Adapting Translational Research Methods to Water, Sanitation, and Hygiene
Abstract
:1. Introduction
2. Methods
- Translational research conceptualization,
- Actor characterization,
- Translational research categorization,
- Research type comparison,
- Practical WaSH applications, and
- Overarching good practices.
3. Results and Discussion
3.1. Conceptualization of Translational Research
3.2. Characterization of Actors
3.3. Comparison of Research Types
3.3.1. Purpose
3.3.2. History
3.3.3. Actors
3.3.4. Good Practices
3.4. Model Research Questions
3.5. Practical Recommendations
3.5.1. Recognize Challenges and Potential Pitfalls
3.5.2. Select a Guiding Theory and Define Terms
3.5.3. Consider Context
3.5.4. Involve Diverse Stakeholder Groups
3.5.5. Document Fidelity and Adaptations
3.5.6. Conduct Long-Term Monitoring and Evaluation
3.5.7. Revisit Results
3.5.8. Seek Continuing Education in Research Rigor and Reliability
3.6. Carrying Out Recommendations in Action: Example of Community-Led Total Sanitation
3.7. Examples and Resources for Carrying Out Translational Research Recommendations
- Koehler et al. (2018) carefully articulated how cultural theory, in the context of rural water management, provided a basis for understanding the cooperation and conflict between management cultures to handle operational, financial, institutional and environmental risk. The authors thoroughly defined terminology relevant to cultural theory and a pluralist framework at the outset of the study [169].
- Bresee et al. (2016) explained how theory informed their study design in multiple ways. Researchers aligned focus group data collection methods with diffusion of innovation theory, and based data analysis methods on grounded theory. They cited the original works that provided a basis for these approaches when reporting [107].
- Pfadenhauer et al. (2017) developed the Context and Implementation of Complex Interventions (CICI) framework for use as a determinant or evaluation framework broadly applicable to public health interventions. They describe contextual domains but do not define constructs within domains [87].
- The Consolidated Framework for Implementation Research (CFIR) outlines contextual determinants likely to influence implementation [70] and provides qualitative and quantitative tools for researchers to assess context (https://cfirguide.org/).
- Craig et al. (2018) proposed guidelines for addressing the influence of context when adapting and scaling population health interventions [132].
- West et al. (2016) investigated the effects of context on residential recycled water schemes in Australia to assess common reasons for failure. They found contextual factors such as regulatory environment, operational costs, and consumer preferences to influence success [170].
- Novotný et al. (2018) conducted a systematic review to identify which studies reported the contextual factors associated with sanitation adoption and implementation. They proposed a typology that categorizes contextual factors into societal, community, interpersonal, and individual levels [171].
- Amjad et al. (2016) used service provider interviews to assess perceived willingness and ability as measures of actor readiness for implementing the WHO’s Water Safety Plan intervention [172]. Setty et al. (2019a) used this preliminary research on context and the CFIR to inform a multi-criteria decision process for selecting appropriate intervention guidance for US source water risk management [173]. The authors recommended adapting the intervention guidance, e.g., by hybridizing with existing programs, to fit the context.
- White et al. (2008) qualitatively analyzed data from in-depth interviews with water managers to assess perceptions. They published a model for boundary organizations to mediate negotiations between scientific and political actors to inform decision making for water resources [16].
- Liu et al. (2008) applied an integrated modeling framework that engages stakeholders in every step from problem formation to monitoring and evaluation. They suggest adoption of research results and informed decision making requires open lines of communication among all parties associated with the project [174].
- Nelson et al. (2014) suggest the perspectives and values of stakeholders must be considered in the process of policy formation and decision-making. They examine the strategy of assigning roles and responsibilities to different stakeholders, concluding that engagement between actors and ‘clear messages’ from top level political entities are important factors in the provision of sanitation facilities [175].
- Sigler et al. (2014) helped to identify core components of community-led total sanitation by documenting (a) which behavior change frameworks and techniques were commonly used, (b) how implementation differs by region and context, and (c) which implementation activities were considered most valuable in achieving and sustaining desired intervention outcomes [176].
- Crocker et al. (2016) evaluated how an implementation variation to train natural leaders (motivated community members) to influence peer behaviors affected implementation and intervention outcomes for community-led total sanitation [177].
- Benjamin-Chung et al. (2017) assessed program delivery of a UNICEF intervention called Sanitation Hygiene Education and Water Supply in Bangladesh (SHEWA-B) to 20 million rural people to assess whether implementation quality affected program success, as measured by a survey of household recall. They developed an implementation quality index and compared fidelity measures, such as hygiene promotor visitation and knowledge of key messages, to outcome measures, such as health behaviors and sanitation infrastructure access [109].
- Using annual school-level data approximately 14 years after implementation of a sanitation intervention in India, Adukia (2017) demonstrated health benefits associated with school-latrine construction (especially for younger children) but not educational benefits [178].
- Cronk and Bartram (2017) aggregated existing country-level monitoring program data across Nigeria and Tanzania to develop Bayesian network models comparing diverse water system and management types. By following systems ranging from zero to more than 30 years of use, they garnered insights on water system functionality and service availability [113].
- Following a national program adopted in 2011, Senbeta and Shu (2019) studied three different management modalities (community, local government, and other external sources including non-governmental organizations) used for rural water supply sustainability in Ethiopia. Data were collected via household surveys, interviews with committee members, direct observation, and records review. They found community-management modalities performed better on most sustainability indicators [179].
- The WaSH Benefits randomized controlled trials in Kenya and Bangladesh assessed the effects on stunting and diarrhea of WaSH interventions separately and in combination with nutrition interventions. Interventions were adapted to fit the local cultural context but adhere to the same theory of change [103,180].
- The Open Science Framework (https://osf.io/) is a free scholarly commons that seeks to align practice with scientific values by improving research openness, integrity and reproducibility. They also offer a training curriculum (https://osf.io/48up3/).
- Dataverse (https://dataverse.org/) offers an open-source research data repository.
- The US National Institutes of Health provide training modules on rigor (https://www.nih.gov/research-training/rigor-reproducibility/training) as well as periodic email updates on rigor and reproducibility topics (https://www.nih.gov/research-training/rigor-reproducibility).
- The Center for Effective Global Action at the University of California, Berkeley offers in-person fee-based Research Transparency and Reproducibility Training (RT2) events in Los Angeles and London, and openly shares the training materials.
3.8. Limitations and Remaining Research Needs
4. Conclusions
- Recognizing challenges and potential pitfalls,
- Selecting an appropriate theoretical basis for study design and defining terms,
- Considering the role of context,
- Involving a diverse set of stakeholders throughout research phases,
- Documenting intervention adaptations,
- Supporting follow-up monitoring and evaluation,
- Understanding the difference between efficacy and effectiveness research and actively replicating studies in more than one setting or context, and
- Seeking ongoing training in research methods and rigor.
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Roles in Translational Research | ||||||
---|---|---|---|---|---|---|
Individual or Collective Actors 2 | Fund Research | Lead Research Investiga-tions | Interpret and/or Communicate Research | Provide Policies, Guidance, Technical Assistance, and/or Facilitation (“Decision Makers”) | Implement Practices (“Service Providers”) | Receive Services/Engage in Behaviors |
Professional Actors | ||||||
Researchers | X | X | ||||
Educators | X | |||||
Governments | X | X | X | X | X | |
Multilateral organizations | X | X | X | X | X | |
Service providers | X | X | X | |||
Civil society organizations | X | X | X | |||
Policymakers | X | X | X | |||
Businesses | X | X | X | X | ||
Foundations | X | X | ||||
Networks | X | X | ||||
Media | X | |||||
Non-Professional Actors | ||||||
Volunteers | X | X | X | |||
General Public | X | X |
Research Type (Related or Commonly Used Associated Terms) | Purpose | History/ Origins | Primary Actors | Good Practices | Resources for More Information |
---|---|---|---|---|---|
Pure (fundamental, basic) | Observe, describe, question, hypothesize, experiment, and develop theory | Scientific method (17th century) | Researchers | Expand knowledge; avoid bias; share findings among scientific community to develop evidence base | Scientific Method in Brief [40]; Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact [41] |
Efficacy (comparative efficacy) | Determine if an intervention produces desired results in controlled or limited settings | 18th–20th centuries; randomized design (e.g., Peirce, Fisher) [42,43,44] | Researchers | Systematic experimentation or observation; avoid confounding (e.g., via blinding, matched controls, randomization); offer measure of statistical certainty | Improving the reporting of pragmatic trials: An extension of the CONSORT statement [45]; |
Effectiveness (comparative effectiveness) | Determine if an intervention produces desired results in diverse real-world settings | 18th–20th centuries; randomized design (e.g., Peirce, Fisher) [42,43,44] | Researchers | Systematic experimentation or observation; understand confounding; offer measure of statistical certainty | Study designs for effectiveness and translation research: identifying trade-offs [46]; The road to results: designing and conducting effective development evaluations [47] |
Applied 1 | Apply science with intention to address a practical problem | 18th–20th centuries; especially post-WWII | Researchers; service providers; decision-makers | Problem- or client-driven; may or may not lead to invention | Cycles of invention and discovery: Rethinking the endless frontier [48]; Routledge Handbook of Water and Health [49] |
Diffusion | Examine how novel ideas and practices (often passively) spread among groups of people | Rogers (1962) Theory of Diffusion of Innovation | Researchers; service providers; decision-makers | Classify adopters by stages; study channels, rates, variables (e.g., member characteristics), and consequences | Diffusion of innovations, 5th edition [50]; Social networks and health: A systematic review of sociocentric network studies in low- and middle-income countries [51] |
Dissemination | Target (often active) distribution of information or an intervention to (a) specific audience(s) | Rogers (1962) Theory of Diffusion of Innovation; government initiatives beginning in late-1990s and early-2000s (e.g., US National Institutes of Health) | Researchers; service providers; decision-makers | Identify potential adopters; facilitate uptake and effective use of specific (implicitly evidence-based) interventions | An overview of research and evaluation designs for dissemination and implementation [32] |
Implementation (knowledge translation) | Develop methods to promote uptake of research and evidence-based practices into routine practice | Dedicated Implementation Science journal begun in 2006, following evidence-based movement of 1990s and recognition of science-to-service gap | Service providers; researchers (as external facilitators) | Grounded in theory; trans-disciplinary research teams; evidence-based practice, barrier and strategy selection; documenting context and adaptations | An introduction to implementation science for the non-specialist [24] |
Operations/ operational (analytics, systems analysis, management science) | Apply scientific principles to business management, providing quantitative basis for complex decisions | Babbage (1840s); military planning during World Wars I and II (early-mid 1900s) [52] | Service providers; researchers | Often uses simulation, modeling, mathematical, or statistical techniques; practical objective to optimize complex systems | Encyclopedia of operations research and management science [53]; Structured Operational Research and Training IniTiative (SORT IT) from Médecins Sans Frontières (https://msf.lu/de/node/283) |
Participatory action (action, community-based participatory, transdisciplinary) | Undertake self-reflective enquiry to solve social problems, create change to improve quality of life | Popular education (1930s) [54]; Lewin’s (1946) work on action research and minority problems [55]; theories of transdisciplinary knowledge co-production [36,56] | Civil society, service providers, community organizations, and/or public (acting as researchers); researchers | Equitable involvement; shared decision-making and ownership; critical self-examination; empower participants to develop and implement improvements | Action research, 4th ed. [57]; Methods in community-based participatory research for health [58]; Community-based participatory research as a tool to advance environmental health sciences [59]; Michigan Public Health Training Center online course “CBPR: A Partnership Approach for Public Health” (https://www.mitrainingcenter.org/courses/cbprs0218) |
Quality improvement (improvement science) | Design and trial strategies to improve specific problem within specific system | Deming (1950s) [60]; Institute for Healthcare Improvement (IHI) Model for Improvement (2003) | Service providers; researchers (as external facilitators) | Create effective change by repeating plan-do-check-act (PDCA) or plan-do-study-act (PDSA) cycles | The improvement guide [61]; Public Health Foundation (phf.org) |
Research Type | Model Research Question (Linked to End Goal/Outcome) | Example Studies | Specific Research Questions |
---|---|---|---|
Pure | How can we understand a phenomenon? Can we measure ___? Does evidence support theory? How are phenomena related? | Virus inactivation mechanisms: Impact of disinfectants on virus function and structural integrity [99] Defining endemic cholera at three levels of spatiotemporal resolution within Bangladesh [100] | How are viral functions affected by exposure to inactivating treatments? What does whole-genome sequencing tell us about cholera diversity and transmission dynamics at individual, household, regional and intercontinental scales? |
Efficacy | Does intervention work in a controlled setting or specific population? | The effects of input materials on ceramic water filter efficacy for household drinking water treatment [101] A community-designed play-yard intervention to prevent microbial ingestion: A baby water, sanitation, and hygiene pilot study in rural Zambia [102] | How do production methods and quality control protocols alter efficacy of ceramic drinking water filters? Did a novel play-yard intervention help rural farming families reduce infant and young children’s exposure to human and free-range livestock feces? |
Effectiveness | Does intervention work in real-world settings? | Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Bangladesh: a cluster randomized controlled trial [103] | Do individual water, sanitation, handwashing, or nutrition interventions reduce linear growth faltering? Are combined water, sanitation, and handwashing interventions more effective at reducing diarrhea than individual interventions? Does the combination of water, sanitation, handwashing, and nutrition interventions reduce growth faltering more than each individual intervention? |
Applied | What type of intervention might solve a problem? Does intervention fulfill an identified need? Should intervention be modified? | Characterization of pit latrines to support the design and selection of emptying tools in peri-urban Mzuzu, Malawi [104] | What characteristics of household pit latrines are important when designing and selecting pit latrine-emptying tools? |
Diffusion | How or why does intervention spread (often passively)? Who carries information? | Exploring the utility of diffusion theory to evaluate social marketing approaches to improve urban sanitation in Malawi [97] Risk management for drinking water safety in low and middle income countries–cultural influences on water safety plan (WSP) implementation in urban water utilities [105] | Do ‘first movers’ display characteristics of innovators including relatively high incomes and risk-taking behaviors? What is the role of interpersonal information sources (opinion leaders and change agents) on the decision-making process of ‘first movers’ of the ecological toilet? Do ‘first movers’ report all five attributes described by Rogers (2003) [50] (relative advantage, compatibility, simplicity, observability and trialability) as positive reasons for purchasing the ecological toilet? How do cultural constructs in different countries influence implementation of the water safety plan intervention? |
Dissemination | How can we (often actively) facilitate spread of an intervention? Who or what influences spread of the intervention? | Factors supporting the sustained use of solar water disinfection—experiences from a global promotion and dissemination program [106] Social network targeting to maximize population behaviour change: A cluster randomized controlled trial [98] “A child is also a teacher”: exploring the potential for children as change agents in the context of a school-based WASH intervention in rural Eastern Zambia [107] | Which factors influenced acceptance and sustained use of a solar water disinfection intervention? Which methods of targeting influential individuals produce the greatest cascades or spillover effects? Can children can influence their families to adopt healthy WASH behaviors in Eastern Zambia? If so, how? |
Implementation | How can we scale an evidence-based intervention effectively? | Teachers and sanitation promotion: an assessment of community-led total sanitation in Ethiopia [108] Scaling up a water, sanitation, and hygiene program in rural Bangladesh: the role of program implementation [109] Sustainability and scale-up of household water treatment and safe storage practices: enablers and barriers to effective implementation [110] | How did context and process (implementation arrangements) influence effectiveness of the community-led total sanitation intervention? How did the implementation process influence achievement of desired intervention outcomes? What are the barriers and enablers for sustaining and scaling up household water treatment and safe storage practices such as boiling, chlorination, and filtration? |
Operations/ Operational | How can we better understand and intervene on the factors affecting ongoing operational or systems processes? | Bisphenol-A removal in various wastewater treatment processes: Operational conditions, mass balance, and optimization [111] Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction [112] Factors influencing water system functionality in Nigeria and Tanzania: a regression and Bayesian network analysis [113] | Which operational conditions promoted BPA removal during wastewater treatment? What variables were statistically associated with stunting in Indonesian children? What were the data relationships between water system functionality and poverty, population density, groundwater availability, and distance to urban centers? |
Participatory action | How can we work collectively to create knowledge to address a problem? | Improving community health through marketing exchanges: A participatory action research study on water, sanitation, and hygiene in three Melanesian countries [114] Action research for sustainable water futures in western Sydney [115] Using photovoice as a community based participatory research tool for changing water, sanitation, and hygiene behaviours in Usoma, Kenya [116] | How did impoverished communities in urban and peri-urban areas attempt to meet their water, sanitation, and hygiene needs through marketing exchange? How do people who are ‘hard to reach’ or seen as ‘apathetic’ engage using an ‘action-conversations’ tool that explores the social climate for action? How can scientific or technical messages be framed in the language of the community? What are local perceptions and practices around water-health linkages? Did photovoice tool help participants actively engage and/or change their behaviors? |
Quality improvement | How can we adjust systems to achieve a desired improvement? | Strengthening healthcare facilities through water, sanitation, and hygiene improvements: A pilot evaluation of ‘‘WASH FIT’’ in Togo [117] Implementation science in low-resource settings: Using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana [118] | How does the continuous improvement tool work? What are the implementation outcomes? Is the tool acceptable and feasible? Can a quality improvement intervention improve hand hygiene compliance in low-resource settings? |
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Setty, K.; Cronk, R.; George, S.; Anderson, D.; O’Flaherty, G.; Bartram, J. Adapting Translational Research Methods to Water, Sanitation, and Hygiene. Int. J. Environ. Res. Public Health 2019, 16, 4049. https://doi.org/10.3390/ijerph16204049
Setty K, Cronk R, George S, Anderson D, O’Flaherty G, Bartram J. Adapting Translational Research Methods to Water, Sanitation, and Hygiene. International Journal of Environmental Research and Public Health. 2019; 16(20):4049. https://doi.org/10.3390/ijerph16204049
Chicago/Turabian StyleSetty, Karen, Ryan Cronk, Shannan George, Darcy Anderson, Għanja O’Flaherty, and Jamie Bartram. 2019. "Adapting Translational Research Methods to Water, Sanitation, and Hygiene" International Journal of Environmental Research and Public Health 16, no. 20: 4049. https://doi.org/10.3390/ijerph16204049