Endogeneity or reverse causality in regression analysis results in biased estimation of the effects of independent variables on the dependent variable and leads to inaccurate interpretations. However, the biased estimation of the effects of psychological factors on water–related behaviours are rarely discussed. This study investigated the endogeneity of psychological factors in water-related behaviour using an instrument variable (IV) approach. Data from eight household water treatment (HWT) studies in Asia, Africa, and South America were utilized. A combination of several socio-economic characteristics, such as education and accessibility, was used as a control variable and three psychological factors, i.e., perception of risk, attitude towards HWT, and social norms, were used as the predictors of the adoption of HWT. Variables related to institutional quality of the countries, based on the World Governance Indicators of the World Bank were used as IVs to predict the psychological factors. The results suggest that endogeneity exists in water-related behavioural studies. Institutions were found to be valid IV for psychological factors attitude and norms, but not for the perception of risk. This suggests that the institutional quality influences households’ attitude and norms regarding behaviour. If the feedback effect of actual behaviour on the psychological factors were not considered, the effects of attitude and norms on HWT adoption were underestimated by 59% and 40%, respectively. Finally, despite the challenge of finding valid IV, the endogeneity effect of psychological factors needs to be controlled when estimating the effect of psychological factors on water-related behaviour in future water-related behavioural studies.

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Psychological frameworks are rarely used to understand irrigation adoption behaviour in developing countries. A Bayesian belief network (BBN) model was developed that integrated socio-economic characteristics and psychological factors to understand farmer behaviours with respect to irrigation practices in four districts of Maharashtra, India. Strong norms, risk perceptions of water scarcity, and attitude play roles in the adoption of irrigation technology and practices. Critically, it was found that no one factor can explain adoption behaviour; rather, an ensemble of factors is needed to understand farmer behaviour. A farmer who is highly educated, middle-aged, and moderately wealthy with a significant level of family help and an open well as their main water source, while receiving low promotional information related to water scarcity and irrigation adoption, is most likely to adopt irrigation technology. The application of the BBN in this study enables stakeholders and policymakers to better understand the linkages between different factors and behaviour.

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Freshwater resources in coastal areas are under intense pressure from excessive groundwater extraction, which amplifies saltwater intrusion (SWI) into coastal freshwater aquifers, such as in the Mekong Delta. Studies that combine socioenvironmental data and households' psychological factors next to salinity measurement data to design groundwater conservation strategies are rare. In this study, these aspects are combined to explore their influence on the public willingness to conserve groundwater using a Bayesian belief network model. We analyzed 313 household survey data spread over three districts in the coastal province of Tra Vinh, located in the Vietnamese Mekong Delta. The level of salinity is significantly correlated with the willingness to conserve groundwater. The top three socioenvironmental characteristics that influence willingness are the level of salinity, type of employment - i.e., being a farmer - and frequency of being exposed to groundwater or SWI promotional activities. Social norm, i.e., perceived social pressure, is the most influential psychological factor that determines willingness. This study reveals an urgency for the local government to intervene and create social pressure regarding the issue.

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This study provides an overview of water, sanitation, and hygiene (WASH) research trends in Indonesia from 1975 until April 2021. The systematic review compiled 272 articles related to the Sustainable Development Goals 6.1 and 6.2 in Indonesia, which were published in the Web of Science and Scopus databases. The results showed that the water-related topic (41%) was discussed more often than sanitation (22%) or hygiene (13%). Furthermore, the social theme (39%) was dominantly found in all these articles, mostly finding determinants of WASH-related behavior. However, few WASH implementation studies or behavioral change interventions were recorded in Indonesia, suggesting a gap between science and policy or implementation. On the other hand, hygiene-related topics (14%) and WASH-related financial themes (6%) were the least studied in Indonesia. Combinations of topics (23%) and themes (15%) were also often conducted in Indonesia, suggesting that WASH researchers started to recognize the need to analyze WASH problems holistically, i.e., from multiple perspectives. In addition, the distribution of WASH research was still dominated in the central part of Indonesia, whereas the WASH-related problems, i.e., poor WASH services, and behavior, often occur in this area. This study also offers some research gaps, both in terms of topics, themes, and regional distribution, that need to be considered for the design of future WASH research in Indonesia. @en

Household water treatment (HWT), such as boiling, chlorination, and ceramic filtration, is an interim solution to solve the problem of unsafe drinking water at home, especially for households that do not have access to safe drinking water services. However, previous reports indicate that many people in low and middle-income countries (LMICs) do not use HWT regularly, i.e. still drink unsafe and untreated water. A behavioural study is needed to find reasons for these phenomena, which can help related stakeholders in designing appropriate interventions to increase the regular use of HWT.@en

Household water treatment (HWT) is one of the possible technologies to improve the quality of potable water in low–middle-income countries. However, many households still drink untreated water that leads to negative health consequences, highlighting the need for a behavioral study. This study explores the role of eight socio-economic characteristics (SECs) and five psychological factors on the practices of HWT, using a combination of statistical analyses and Bayesian Belief Network (BBN) modeling. The findings were based on 377 household interviews in East Sumba, Indonesia, an area where indigenous belief is still common. Self-reported answers and observed practices of HWT were combined, and 51% of the respondents were categorized as regular users of HWT. Furthermore, favorable socio-economic conditions, e.g., wealthier or more educated parents, facilitated psychological factors that led to regular use of HWT. This suggests the importance of reducing SEC inequalities to improve the HWT adoption. Mother's education was the most influential SEC (ΔP = 8), and people who followed indigenous beliefs tend not to use HWT on a regular basis. Moreover, easy access to water positively influenced the household's ability to operate the HWT technology. Attitude toward the HWT practice, especially the perception of treated water's taste (β = 0.277), was the most significant psychological factor, influencing HWT adoption. An interpretation of complex interlinkages between socio-economic conditions and psychological factors that drive the practice of HWT was therefore offered, alongside recommendations for conservative interventions to change the household's behavior in a culturally unique area with difficult access to water.

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Background: There is increasing recognition of the complexity underlying WASH conditions in developing countries. This article explores the complexity by assessing the vulnerability of a specific area to poor WASH conditions using a qualitative approach. Methods: We present our findings for the district of East Sumba in Indonesia. This area is known as one of the poorest regions in Indonesia with inadequate WASH services, indigenous belief that hinder the practice of WASH-related behaviours, and has a high rate of children malnutrition. All the factors that contribute to poor WASH conditions were discussed through the lens of the Financial, Institutional, Environmental, Technological, and Social (FIETS) framework. We then summarised the factors and visualized the “system” using a mind map which shows how factors are interconnected and helps to find the root causes of poor WASH conditions. Results: There are three main challenges that inhibit the improvement of WASH conditions in this area: inadequate institutional capacity, water scarcity, and poor socio-economic conditions. We found that a village leader is the most important actor who influences the sustainability of WASH services in this area and healthcare workers are influential WASH promoters. This study also shows how culture shapes people’s daily lives and institution performance, and influences the current WASH conditions in East Sumba. The mind map shows there is an overlap and interconnection between FIEST aspects and WASH conditions in the study area. Conclusion: WASH conditions are influenced by many factors and are often interconnected with each other. Understanding this complexity is necessary to improve WASH conditions and sustain adequate WASH services in developing countries. Finally, WASH interventions have to be considerate of the prevailing cultural practices and should involve multidisciplinary stakeholders.

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Household hygiene is critical to prevent pathogen transmission at the household level. Assessing household hygiene conditions and their determinants are needed to improve hygiene conditions, especially in rural and less developed areas where the housing conditions are relatively worse than they are in urban areas. This study used data from 278 household interviews and observations in rural areas in the district of East Sumba, province East Nusa Tenggara, Indonesia. The data were analyzed using statistical methods. In general, the household hygiene conditions in the study need to be improved. The main potential sources of pathogen transmission were from the surrounding environment, i.e., non-permanent floor and garbage, and personal hygiene, i.e., handwashing facilities with water and soap were only observed in the homes of four out of ten respondents. The presence of livestock roaming freely in the house’s yard was another source of contamination. Easy access to water and wealth significantly influenced the hygiene conditions. Implementing low-cost interventions, i.e., cleaning the house of garbage and animal feces and cleaning nails, should be the priority in immediate intervention, while providing easier access to water supply, especially during the dry season, could be a long-term intervention. This paper also argues that analyzing household hygiene conditions or practices should be complemented by analyzing contextual determinants of the hygiene conditions or practices, so that we can develop more precise intervention by considering the local or household context.@en

It is argued that there are interconnected and dynamic factors that influence the sustainability of water, sanitation, and hygiene (WASH) services in developing countries. Five sustainability factors are often mentioned by literature: financial, institutional, environmental, technical, and social (FIETS) factors. This article aims to understand the interaction of those five sustainability factors in the context of WASH services in Indonesia. A system approach, in the form of a “modified” causal loop diagram, was utilized to analyze this interaction. The strength of influence from one factor to others were obtained from small surveys of 16 WASH practitioners and experts from international and national non-governmental organizations (NGOs) based in Indonesia and national government institutions related to WASH. It was found that institutional factor is the “leverage” factor, i.e., the most influential and least dependent, in the WASH services system in Indonesia. It means that WASH institutional strengthening is necessary to sustain WASH services in Indonesia. Furthermore, the most important feedback loop is social–WASH services. This depicts the importance of the bi-directional effect of WASH services and the social conditions of the community, i.e., the more supportive the community is, the higher the likelihood of the sustainability of WASH services, and then positively influence back the social conditions of the community. Moreover, the relationship between factors varies across context or location. Finally, this paper shows that the sustainability of WASH services involves complex interactions of the sustainability factors and understanding these interactions is critical to sustaining the WASH services or program in rural Indonesia.

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All of the possible strategies to reduce water losses in piped distribution systems follow the law of diminishing returns: the higher the expenditure on water loss reduction, the lower the progressive return in terms of water saved. Therefore, water utilities need to estimate the economic level of water losses (ELWL) so that they can reduce their water loss to the level where the cost to reduce the water losses is equal to the value of the water saved. This paper aims to estimate the ELWL using four different methods: the total cost method, the marginal cost method, the cumulative cost–benefit method, and the component‐based methods. This analysis is based on data (2011– 2016) on the water utilities of the city of Malang (PDAM Kota Malang), Indonesia. It was found that the total cost and marginal cost methods gave almost similar results for ELWL. However, the total cost method is preferred to calculate ELWL because it is the most accurate, easier to apply, and does not need a long data series. In addition, the estimated ELWL for PDAM Kota Malang was 21.76%, which is 3.71% higher than the water loss level estimated in 2016, which means that their strategies to reduce water loss are not cost‐efficient. Moreover, the lack of data is a major challenge in the estimation of ELWL in Indonesia. This study emphasizes the importance of estimating the ELWL so that water utilities, especially in Indonesia, can evaluate their strategies in reducing water loss and improving their cost‐effectiveness.

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The sustainability of the water supply program in developing countries is influenced by many inter-linked and dynamic factors, suggesting the need to analyse the system behaviour of the water supply program. However, no study analyses factors influencing the sustainability of rural drinking water supply programs holistically, and this study aims to fill that gap. This study utilized a system dynamics approach based on a case study of a community-based rural drinking water supply program (PAMSIMAS in Bahasa) in Magelang Regency, Indonesia. Five sustainability aspects were considered in the model development and simulation: Financial, institutional, environmental, technical, and social aspects. Eight scenario analyses related to those five aspects were conducted. The causal loop diagrams suggest that the overall loop in the system is reinforcing, meaning that the improvement in one aspect will improve the overall condition of the system and deterioration in one aspect will reduce the overall condition of the system. Scenario analysis shows that external fund is critical to support the program financially, especially at the beginning of the project when the piped system is being built and water revenue is still low. Scenario and sensitivity analyses revealed that human factors, i.e., the performance of the water board and response and support from the community, positively influence the sustainability of the water supply program. Additionally, the water board plays a key role in accelerating the pipe network growth. Finally, this paper argues that visualising and simulating the causal relationship and dynamic behaviour of the rural water supply program are critical for water stakeholders to better design and implement the water supply program.

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Assessing water quality and identifying the potential source of contamination, by Sanitary inspections (SI), are essential to improve household drinking water quality. However, no study link the water quality at a point of use (POU), household level or point of collection (POC), and associated SI data in a medium resource setting using a Bayesian Belief Network (BBN) model. We collected water samples and applied an adapted SI at 328 POU and 265 related POC from a rural area in East Sumba, Indonesia. Fecal contamination was detected in 24.4 and 17.7% of 1 ml POC and POU samples, respectively. The BBN model showed that the effect of holistic—combined interventions to improve the water quality were larger compared to individual intervention. The water quality at the POU was strongly related to the water quality at the POC and the effect of household water treatment to improve the water quality was more prominent in the context of better sanitation and hygiene conditions. In addition, it was concluded that the inclusion of extra “external” variable (fullness level of water at storage), besides the standard SI variables, could improve the model’s performance in predicting the water quality at POU. Finally, the BBN approach proved to be able to illustrate the interdependencies between variables and to simulate the effect of the individual and combination of variables on the water quality.

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Understanding the determinants of household water treatment (HWT) behavior in developing countries is important to increase the rate of its regular use so that households can have safe water at home. This is especially so when the quality of the water source is not reliable. We present a hierarchical Bayesian Belief Network (BBN) model supported by statistical analysis to explore the influence of household's socio-economic characteristics (SECs) on the HWT behavior via household's psychological factors. The model uses eight SECs, such as mother's and father's education, wealth, and religion, and five RANAS psychological factors, i.e., risk, attitude, norms, ability, and self-regulation to analyse HWT behavior in a suburban area in Palu, Indonesia. Structured household interviews were conducted among 202 households. We found that mother's education is the most important SEC that influences the regular use of HWT. An educated mother has more positive attitude towards HWT and is more confident in her ability to perform HWT. Moreover, self-regulation, especially the attempt to deal with any barrier that hinders HWT practice, is the most important psychological factor that can change irregular HWT users to regular HWT users. Hence, this paper recommends to HWT-program implementers to identify potential barriers and discuss potential solutions with the target group in order to increase the probability of the target group being a regular HWT user.

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Household water treatment (HWT) can tackle the issue of consuming unsafe drinking water at home. While household socio-economic characteristics are often assumed to influence the psychology of HWT use, no study has rigorously tested such an assumption. We aim to fill the gap by a cross-sectional study in a rural area in Sumba Timur, Indonesia (N = 256). Using mediation analysis, we demonstrated that psychosocial factors mediated the relationship between socio-economic characteristics and the use of household water treatment, and socio-economic characteristics strongly influenced the psychology of household water treatment usage. The use of HWT asked from different angles allowed more degrees of freedom to better assess the true status of the HWT usage, via the principal component of the answers. This paper concludes that “causal” relationship pathway from socio-economic characteristics to the use of HWT via psychosocial factors is a realistic assumption when assessing the influence of socio-economic characteristics on HWT.

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Accurate assessments of drinking water quality, household hygenic practices, and the mindset of the consumers are critical for developing effective water intervention strategies. This paper presents a microbial quality assessment of 512 samples from household water storage containers and 167 samples from points of collection (POC) in remote rural communities in the hilly area of western Nepal. We found that 81% of the stored drinking water samples (mean log10 of all samples = 1.16 colony-forming units (CFU)/100 mL, standard deviation (SD) = 0.84) and 68% of the POC samples (mean log10 of all samples = 0.57 CFU/100 mL, SD = 0.86) had detectable E. coli. The quality of stored water was significantly correlated with the quality at the POC, with the majority (63%) of paired samples showing a deterioration in quality post-collection. Locally applied household water treatment (HWT) methods did not effectively improve microbial water quality. Among all household sanitary inspection questions, only the presence of livestock near the water storage container was significantly correlated with its microbial contamination. Households' perceptions of their drinking water quality were mostly influenced by the water's visual appearance, and these perceptions in general motivated their use of HWT. Improving water quality within the distribution network and promoting safer water handling practices are proposed to reduce the health risk due to consumption of contaminated water in this setting.

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Risk assessment for drinking water systems combines sanitary inspections (SI) and water quality testing and is critical for effectively managing the safety of these systems. SI forms consist of question sets relating to the presence of potential sources and pathways of contamination specific to different types of water points, piped distribution systems, and household collection and storage practices. As part of the revision to the Guidelines for Drinking-water Quality (GDWQ), the World Health Organization (WHO) is updating the suite of SI forms to reflect and include the most recent technical and scientific information available. This paper reports the results from a field pilot of a selection of published and revised SI forms and water quality testing in the municipality of Bushenyi-Ishaka, Uganda. We collected data from 45 springs, 61 taps from piped distribution systems, and 129 household storage containers filled with water from those springs and taps. The median total risk scores, according to the revised forms, for spring, tap, and household practices were 36, 53, and 33%, respectively, with higher percentages indicating greater risk. The median Escherichia coli concentrations of spring, tap, and household storage systems were 17, <1, and 7 CFU/100 mL, respectively. We found that increased questioning in the revised SI forms do not necessarily translate to a higher total risk. There is potential for misinterpretation of terminology in the revised SI forms and occasional redundancy of concepts. For the revised SI form for springs, we suggest specific text changes to reduce potential bias. We recommend that users of SI forms receive training in their use and be familiar with their locale. Furthermore, the revised SI forms may need to be adapted in accordance with the local context.

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About 20 Million (73%) people in Nepal still do not have access to safely managed drinking water service and 22 million (79%)do not treat their drinking water before consumption. Few studies have addressed the combination of socio-economic characteristics and psychosocial factors that explain such behaviour in a probabilistic manner. In this paper we present a novel approach to assess the usage of household water treatment (HWT), using data from 451 households in mid and far-western rural Nepal. We developed a Bayesian belief network model that integrates socio-economic characteristics and five psychosocial factors. The socio-economic characteristics of households included presence of young children, having been exposed to HWT promotion in the past, level of education, type of water source used, access to technology and wealth level. The five psychosocial factors capture households’ perceptions of incidence and severity of water-borne infections, attitudes towards the impact of poor water quality on health, water treatment norms and the knowledge level for performing HWT. We found that the adoption of technology was influenced by the psychosocial factors norms, followed by the knowledge level for operating the technology. Education, wealth level, and being exposed to the promotion of HWT were the most influential socio-economic characteristics. Interestingly, households who were connected to a piped water scheme have a higher probability of HWT adoption compared to other types of water sources. The scenario analysis revealed that interventions that only target single socio-economic characteristics do not effectively boost the probability of HWT practice. However, interventions addressing several socio-economic characteristics increase the probability of HWT adoption among the target groups.@en

Household water treatment (HWT) is a simple technology to tackle this issue of non-potable drinking water at household level. Unfortunately, studies have showed that people do not use it regularly which diminishes the impact of HWT on health.@en

Household water treatment (HWT) can effectively reduce exposure to unsafe drinking water at home. Understanding the characteristics of target groups who successfully adopt HWT, such as perception about water quality and usefulness of HWT, income, or parental education, is essential for enhancing the adoption of HWT in developing countries. The objective of this study is to analyze the interactions between such socio-environmental characteristics, rather than a single characteristic, in order to explain the adoption of HWT. Five socio-environmental characteristics and behavior determinants were analyzed using Qualitative Comparative Analysis (QCA) from 41 case studies in Africa, Asia, and South America. Results show that there is no single characteristic that alone explains the adoption of HWT. QCA identified five pathways leading to high adoption of HWT. Perceived threat due to bad water quality is a pre-condition for three of the pathways. However, perceived threat does not alone explain adoption of HWT and must be accompanied by other conditions. Households connected to piped water schemes can also be potential HWT adopters as long as they perceive poor tap water quality. Finally, households who are able to afford the full cost of HWT tend to adopt it only when they neither have prior experience with HWT nor a connection to a piped scheme. Our findings therefore highlight the necessity to analyze interactions between socio-environmental characteristics of households and behavior determinants in order to determine the adoption of HWT.@en