interventions showed non-significantly greater effects than CLTS alone. The effects of CLTS on latrine construction were significantly mediated by changes in four determinants: others' behaviour and approval, self-efficacy, action planning and commitment. Changes in vulnerability, severity, and barrier planning were positively connected to latrine construction but not affected by CLTS.
conclusionThis study corroborates the effectiveness of CLTS in increasing latrine coverage, and additional activities can be improved further. Behaviour change techniques within CLTS that strengthened the relevant factors should be maintained. The study also recommends interventions based on the RANAS approach to improve CLTS. Further research is needed to understand the effects of RANAS-based interventions combined with CLTS at longer follow-up.
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