Volume 98, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Open defecation is a public health problem worldwide. Non-governmental organizations in developing countries use various approaches to increase latrine coverage, but for little-understood reasons, some of the population does not adopt latrine construction. The objective of our research was to uncover which of the factors predicting latrine construction are relevant to the last nonowners of latrines, termed laggards in the diffusion of innovations theory. In a cross-sectional study, quantitative face-to-face interviews were conducted in households in rural Malawi ( = 824) to assess the behavioral determinants of latrine construction, mental health, and leadership. Around 14% of the households interviewed did not own a latrine. Study results suggest that nonowners have limited economic resources and perceive that latrine construction is expensive, that it is difficult to find money for latrine construction, and that it needs a lot of time and effort. The last nonowners of latrines live in smaller groups than latrine owners, communicate less with others about latrine construction, and are less influenced by the opinion of their leaders. They consist, in particular, of socially vulnerable households, are younger, are less educated, often have more impaired mental health, feel more vulnerable to contracting diseases, are less aware of the latrine construction of others in the village, feel less personally obliged to construct their own latrines, and are less confident in their ability to rebuild latrines damaged by flooding. The study confirmed that the assumptions of the diffusion of innovation theory are useful in combination with the risks, attitudes, norms, abilities, and self-regulation behavior change approach for developing evidence-based behavior change strategies in developing countries.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization and UNICEF, 2013. Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). Geneva, Switzerland: WHO. Available at: http://www.who.int/entity/maternal_child_adolescent/documents/global_action_plan_pneumonia_diarrhoea/en/index.html. Accessed June 18, 2015.
  2. United Nations. Available at: http://www.un.org/millenniumgoals/endopendefecation.shtml. Accessed July 20, 2017.
  3. Pattanayak SK, Dickinson K, Yang JC, Patil SR, Praharaj P, Poulos C, 2007. Promoting Latrine Use: Midline Findings from a Randomized Evaluation of a Community Mobilization Campaign in Bhadrak, Orissa. Working Paper 07_02, Research Triangle Institute. Available at: https://www.rti.org/sites/default/files/resources/rtipaper_07_02.pdf. Accessed July 19, 2017.
  4. Barnard S, Routray P, Majorin F, Peletz R, Boisson S, Sinha A, Clasen T, 2013. Impact of Indian total sanitation campaign on latrine coverage and use: a cross-sectional study in Orissa three years following programme implementation. PLoS One 8: e71438.
    [Google Scholar]
  5. Rogers EM, 2003. Diffussion of Innovations, 5th edition. New York, NY: Free Press.
  6. Mosler HJ, 2012. A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. Int J Environ Health Res 22: 431449.
    [Google Scholar]
  7. Sonego IL, Mosler HJ, 2014. Why are some latrines cleaner than others? Determining the factors of habitual cleaning behaviour and latrine cleanliness in rural Burundi. J Water Sanit Hyg Dev 4: 257267.
    [Google Scholar]
  8. Avolio BJ, Bass BM, 2004. Multifactor Leadership Questionnaire. Manual and Sampler Set, 3rd edition. Redwood City, CA: Mind Garden.
  9. WHO, 1994. A User’s Guide to the Self Reporting Questionnaire (SRQ). Geneva, Switzerland: World Health Organization, 184.
  10. Stewart RC, Kauye F, Umar E, Vokhiwa M, Bunn J, Fitzgerald M, Tomenson B, Rahman A, Creed F, 2009. Validation of a Chichewa version of the self-reporting questionnaire (SRQ) as a brief screening measure for maternal depressive disorder in Malawi, Africa. J Affect Disord 112: 126134.
    [Google Scholar]
  11. Wang XH, Howell JM, 2010. Exploring the dual-level effects of transformational leadership on followers. J Appl Psychol 95: 11341144.
    [Google Scholar]
  12. Cohen J, 2013. Statistical Power Analysis for the Behavioral Sciences. New York, NY: Routledge, 579 (Taylor & Francis).
  13. Moser S, Mosler HJ, 2008. Differences in influence patterns between groups predicting the adoption of a solar disinfection technology for drinking water in Bolivia. Soc Sci Med 67: 497504.
    [Google Scholar]
  14. Jenkins MW, Cairncross S, 2010. Modeling latrine diffusion in Benin: towards a community typology of demand for improved sanitation in developing countries. J Water Health 8: 166183.
    [Google Scholar]
  15. Gilles JL, Thomas JL, Valdivia C, Yucra ES, 2013. Laggards or leaders: conservers of traditional agricultural knowledge in Bolivia. Rural Sociol 78: 5174.
    [Google Scholar]

Data & Media loading...

  • Received : 20 Jul 2017
  • Accepted : 10 Sep 2017
  • Published online : 23 Oct 2017
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error