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Abstract
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Before
The proposed study is organized around a well-designed and rigorous RCT aimed at identifying the role of knowledge dissemination, skills training and regular practice, achieved by goal setting and regularly monitoring (either by project facilitators/trainers or by local peers), in the sustained adoption of good WASH-related practices. The idea is not only to replace bad habits with good ones but also to maintain them by slow habit formation with the help of regular monitoring, motivation and encouragement. This research endeavor encapsulates about 2,000 mother-child dyads hailing from 100 distinct slum clusters situated in the district of Kanpur in Uttar Pradesh, India. We will focus on mothers aged 18-45 years with a child below five years i.e. the focus will be on targeted mothers to see if good hygienic and sanitary practices can be adopted in a more sustained manner. The overall focus of the study will not be on adoption but persistent and continued adoption or habit formation. We will also focus on transmission of good habits from mothers to young kids thereby leading to early childhood development.
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After
The proposed study is organized around a well-designed and rigorous RCT aimed at identifying the role of knowledge dissemination, skills training and regular practice, achieved by goal setting and regularly monitoring (either by project facilitators/trainers or by local peers), in the sustained adoption of good WASH-related practices. The idea is not only to replace bad habits with good ones but also to maintain them by slow habit formation with the help of regular monitoring, motivation and encouragement. This research endeavor encapsulates about 2,500 mother-child dyads hailing from 110 distinct slum clusters situated in the district of Kanpur in Uttar Pradesh, India. We will focus on mothers aged 18-45 years with a child below five years i.e. the focus will be on targeted mothers to see if good hygienic and sanitary practices can be adopted in a more sustained manner. The overall focus of the study will not be on adoption but persistent and continued adoption or habit formation. We will also focus on transmission of good habits from mothers to young kids thereby leading to early childhood development.
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Last Published
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Before
October 28, 2024 01:34 PM
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After
May 27, 2025 01:26 PM
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Intervention (Public)
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Before
There will be two different treatment arms in the proposed study, in addition to the control arm:
Control group: Information and skills training: 800 mother-child pairs (from 40 slums). There will be no pure control group.
Treatment 1: Information and skills training + Individual Monitoring (n=600): 600 mother-child pairs (from 30 slums).
Treatment 2: Information and skills training + Peer monitoring (n=600): 600 mother-child pairs (from 30 slums)
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After
There will be two different treatment arms in the proposed study, in addition to the control arm:
Control group: Information and skills training: About 900 mother-child pairs (from 40 slums). There will be no pure control group.
Treatment 1: Information and skills training + Individual Monitoring (About 800 mother-child pairs from 35 slums).
Treatment 2: Information and skills training + Peer monitoring (About 800 mother-child pairs from 35 slums)
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Intervention End Date
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February 28, 2025
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After
May 15, 2025
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Primary Outcomes (End Points)
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Before
The main objective of the proposed project is to help understand the major determinants of going from knowledge to action that is adopting and maintaining (sustained use/regular practice) safe wash, sanitation, and hygienic behavior. We will focus on three sets of outcomes here: respondent and child-assessed subjective outcomes; behavioural outcomes (revealed preference for hygienic behaviours and products) and objective outcomes (evaluator assessed or directly collected).
We want to gauge whether and to what extent the treatments positively improve wash, sanitation, and hygiene related knowledge (a knowledge index constructed from responses to MCQs by mothers), habit/practice indicators (for both mothers as well as their children) and overall health and development captured using health indicators to gauge the immunity and liveliness of the child and mother (frequency of illness, etc). In addition, we will conduct enumerator assessments to asses to what extent the respondent has followed the protocols in terms of keeping self, their child, house and area around the house clean (detailed objective assessments). Hand swabs and revealed preference games will also be conducted on a sub-sample of randomly selected households (and participants/respondents) from both treatment and control clusters to check for cleanliness and assess behavioural or change in preferences/attitudes. We will also focus on household expenditures on cleaning and hygienic products, and substitution if any.
While there will be no spillover from treatment group to control group as we will randomize at the slum level, there may be significant spillover effects within the household, which we will capture via behavioral changes among non-targeted participants from the same household i.e. other household members such as husband of the respondents and other siblings of the targeted child, friends of the mothers and nearest neighbors (i.e. the focus will be on members in the study participant’s social networks).
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After
The main objective of the proposed project is to help understand the major determinants of going from knowledge to action that is adopting and maintaining (sustained use/regular practice) safe wash, sanitation, and hygienic behavior. We will focus on three sets of outcomes here: respondent and child-assessed subjective outcomes; behavioural outcomes (revealed preference for hygienic behaviours and products) and objective outcomes (evaluator assessed or directly collected).
We want to gauge whether and to what extent the treatments positively improve wash, sanitation, and hygiene related knowledge (a knowledge index constructed from responses to MCQs by mothers), habit/practice indicators (for both mothers as well as their children) and overall health and development captured using health indicators to gauge the immunity and liveliness of the child and mother (frequency of illness, etc). In addition, we will conduct enumerator assessments to asses to what extent the respondent has followed the protocols in terms of keeping self, their child, house and area around the house clean (detailed objective assessments). Revealed preference games will also be conducted with the households (and participants/respondents) from both treatment and control clusters to check for cleanliness and assess behavioural or change in preferences/attitudes. We will also focus on household expenditures on cleaning and hygienic products, and substitution if any.
While there will be no spillover from treatment group to control group as we will randomize at the slum level, there may be significant spillover effects within the household, which we will capture via behavioral changes among non-targeted participants from the same household i.e. other household members such as husband of the respondents and other siblings of the targeted child, friends of the mothers and nearest neighbors (i.e. the focus will be on members in the study participant’s social networks).
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Experimental Design (Public)
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Before
This research endeavor encapsulates about 2,000 mother-child dyads hailing from 100 distinct slum clusters situated in the district of Kanpur in Uttar Pradesh, India. We will focus on mothers aged 18-45 years with a child below five years i.e. the focus will be on targeted mothers to see if good hygienic and sanitary practices can be adopted in a more sustained manner. These 2,000 individuals will be randomly assigned to two treatments and one control group. While 1,200 mother-child dyads (from 60 slums) will be randomly assigned to the treatment groups (30 slums in each of the two treatments), 40 slums and the remaining 800 mother-child dyads will be assigned to the control group. Randomization will be done at the slum-level.
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After
This research endeavor encapsulates about 2,500 mother-child dyads hailing from 110 distinct slum clusters situated in the district of Kanpur in Uttar Pradesh, India. We will focus on mothers aged 18-45 years with a child below five years i.e. the focus will be on targeted mothers to see if good hygienic and sanitary practices can be adopted in a more sustained manner. These ~2,500 individuals will be randomly assigned to two treatments and one control group. While about 1,600 mother-child dyads (from 70 slums) will be randomly assigned to the treatment groups (35 slums in each of the two treatments), 40 slums and the remaining 900 mother-child dyads will be assigned to the control group. Randomization will be done at the slum-level.
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Planned Number of Clusters
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100 slums
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After
110 slums
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Planned Number of Observations
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2000 mother-child dyads.
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After
About 2500 mother-child dyads.
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Sample size (or number of clusters) by treatment arms
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Before
Number of observations: While there will be 600 mother-child dyads (from 30 slums) in treatment 1, there will be another 600 mother-child dyads (from 30 slums) in treatment 2, finally, the remaining 800 mother-child dyads (from 40 slums) will be assigned to the control group.
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After
Number of observations: While there will be about 800 mother-child dyads (from 35 slums) in treatment 1, there will be another 800 mother-child dyads (from 35 slums) in treatment 2, finally, the remaining 900 mother-child dyads (from 40 slums) will be assigned to the control group.
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Intervention (Hidden)
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Before
Control Group: Information and skills training: 800 mother-child pairs (from 40 slums) will serve as the control group and will not receive any monitoring interventions. In the control group, we shall focus on delivering to these households detailed information on safe hygiene and sanitation practices. We shall focus on information dissemination and providing guidelines emphasizing the importance of hand washing frequently; avoiding open defaecation and adopting safe sanitation practices; importance of safe and clean drinking water, cleaning the floors and surfaces regularly; and the adverse effects of mould infestation at home and infection on skin and techniques that can be adopted to eliminate it. The targeted individuals will also be briefed about the different products that can purchased from the local market to address these issues. Interestingly, most households will already be using them or knowing about handwash but our focus will be on the right technique, and effective use and filling in gaps if any exist. So, this will be a combination of knowledge and skills training via on-site demonstration. We will also tell them about the goals that can be achieved.
There will be no pure control group as the focus of the study is to find cost effective solutions to continued adoption of hygienic practices—facilitator/trainer-based or peer-based monitoring. We already know that knowledge alone is not enough and there is often disadoption as soon as the intervention or incentive is stopped. The next goal is to identify the best intervention that can lead to continued use.
There will therefore be two different treatment arms in the proposed study:
Treatment 1: Information and skills training + Individual Monitoring (n=600): 600 mother-child pairs (from 30 slums) selected randomly from a list of 100 slums will be randomly assigned to Treatment 1. In addition to the information and skills training as provided in control group, we will also engage the Treatment 1 households in a rigorous self-goal-setting and achieving exercise, with support and regular monitoring (via random visits) by facilitators/counsellors from the research/project team. These households will be provided with continuous support, regular monitoring and comprehensive guidance so that they adopt and continue with these safe and good habits. Households will also be helped and guided to set goals for themselves and achieve them. Thus, treatment 1 will entail a combination of knowledge, skill and desire brought about by goal setting and commitment via grit and a sense of internal locus of control, thereby leading to adoption and regular practice. Project facilitators will visit them once every month.
Treatment 2: Information and skills training + Peer monitoring (n=600): In treatment 2, instead of continued visits by project facilitators as in Treatment 1, after the information sessions and skills training, the same will be provided by peers. Each mother from the slum will be randomly matched with another mother i.e. a 1:1 matching will be done with peers (other mothers) from the same community (slum), to be referred to as WASH-buddies. They will regularly monitor, support, motivate and encourage each other so that both adopt these good habits. At the end of the survey, the best group will be rewarded based on evaluations made by WASH-evaluators.
There will be a bi-monthly visit by WASH-evaluators (a separate team compared to the project facilitators/trainers to eliminate any bias; with focus on standardized training and objective evaluations) to check how the households are adopting the WASH practices. All evaluations for all treatment and control group will be done by trained WASH evaluators. The performance of the control group will be compared to Treatment 1 to find the effectiveness of facilitator monitoring while comparing the control with the treatment 2 households will help us understand the effect of the peer monitoring exercise. The idea is to achieve regular and persistent use. We will compare the effects of the two treatments and calculate cost per SD effect to find which of the two interventions is most cost effective and can be scaled up in the future for policy purposes.
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After
Control Group: Information and skills training: About 900 mother-child pairs (from 40 slums) will serve as the control group and will not receive any monitoring interventions. In the control group, we shall focus on delivering to these households detailed information on safe hygiene and sanitation practices. We shall focus on information dissemination and providing guidelines emphasizing the importance of hand washing frequently; avoiding open defaecation and adopting safe sanitation practices; importance of safe and clean drinking water, cleaning the floors and surfaces regularly; and the adverse effects of mould infestation at home and infection on skin and techniques that can be adopted to eliminate it. The targeted individuals will also be briefed about the different products that can purchased from the local market to address these issues. Interestingly, most households will already be using them or knowing about handwash but our focus will be on the right technique, and effective use and filling in gaps if any exist. So, this will be a combination of knowledge and skills training via on-site demonstration. We will also tell them about the goals that can be achieved.
There will be no pure control group as the focus of the study is to find cost effective solutions to continued adoption of hygienic practices—facilitator/trainer-based or peer-based monitoring. We already know that knowledge alone is not enough and there is often disadoption as soon as the intervention or incentive is stopped. The next goal is to identify the best intervention that can lead to continued use.
There will therefore be two different treatment arms in the proposed study:
Treatment 1: Information and skills training + Individual Monitoring. About 800 mother-child pairs from 35 slums selected randomly from a list of 110 slums will be randomly assigned to Treatment 1. In addition to the information and skills training as provided in control group, we will also engage the Treatment 1 households in a rigorous self-goal-setting and achieving exercise, with support and regular monitoring (via random visits) by facilitators/counsellors from the research/project team. These households will be provided with continuous support, regular monitoring and comprehensive guidance so that they adopt and continue with these safe and good habits. Households will also be helped and guided to set goals for themselves and achieve them. Thus, treatment 1 will entail a combination of knowledge, skill and desire brought about by goal setting and commitment via grit and a sense of internal locus of control, thereby leading to adoption and regular practice. Project facilitators will visit them once every month.
Treatment 2: Information and skills training + Peer monitoring (Remaining 800 mother child pairs): In treatment 2, instead of continued visits by project facilitators as in Treatment 1, after the information sessions and skills training, the same will be provided by peers. Each mother from the slum will be randomly matched with another mother i.e. a 1:1 matching will be done with peers (other mothers) from the same community (slum), to be referred to as WASH-buddies. They will regularly monitor, support, motivate and encourage each other so that both adopt these good habits. At the end of the survey, the best group will be rewarded based on evaluations made by WASH-evaluators.
There will be visits by WASH-evaluators (a separate team compared to the project facilitators/trainers to eliminate any bias; with focus on standardized training and objective evaluations) to check how the households are adopting the WASH practices. All evaluations for all treatment and control group will be done by trained WASH evaluators. The performance of the control group will be compared to Treatment 1 to find the effectiveness of facilitator monitoring while comparing the control with the treatment 2 households will help us understand the effect of the peer monitoring exercise. The idea is to achieve regular and persistent use. We will compare the effects of the two treatments and calculate cost per effect to find which of the two interventions is most cost effective and can be scaled up in the future for policy purposes.
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Secondary Outcomes (End Points)
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Before
As part of the secondary outcomes, we will also focus on physical, mental health condition, cognitive, non-cognitive and psychosocial outcomes of both mothers as well as their children. For mothers: we will particularly focus on different aspects of mental health such as perceived stress, anxiety, depression as well as overall wellbeing (satisfaction with life, marital relationship and family), labor market outcomes (employment and income), and time-use (effort, preparation, leisure, socializing, etc). For children, we will also focus on attendance, learning outcomes and also anthropometric outcomes (in the long run via a round of follow-up survey).
We will also focus on empowerment and autonomy related indicators, mobility and decision-making within the household, gender bias, inequality and discrimination, support from family (quality of support), lab-in-the field games to capture risk, time preference and preference for healthy living and other survey based preference indicators such as trust, reciprocity, altruistic behaviour, etc.
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After
As part of the secondary outcomes, we will also focus on physical, mental health condition, cognitive, non-cognitive and psychosocial outcomes of both mothers as well as their children. For mothers: we will particularly focus on different aspects of mental health such as perceived stress, anxiety, depression as well as overall wellbeing (satisfaction with life, marital relationship and family), labor market outcomes (employment and income), and time-use (effort, preparation, leisure, socializing, etc). For children, we will also focus on attendance, learning outcomes and also anthropometric outcomes (in the long run via a round of follow-up survey).
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