Determination of Psychosocial Factors of Drinking Chlorinated Water to Design Behavior Change Interventions in Rohingya Camps in Bangladesh

Am J Trop Med Hyg. 2022 Feb 7;106(4):1126-1134. doi: 10.4269/ajtmh.21-0313. Print 2022 Apr 6.

Abstract

The purpose of this study was to identify the psychosocial factors of chlorinated water uptake and to design effective behavior change techniques applying the risk, attitude, norm, ability, and self-regulation (RANAS) behavior change model. This cross-sectional study was conducted in two Rohingya refugee camps in Cox's Bazar, Bangladesh. In total, 596 respondents were recruited through systematic random sampling. A structured interviewer-administered questionnaire was used to assess the psychosocial factors according to the RANAS model. We used correlation analysis and multivariable linear regression models to predict the psychosocial factors of the consumption of chlorinated water. The respondents in this study had a medium to high habit of drinking chlorinated water. For the overall sample, participants' habits were predicted by income, perceived vulnerability, like of chlorinated water, feelings of being healthy, action planning skills, and coping planning skills. In Camp 14, income, vulnerability, and coping planning were strongly influential in predicting habit; in Camp 16, liking chlorinated water and action planning were the most influential factors. Behavior change techniques against each factor with proper communication channels have been proposed for the overall sample and specific to each camp. The psychosocial factors identified and the behavior change strategies proposed in this study may help to promote chlorinated water consumption among the camp population. This study also recommends follow-up research that considers more contextual factors, uses larger sample sizes, and examines the effectiveness of the intervention.