Exploring determinants of community led total sanitation (clts) on latrine adoption among rural cambodians utilizing the diffusion of innovation theory: a pragmatic approach

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Open defecation is a global health problem in which 90% of the cases observed occur in rural settings among developing countries. Individuals exposed to open defecation may face higher risks of diarrheal diseases and health consequences. Basic sanitation facilities may mitigate adverse health effects associated with open defecation. In Cambodia, the lowest percentage of basic sanitation (48.3%) has been reached compared to neighboring countries. This dissertation research explored determinants of Community Led Total Sanitation on latrine construction and usage among rural Cambodians. This exploration was guided by diffusion of innovation theory. This multi-site study included a stratified sample of six community meetings (n=61) conducted across six villages in two districts of Pursat Province, Cambodia in August 2019. Small connected community methodology was employed to gather qualitative data and semi-structured community meetings were utilized to collect data. Thematic analysis and diffusion of innovation theory was used to analyze data derived from this study. Qualitative findings identified the following facilitators of latrine construction: relative advantage (overall health and well-being, convenience, and environmental awareness); complexity (perceived level of simplicity); compatibility (obligation to others); and observability (demonstrations, observable improved health of others). Latrine construction barriers included complexity (lack of resources) and compatibility (interferences to daily life). Facilitators of latrine construction included: relative advantage (overall health and well-being, convenience, economic advantages, and environmental impacts), complexity (ease of use); compatibility (obligation to others); and observability (demonstrations). The latrine uptake barrier was compatibility (misalignment with current practices). Compared to neighboring countries, basic sanitation within Cambodia continues to be a challenge. Rural Cambodians lack resources pertaining to knowledge (of how to build latrines) and cost (of materials). The development and implementation of health education and health promotion programs may effectively address the sanitation challenges in rural communities in low income and developing countries, while simultaneously enhancing the quality of life and well-being of communities.

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