Mixed Methods Process Evaluation of a Sanitation Behavior Change Intervention in Rural Odisha, India

Abstract Background Process evaluations of public health programs are critical to understand if were delivered as intended and identify improvements for future implementations. Here we present a mixed methods process evaluation the Sundara Grama intervention , which sought improve latrine use safe child feces disposal among latrine-owning households in rural Odisha, India. Methods The was 36 villages Puri district by grassroots non-governmental organization (NGO) included eight activities: palla performance, transect walk, community meeting, wall painting, mother’s positive deviant household recognition, visit, repairs. quantitatively assessed fidelity, dose delivered, reach, qualitatively examined recruitment, context, satisfaction. Quantitative data collection an activity observation survey, record, endline trial survey. Qualitative debrief in-depth interviews with NGO mobilizers. For quantitative data, ‘delivery score’ calculated each activity, well proportion target participants attendance. analyzed using thematic analysis. Results Mean delivery scores, reported percentage, moderate high. Household visit activities (97% general 96% visit) meeting (81%) had highest followed (77%), walk (60%). Activities attended, on average, 30% 73% households. Several factors aided delivery, including pre-intervention rapport building visits village stakeholder support. Factors that hindered inclement weather, certain recruitment strategies, social dynamics. Conclusions Overall, implemented achieved good reach. findings suggest education-entertainment like palla, multi-level communication approaches particularly beneficial. results also showcase importance examining implementer experience broader context.