Sustained adoption of water, sanitation and hygiene interventions: systematic review

To understand factors that influence sustained adoption of water, sanitation, and hygiene (WASH) technologies or behaviors. Systematic review of current literature. Articles were gathered from databases of peer-reviewed articles and grey literature, and screened for relevance. After exclusion, we created a descriptive map of 148 articles and analyzed in-depth 44 articles that had an explicit focus on promoting or evaluating sustained adoption or program sustainability. 21 of these articles met our definition of measuring sustained adoption. Definitions of sustained adoption varied widely and were often inadequate, making comparison of sustained adoption across studies difficult. The timeframe for measurements of sustained adoption is frequently inadequate for examination of longer-term behavior change. Ideally, an evaluation should specify the project period and describe the context surrounding adoption, make measurements at multiple time points, diversify measurement methods, and describe and measure a range of factors affecting sustained adoption. Additional consideration needs to be given to developing behavior change models that emphasize factors related to sustained adoption, and how they differ from those related to initial adoption. This article is protected by copyright. All rights reserved.