Adoption of Safe Water Behaviors in Zambia: Comparing Educational and Motivational Approaches

CONTEXT: In the developing world, drinking water is an important route for transmission of diarrheal disease, a leading cause of morbidity and mortality in children. OBJECTIVES: In Field Trial 1 (FT1) and Field Trial 2 (FT2), the effectiveness of the behavior change approach known as motivational interviewing (MI) was compared to the standard practice of health education alone in initiating and sustaining safe water treatment and storage behavior among community residents. In Field Trial 3 (FT3), MI was compared with social marketing. DESIGN: Community surveys were conducted prior to local health promoter training and at follow-up. SETTING AND PARTICIPANTS: Low socioeconomic status peri-urban communities in Zambia were project sites. Local volunteer health promoters from communities were trained in an adaptation of MI for safe water treatment and storage. INTERVENTIONS: All health promoters received instruction in the causes and prevention of diarrhea. Health promoters in the experimental (MI) groups received MI training. MAIN OUTCOME MEASURES: FT1 and FT3 measured detectable disinfectant levels in stored household water. FT2 measured disinfectant sales. FINDINGS: No significant differences between the treatment groups were found in FT1. Subsequent MI training incorporated lessons learned from the previous trial and resulted in much higher purchase rates of the disinfectant (FT2) and levels of disinfectant in stored household water (FT3) in the MI group. CONCLUSION: MI appears promising for public health initiatives in the developing world. Further research to improve and refine the method is needed.