Health in perspective: framing motivational factors for personal sanitation in urban slums in Nairobi, Kenya, using anchored best-worst scaling

Severe health, safety and environmental hazards are being created by the growing population of urban poor in low-income countries due to lack of access to sanitation and to inadequate existing sanitation systems. We developed a multi-faceted motivational framework to examine the constituents that explain user motivation regarding a personalised sanitation system. In 2012 we interviewed slum dwellers in Nairobi, Kenya, to estimate individual motivational factor importance rankings from anchored best-worst scaling (ABWS) using hierarchical Bayesian methods. We found that personal safety, avoidance of discomfort with shared toilets, cleanliness and convenience for children were ranked of highest importance. Motivational factors related to health were only relatively highly ranked. Thus factors contributing to overall individual wellbeing, beyond health benefits, drive adoption and use of the low-cost personal sanitation solution studied. This suggests that non-health benefits of low-cost sanitation solutions should be better acknowledged and communicated to raise awareness and encourage adoption of improved sanitation in urban slums. These findings may help develop policies to promote personal sanitation, improve public health and safety and reduce environmental risks.