title: Explaining low rates of sustained use of siphon water filter: evidence from follow-up of a randomised controlled trial in Bangladesh.
abstract: OBJECTIVE
  To assess sustained siphon filter usage among a low-income population in Bangladesh and study relevant motivators and barriers.
  
  
  METHODS
  After a randomised control trial in Bangladesh during 2009, 191 households received a siphon water filter along with educational messages. Researchers revisited households after 3 and 6 months to assess filter usage and determine relevant motivators and barriers. Regular users were defined as those who reported using the filter most of the time and were observed to be using the filter at follow-up visits. Integrated behavioural model for water, sanitation and hygiene (IBM-WASH) was used to explain factors associated with regular filter use.
  
  
  RESULTS
  Regular filter usage was 28% at the 3-month follow-up and 21% at the 6-month follow-up. Regular filter users had better quality water at the 6-month, but not at the 3-month visit. Positive predictors of regular filter usage explained through IBM-WASH at both times were willingness to pay >US$1 for filters, and positive attitude towards filter use (technology dimension at individual level); reporting boiling drinking water at baseline (psychosocial dimension at habitual level); and Bengali ethnicity (contextual dimension at individual level). Frequently reported barriers to regular filter use were as follows: considering filter use an additional task, filter breakage and time required for water filtering (technology dimension at individual level).
  
  
  CONCLUSIONS
  The technological, psychosocial and contextual dimensions of IBM-WASH contributed to understanding the factors related to sustained use of siphon filter. Given the low regular usage rate and the hardware-related problems reported, the contribution of siphon filters to improving water quality in low-income urban communities in Bangladesh is likely to be minimal.
authors.affiliation: International Center for Diarrheal Disease Research, Dhaka, Bangladesh; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Monash, Melbourne, Australia.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Najnin
authors.forename: Shaila
authors.initials: S
authors.lastname: Arman
authors.forename: Jaynal
authors.initials: J
authors.lastname: Abedin
authors.forename: Leanne
authors.initials: L
authors.lastname: Unicomb
authors.forename: David I
authors.initials: DI
authors.lastname: Levine
authors.forename: Minhaj
authors.initials: M
authors.lastname: Mahmud
authors.forename: Karin
authors.initials: K
authors.lastname: Leder
authors.forename: Farzana
authors.initials: F
authors.lastname: Yeasmin
authors.forename: Jill E
authors.initials: JE
authors.lastname: Luoto
authors.forename: Jeff
authors.initials: J
authors.lastname: Albert
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001459:Bangladesh; D004203:Disinfection / Q000379:methods* / Q000706:statistics & numerical data; D060766:Drinking Water; D005006:Ethnicity; D005191:Family Characteristics; D005260:Female; D005374:Filtration; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D006920:Hygiene; D009042:Motivation; D011203:Poverty; D012499:Sanitation; D018508:Water Purification / Q000379:methods*; D060753:Water Quality; D014881:Water Supply; D055815:Young Adult
chemical_list: D060766:Drinking Water
keywords: Bangladesh; IBM-WASH; barreras para el uso; barrières d'utilisation; filtres à eau Siphon; filtro de agua Siphon; integrated behavioural model for water, sanitation and hygiene; siphon water filters; usage barriers