title: Factors associated with compliance among users of solar water disinfection in rural Bolivia.
abstract: BACKGROUND
  Diarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year. Promotion of Solar Water Disinfection (SODIS) has been suggested as a strategy for reducing the global burden of diarrhoea by improving the microbiological quality of drinking water. Despite increasing support for the large-scale dissemination of SODIS, there are few reports describing the effectiveness of its implementation. It is, therefore, important to identify and understand the mechanisms that lead to adoption and regular use of SODIS.
  
  
  METHODS
  We investigated the behaviours associated with SODIS adoption among households assigned to receive SODIS promotion during a cluster-randomized trial in rural Bolivia. Distinct groups of SODIS-users were identified on the basis of six compliance indicators using principal components and cluster analysis. The probability of adopting SODIS as a function of campaign exposure and household characteristics was evaluated using ordinal logistic regression models.
  
  
  RESULTS
  Standardised, community-level SODIS-implementation in a rural Bolivian setting was associated with a median SODIS use of 32% (IQR: 17-50). Households that were more likely to use SODIS were those that participated more frequently in SODIS promotional events (OR=1.07, 95%CI: 1.01-1.13), included women (OR=1.18, 95%CI: 1.07-1.30), owned latrines (OR=3.38, 95%CI: 1.07-10.70), and had severely wasted children living in the home (OR=2.17, 95%CI: 1.34-3.49).
  
  
  CONCLUSIONS
  Most of the observed household characteristics showed limited potential to predict compliance with a comprehensive, year-long SODIS-promotion campaign; this finding reflects the complexity of behaviour change in the context of household water treatment. However, our findings also suggest that the motivation to adopt new water treatment habits and to acquire new knowledge about drinking water treatment is associated with prior engagements in sanitary hygiene and with the experience of contemporary family health concerns.Household-level factors like the ownership of a latrine, a large proportion of females and the presence of a malnourished child living in a home are easily assessable indicators that SODIS-programme managers could use to identify early adopters in SODIS promotion campaigns.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00731497.
authors.affiliation: Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, P,O, Box, 4002 Basel, Switzerland.
authors.forename: Andri
authors.initials: A
authors.lastname: Christen
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Duran Pacheco
authors.forename: Jan
authors.initials: J
authors.lastname: Hattendorf
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Arnold
authors.forename: Myriam
authors.initials: M
authors.lastname: Cevallos
authors.forename: Stefan
authors.initials: S
authors.lastname: Indergand
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
authors.forename: Daniel
authors.initials: D
authors.lastname: Mäusezahl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001838:Bolivia; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control; D004059:Diffusion of Innovation; D004203:Disinfection / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D019983:Guideline Adherence; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014871:Water Microbiology; D018508:Water Purification / Q000379:methods*; D014881:Water Supply; D055815:Young Adult