Hygiene Evaluation Procedures: Approaches and Methods for Assessing Water - and Sanitation - related Hygiene Practices

Table of contents

Astier M. Almedom,1 Ursula Blumenthal,1 and Lenore Manderson2

1 London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom

2 Australian Centre for International and Tropical Health and Nutrition, University of Queensland Medical School, Herston Road, Herston, Brisbane, Qld 4006, Australia


(c) Copyright 1997 International Nutrition Foundation for Developing Countries (INFDC)

ISBN No. 0-9635522-8-7

Library of Congress Cataloging-in-Publication (CIP) Data Applied for.

The handbook provides practical guidelines for evaluation water- and sanitation-related hygiene practices. An evaluation of hygiene practices can be used for the purposes of project planning, monitoring, or final assessment of the project’s impact. The main focus is on the practical concerns of field personnel working in water supply, sanitation, and health/hygiene education projects who want to design and conduct their own evaluations of hygiene practices. It is designed to make qualitative research skills accessible to practitioners with little or no previous training in social sciences and emphasizes how to gather, review, and interpret qualitative information. The handbook was developed as a practical answer to the limitations of using a single method or instrument for information gathering, especially when trying to investigate sociocultural aspects of human behavior that do not easily lend themselves to quantifiable measurement. It explores alternatives to the limitations of a questionnaire-based survey design by examining other tools for systematically gathering qualitative information. It includes use of a variety of methods and tools which can be chosen and combined; appraisals of individuals methods and tools to help in the selection of the most appropriate combinations of methods for the desired purpose; and examples from field experience of common mistakes and pitfalls. The use of a variety (triangulation) of sources and methods is advocated as the best way to obtain complete and reliable information on the issues under study.

The digitalization of this publication was made possible by a grant from the Nestlé Foundation



List of abbreviations



1. What is the HEP?

Why assess hygiene practices?
Who is this handbook for?
Is this a participatory handbook?

2. Planning a hygiene evaluation study

What am I going to investigate?
What types of information will I need?
Who will be involved?
Who will be in the study team?
What resources will I need?
When should I do a hygiene evaluation study?

3. Training the study team

Sensitizing the study team
Transferring technical know-how
Management, review, and analysis of information
Developing working hypotheses
Outlining the study design
What resources are needed?
How much time should be allowed for training?

4. Designing a hygiene evaluation study

Hygiene evaluation cycle
Defining the objectives of the study
Developing specific objectives
Sampling strategies
Putting in place data quality checks
Scheduling activities

5. Methods and tools for investigating the context

Healthwalk (systematic walkabout)
Structured (spot-check) observations
Key-informant interviewing
Community mapping
Seasonal calendar
Gender roles/tasks analysis
Appraisal of the methods and tools

6. Investigating hygiene practices

Three-pile sorting
Pocket chart
Semi-structured (informal) interviews
Focus group discussion
Appraisal of the methods and tools

7. Analysis, presentation, and implementation of findings

Stages of analysis and interpretation of findings
Establishing the trustworthiness of information
Presentation of findings
Implementation of findings

Selected reading

Analysis and interpretation of data
Water supply and sanitation
Hygiene promotion