The Integrated Behavioural Model for Water, Sanitation, and Hygiene: A Systematic Review of Behavioural Models and a Framework for Designing and Evaluating Behaviour Change Interventions in Infrastructure-Restricted Settings

Promotion and provision of low-cost technologies that enable improved water, sanitation, and hygiene (WASH) practices are seen as viable solutions for reducing high rates of morbidity and mortality due to enteric illnesses in low-income countries. A number of theoretical models, explanatory frameworks, and decision making models have emerged which attempt to guide behaviour change interventions related to WASH. The design and evaluation of such interventions would benefit from a synthesis of this body of theory informing WASH behaviour change and maintenance. This paper is a systematic review of existing models and frameworks through a search of related articles available in PubMed and in the grey literature. Information on the organisation of behavioural determinants was extracted from the references that fulfilled the selection criteria and synthesised. Results from this synthesis were combined with other relevant literature, and from feedback through concurrent formative and pilot research conducted in the context of two cluster-randomized trials on the efficacy of WASH behaviour change interventions to inform the development of a framework to guide the development and evaluation of WASH interventions: the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH).