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Health educators working in developing nations commonly encounter administrative constraints and methodological problems which prevent rigorous program evaluation. Using a time-series design, this study followed approximately 600 families in two Guatemalan villages during a four-year period to measure the impact of community health education on seven indicators of change in environmental sanitation.Adoption of new behavior was accompanied by widespread change in village attitudes and perceptions of health benefits. At the level of the family, change in perception was not predictive of change in behavior. A strong relationship between participation in planned educational events and the adoption of sanitation changes suggests that the formative educational strategy was responsible for stimulating change for five of seven indicators. Suggestions are made about the usefulness of the methodology, ways that private behavioral changes may be measured are discussed, and the advantages of the time-series design for health education evaluation and monitoring are noted.
Marilyn A. Tonon (Tue,) studied this question.