title: Rapid assessment procedures in environmental sanitation research: a case study from the northern border of Mexico.
abstract: BACKGROUND
  There is a need to enhance the quality and sustainability of environmental health programs in Mexico. What socio-cultural factors influenced the adoption or rejection of Clean Water in Homes programs in this population? We applied rapid appraisal procedures (RAP) to evaluate these community-based programs.
  
  
  METHODS
  Qualitative study conducted in communities along Mexico's northern border. We conducted informal dialogues, semi-structured interviews, field notes and observations. Home visits used a checklist to observe: sources of water, handwashing, as well as human waste and garbage disposal patterns. Data analysis was conducted using ATLAS.ti, which facilitated comparison and illustration of discrepancies, the elaboration of emerging issues and relationships between them.
  
  
  RESULTS
  Community members perceived that the Clean Water program was a top-down intervention. Water is perceived as a political issue and a matter of corruption. Inequity also limits solidarity activities involved in environmental sanitation. Migration to the United States of America (US) contributes to community fragmentation, which in turn dilutes communal efforts to improve water and sanitation infrastructure. While targeting women as program "recipients", the Clean Water program did not take gendered spheres of decision-making into account. Community members and authorities discussed the main results in "assemblies", particularly addressing the needs of excluded groups.
  
  
  CONCLUSIONS
  The oversight of not exploring community members' needs and priorities prior to program implementation resulted in interventions that did not address the structural (economic, infrastructure) and socio-cultural barriers faced by community members to undertake the health-promoting behaviour change, and provoked resentment.
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, México. ecifuent@insp.mx
authors.forename: Enrique
authors.initials: E
authors.lastname: Cifuentes
authors.forename: Urinda
authors.initials: U
authors.lastname: Alamo
authors.forename: Tamil
authors.initials: T
authors.lastname: Kendall
authors.forename: Joan
authors.initials: J
authors.lastname: Brunkard
authors.forename: Susan
authors.initials: S
authors.lastname: Scrimshaw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018672:Community Health Planning / Q000458:organization & administration*; D003256:Community Participation; D003466:Cultural Characteristics; D003657:Decision Making; D003906:Developing Countries; D005260:Female; D017144:Focus Groups; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D008297:Male; D008800:Mexico; D008875:Middle Aged; D016730:Program Development; D036301:Qualitative Research; D012499:Sanitation / Q000379:methods* / Q000592:standards; D012944:Social Support; D012959:Socioeconomic Factors; D013997:Time Factors; D014876:Water Pollution / Q000517:prevention & control; D014881:Water Supply / Q000592:standards*