wash communication project

KNOWLEDGE, ATTITUDES AND PRACTICE

(KAP) SURVEY FOR

SOLOMON ISLANDS

Solomon Islands Ministry of Health &

Medical Services and UNICEF PACIFIC

WASH COMMUNICATION PROJECT

Prepared by

Pasifika Communications

April 2014

Table of Contents

Executive Summary

1. Background Page 3

2. Rationale Page 3

3. Populations Page 3

4. Expected Outcomes Page 3

5. General Information Page 4

6. Rationale Page 4

7. Survey Goals and Objectives Page 6

8. Survey Design Page 6

9. Methodology Page 7

10. Key Stakeholders and Research Participant Selection Page 8

11. Research Tools Page 8

12. Field Research Process Page 9

13. Research Ethics Page 10

14. Informed Consent Forms Page 10

15. Survey Research Page 11

16. Research Findings Page 11

17. Modified Key Messages Page 12

18. Conclusion Page 13

Appendix 1 Research Certificate

Appendix 2 KAP Questionnaire

Appendix 3 Consent Form

Appendix 4 KAP Research Observations and Summary

Appendix 5 KAP Survey Findings

WASH Communication Survey – Solomon Islands Page 2

Executive Summary

Background As part of the UNICEF WASH project (details), a baseline KAP survey was conducted in six peri-urban and rural communities on Guadalcanal in the Solomon Islands. This survey was conducted in March 2014 on behalf of the SI Ministry of Health and UNICEF. The purpose of the survey was to provide a baseline of data to inform the development of communication materials that form part of this Project. The main purpose of these materials will be to help trigger and sustain behavioural change, particularly in areas of water, sanitation and hygiene. The Survey An experienced Solomon Island social researcher, Melissa Kii, was engaged to undertake the supervision and implementation of the survey. A total of 72 households were included in the survey. She utilised other data collectors who worked under her supervision. The survey involved six communities that were chosen from three geographical settings – coastal, plains and highlands. The survey also sought to maintain a balance between male and female respondents and between different age groups as well. Karuna Reddy, Research Data Analyst at the University of the South Pacific, conducted data analysis of the survey results. Karuna examined many different parameters in the study to identify whether there were any commonalities and/or differences amongst the respondents and amongst their responses. The Findings Although the sampling size was relatively small, the analysis found the data to be useful and reasonably accurate using non-parametric methods. The survey communities were fairly homogenous and allow for some assumptions for similar communities, but not for the entire population of the country. Various statistical methodologies were used to test for accuracy of the result findings. For some key questions, the survey results found substantial differentiation between Knowledge and Practice. For example, 95% of those interviewed agreed that using toilets would help avoid disease and ensure family health. And yet, 53% of the same respondents said that they and their family defecated in their compound near their home. There is a distinct gap between knowledge and practice in several key areas. The findings also provided insight into opportunities to engage with the public, showing that radio and mobile phones were two potential tools for communicating with them. Conclusions There is considerable useful data from the survey to help develop an effective Communication Strategy for the development and distribution of materials for this Project. The data has helped to refine the primary messages for the campaign, as well as to refine the age groups to be targeted for the messages. This will in turn help inform the choice of effective communication materials.


1. Background The WASH Communication Project is being undertaken for the Solomon Islands Ministry of Health and Medical Services (MHMS) with funding and technical support provided by UNICEF Pacific. Team members of Pasifika Communications as well as Solomon Island and Fiji-based consultants are implementing the Project. The Project’s purpose is to provide support to MHMS to deliver communication in support of WASH (water, sanitation and hygiene) and up to ten related key family practices through the participatory development and pre-testing of a set of comprehensive multimedia materials and activities. Community consultations, in the form of a KAP survey and focus groups, were required to inform the development of these materials. With supervision and guidance from UNICEF Pacific Communication and WASH specialists, Pasifika Communications and their consultants oversaw all aspects of ensuring proper and participatory community consultations and assessments, as well as oversaw research into behavioural determinants.

2. Rationale The Project addresses the expressed need for more suitable and effective communication materials to support WASH advocacy efforts. Using an evidence-based approach, the household KAP survey provides much needed insight into the knowledge, attitudes and practices that need to be addressed by the communication materials. 3. Populations Six communities have been selected in the Guadalcanal area based on various criteria. One person from each of 12 random households in each community will be consulted.

No. Name of Community

Geographical Settings

Male Female Youth Children Total

Male Female

1 Maravovo Coastal 50 63 57 64 81 315 2 Leosa –

Veuru Coastal 156 171 124 98 205 754

3 Turarana Highlands 230 220 250 250 300 1200 4 Gilbert camp Highlands 200 200 300 250 150 1,100 5 Pitukoli Plains 103 106 54 61 131 455 6 Papangu Plains 129 105 46 35 57 372

4. Expected Outcomes The data collected through the community survey provides insight into the various behavioural determinants that lead to water, sanitation and hygiene practices that put both children and adults’ health at risk. Materials will be developed from these community consultations that prove to be easily understood and effective in communicating WASH-related best practices. The


communication materials that are developed are expected to help health workers in both MHMS as well as various NGOs who are engaged in WASH-related advocacy efforts. 5. General Information Project Title: WASH Communication Project Project owner: Ministry of Health and Medical Services (MHMS) Funded by: UNICEF Pacific Implementing agency: Pasifika Communications and local consultants Community Researcher: Melinda Kii, Solomon Islands Research

Development Specialist Research Sites: Maravovo Village Leosa-Veuru Gilbert Camp Papangu Turarana Pitukoli Survey Analysis: Karuna Reddy, Research Data Analyst, Office of

the Pro Vice-Chancellor, Research & International, The University of the South Pacific, Fiji

6. Rationale & Background Information Around 80% of the population of the Solomon Islands lives in rural areas. Overall safe water supply coverage is low at 65% and half of the systems included in the national coverage figure are commonly believed to be operating at less than design capacity or totally inoperative. Sanitation and hygiene promotion lag behind water supply in coverage and policy priority. Sanitation coverage is estimated at 18%, and open defecation is prevalent. Increasing coverage is a Solomon Islands Government (SIG) priority highlighted in the National Development Strategy (2011-2020) and supported by new policies adopted by the Ministry of Health and Medical Services (MHMS) as the responsible party for rural water supply, sanitation and hygiene promotion (WASH).

These factors continue to foster large numbers of diarrhoeal and other illnesses every year, especially amongst young children where very high mortality rates are seen.

Within MHMS, rural water and sanitation is the responsibility of the Rural Water Supply and Sanitation (RWSS) section of the Environmental Health Department (EHD) while community hygiene promotion is the responsibility of


the Health Promotion Unit (HPU). Historically, RWSS and HPU have had a low level of integration, but MHMS has recently renewed their commitment to delivering integrated WASH programming. The UNICEF WASH program aims to support MHMS to identify and promote a common set of WASH objectives and related communication messages, and to increase coverage of integrated WASH programmes across the country.

In all WASH projects, community approaches to total sanitation (CATS) will be used by communities to eliminate open defecation through affordable, appropriate technology and behaviour change. The emphasis of CATS is the sustainable use of sanitation facilities rather than the construction of infrastructure. CATS depend on broad engagement with diverse members of the community, including households, schools, health centres and traditional leadership structures.

Communities lead the change process and use their own capacities to attain their objectives. Their role is central in planning and implementing improved sanitation, taking into account the needs of diverse community members, including vulnerable groups, people with disabilities, and women and girls. In April 2013 MHMS and partners in Solomon Islands agreed to adopt and adapt the Community Led Total Sanitation (CLTS) approach to ensure tangible outcomes on WASH related indicators.

Innovative demand creation activities are important for achieving behaviour change and sustaining long-term preventive practices. It is expected that water, sanitation and hygiene interventions, including access to and use of safe drinking water and sanitation, as well as promotion of key hygiene practices, will provide health, economic and social benefits.

The purpose of the consultancy is to support the Ministry of Health and Medical Services (MHMS) to deliver communication in support of WASH and other key family practices through the participatory development and pre-testing of a set of comprehensive multimedia materials and activities. Community consultations will be required to inform the development of these materials, which may include print, radio, video and digital formats. The institutional contractor is expected to oversee all aspects of ensuring participatory community consultations and assessments; research into behavioural determinants; and materials development, pre-testing and finalisation.

Specifically, the institutional contractor will support MHMS to consult with partners by carrying out the following tasks:

1) Community consultations and research: Undertake community consultations to identify knowledge, attitudes, and practices related to WASH and related key family practices using verifiable qualitative and quantitative methods and tools; and to identify appropriate formats and channels for delivery and facilitation of communication.

2) Planning and message refinement: Based on the consultations, develop: (i) a set of messages to promote WASH and related family practices at national and community levels and a communication plan with budget to support their


dissemination; (ii) a Solomon Islands-specific CLTS trainer of trainers and trainer of facilitators guide; and (iii) a life skills-based hygiene education program for school children of different ages (ECE, primary, secondary).

3) Materials development: In partnership with two of the targeted communities and other relevant partners at national and provincial level, facilitate participatory development, pre-testing and finalization of multimedia materials to promote message delivery. This will include (i) a guide and training plan for interpersonal communication in at community level; (ii) CLTS toolkit; (iii) hygiene education program for school children; and (iv) a set of print materials, text messages and radio spots for promoting WASH and related key family practices during disasters.

7. Survey Goals and Objectives The survey’s primary goal is to obtain data on the knowledge, attitudes and practice of those in peri-urban and rural communities in relation to WASH practices and other family health issues. This data will help identify gaps in people’s awareness of the importance of specific sanitation and hygiene practices that are related to health risks.

The survey findings will inform the development of communication materials to advocate WASH best practices. These materials will be trialed in the communities to test their appropriateness and clarity in communicating the key messages. The materials are intended to not just raise awareness, but to begin the longer-term process of behavioural change. The initial survey’s objectives are to:

Establish a baseline of the current knowledge, attitudes and behaviour of those in peri-urban and rural areas in relation to sanitation, hygiene and other health-related practices;

Identify specific areas where intervention is necessary to increase knowledge or lead to specific behavioural changes for better health;

The follow-up survey’s objectives are to:

Identify areas of the previous knowledge, attitudes and behaviour that may have changed due to the implementation of the communication materials;

Identify specific areas where additional intervention or improved communication may be needed.

8. Survey Design This will be a two-part KAP survey conducted in six different communities in the surrounding rural areas outside of Honiara. Based on recommendations from RDLP, communities were chosen from the three basic geographic types of communities – coastal, highlands and plains. To obtain untainted


responses, care has been taken to identify communities that have not yet had any WASH related interventions undertaken there. Twelve households will be randomly chosen in each of the six communities and one person from each household will be interviewed. An effort will be made to have a balance of males and females, as well as to involve some younger persons as respondents, but this will be dependent on cultural and other sensitivities when the household members are approached. This survey uses a very small sampling of communities, and is limited to only one of the islands in Solomon Islands, so results cannot be considered representative of “national” knowledge, attitudes and practices. These limitations are primarily budget-driven. Nevertheless the sampling will examine different types of communities as well as different ages and genders in order to gauge differentiation and similarities in responses. A questionnaire was developed which has both quantitative and qualitative questions. To maximise the participation of each respondent, the questionnaire was designed to take no more than 30 minutes to complete. As can be seen from the attached questionnaire form, the study will first obtain basic socio-demographic information on each respondent. This is designed to correlate any potential significance between WASH behaviours and geographic location. The survey then measures knowledge of respondents to specific WASH related topics, as well as their attitudes and practices to specific activities, including open defecation. The qualitative questions will allow less structured responses to be recorded, adding further value to the integrity of the data. 9. Methodology In line of the overall goal of the research - to improve and deliver communication in support of WASH in the Solomon Islands, the research methodology will be undertaken in three phases. Phase one of the research is to identify knowledge, attitude and practices (KAP) of families within the targeted communities which both qualitative and quantitative methods will be used; more emphasis will be on quantitative. Phase 2 is to Identify appropriate channels and formats for delivery and facilitation of communications related to WASH by pretesting of comprehensive material and activities. The qualitative approach will be emphasised in order to acquire information that is objective and complements subjective issues in Phase 1. Phase 3 is monitoring and evaluation. Health professionals from MHMS and key NGO groups will conduct WASH related interventions in three of the communities and in nearby schools using the communication materials developed for this project. Following these interventions, a follow up survey (Phase 3) will be conducted. This survey will essentially utilise the same questionnaire as Phase 1. Three of the communities will not have had any WASH related interventions. These three communities will be the control


group to help identify whether or not the materials used in the interventions have been effective. Correlations will be made between the Phase 1 responses and the Phase 3 responses following these interventions. This evidence will used to substantiate the effectiveness of the materials, or identify remaining gaps that need to be addressed. Although the follow-up survey cannot measure behavioural change, it can measure changes in the knowledge and attitudes of the respondents, if any. The results may also provide indications that any improvement in responses may be a result of the communication materials used in the interventions. The two main data gathering methods;

Questionnaires for the KAP survey which also contains a few qualitative questions;

Focus group discussions (fgd) in three target controlled communities on pretesting of materials.

These will be collected primarily for the purpose of providing a baseline for on going monitoring and evaluation which will be relevant for key stakeholders such as the Ministry of Health, UNICEF, World Vision and other key players who are involved in the WASH campaign. 10. Key stakeholders and research participant selection Initial consultations with key stakeholders have identified 6 communities for the research. The communities were selected according to:

geographical settings 25-mile radius from Honiara No previous WASH interventions

One of the 6 communities is a Malaitan settlement, which was selected for rehabilitation purposes, which was highly affected during the ethnic tension. These various selection criteria were provided by both UNICEF (to address funding requirements) and by the Rural Water program. From the findings of Phase 1, communities will be identified for Phase 2.

11. Research Tools

The key research tools are questionnaires for the KAP survey, focus group discussions for pretesting of materials and participatory workshops for recommended youths who will be involved in a radio talkback show on WASH. A copy of the questionnaire for Phase 1 is provided as Appendix 2 and the focus group discussion guides will be provided after Phase 1 is completed.

The questionnaire was the key source of quantitative data. It was developed based on the MHMS’s 10 key messages and family practices as well as from inputs from key stakeholders in areas relevant to them. This was to enable key stakeholders to understand the KAP of the targeted communities. The


questionnaire has been designed to collect some qualitative data that will allow the reporting of qualitative findings on the KAP key issues, which will help formulate materials for pretesting in Phase 2 of the research.

Availability of reliable qualitative data was limited and it was expected that respondents would be reluctant to answer a lengthy questionnaire. Therefore, a balance was sought between including questions about all the areas of interest and designing a questionnaire that is 30 minutes in length and is more likely to engage higher level of participation from respondents. The questionnaire was administered in the form of a structured interview by the interviewer to avoid bias.

Focus Group Discussions will be held in 3 target-controlled communities with youths and adults. A guideline of key questions for the focus group discussions will be provided prior to commencement of Phase 2. Separate discussion groups will be held for women, men, youths and the research team will consist of at least one woman and a man. A voice recorder will be used and participants informed that the recordings would be deleted once the content is transcribed.

12. Field Research Process

The research team, comprised of two experienced Solomon Island researchers, one of whom is our local Research Specialist, conducted the field research in the 6 selected communities. The selected communities were contacted prior to undertaking the research to inform them of the purpose of the research through scoping. Interviews commenced after that.

Scoping

Scoping took place with initial visits to each community by the local Research Specialist. Village elders and Chiefs were consulted including a hand delivered letter from the Ministry of Health with details of the research. Information dissemination and sharing also took place during this activity.

Recruitment Process

After consultations with the chiefs and elders of each community, the Research Specialist made first contact to potential respondents. There were a total of 72 respondents, 12 households with one respondent per household. 3 male adults, 3 female adults, 3 male youths and 3 female youths were identified in each community. Youths were identified from 12 years of age to 24 years. There were 12 X 30 minutes interviews in each community. As mentioned above, a spread of age and gender was sought in this sub-sample. The interviews were conducted in Solomon Pidgin.

Voice recorders will be used to record the focus group discussions. These recordings will be transcribed, and complimented by written notes. Feedback of key impressions, findings and challenges will be provided by the research


team. The Research Specialist will then be responsible for the collation of data and will provide inputs on the report write up. 13. Research Ethics Ethical principles are of high priority for this research. The research context involved several aspects that presented particular ethical issues including; the potential sensitivity of the content, e.g., language used such as ‘toilet’, ‘shit’ and other cultural dimensions. Research always brings the potential for unintended, negative outcomes, and in an international development setting, there are added challenges of cross-cultural communication and power dynamics. Respecting the privacy and confidentiality of children participating in research involved close consideration of several aspects: privacy with regard to how much information the child wanted to reveal or share, and with whom; privacy in the processes of information gathering/data collection and storage that allows the exchange of information to be confidential to those involved; and privacy of the research participants so that they are not identifiable in the publication and dissemination of findings. Obtaining consent from parents/carers and children was central to the research relationship and signals respect for the research participant’s dignity, their capability to express their views and their right to have these heard in matters that affect them. Informed consent was an explicit agreement that required participants to be informed about, and have an understanding of, the research. This was given voluntarily and was renegotiable, so that children could withdraw at any stage of the research process. 14. Informed Consent Forms Core to the principle of respect is ensuring all participants provide their informed consent to voluntarily participate in the research. Prior to the interview each respondent shall be provided a consent form and will also be thoroughly briefed by the Research Specialist. The participant will be asked to give their consent either in the form of a signed declaration or provide their fingerprint in a fingerprint box provided on the consent form which ever the participant prefers. Respondents below 18 years of age will be briefed under the supervision of their parents and have parental consent by confirmation of signing the consent form. A copy of the Informed Consent Form is attached as Appendix 3.

15. Survey Research The research team provided a full explanation of the research, how research findings would be used and disseminated, and how it was the participants’ right to choose whether to participate or not, and to withdraw at any time


during the research process. This explanation was provided in English and/or pidgin, depending on requirements. As a piece of research that responds to Solomon Island identified priorities and concerns, and is designed to assist local stakeholders to advance their understandings and tools, the research meets the principles of beneficence and merit. Considerable effort will be invested in ensuring the research findings are widely disseminated, including reporting back to all participants. The research has been published in English, which will be distributed to all key stakeholders. This will include reporting on any decisions or commitments made by Government, donors or providers, in response to the research. The field research and questionnaires are designed to ensure they do not create an undue burden/time commitment on the participants. 16. Research Findings Details of the research findings can be found in the attached reports by the USP-based Research Data Analyst and the Solomon Islands Research Development Specialist. A number of socio-demographic data was collected, as well data on access to and prevalence of radio, newspaper and mobile phones as communication tools. Some of the questions on hygiene may have stimulated some social embarrassment resulting in disproportionately high responses. This is an assumption based on the fact that the responses to these type of questions did not correlate closely with similar questions. The responses also did not always correlate to physical evidence (such as a lack of visible toilets). Observations on the some of the more relevant findings of the survey are provided below:

1) The communities surveyed had an average of 5 children per household;

2) 85% of respondents had attained primary or secondary education; 3) 21% of the female respondents were pregnant as teenagers; 4) 42% of respondents accessed their drinking water from a well, river,

rainwater or bore hole; The remainder had access to tap water; 5) 70% of respondents agreed that properly disposing of faeces would

keep their family healthy; however, at least 53% admitted that they defecated in their compound near their home.

6) 34% of respondents admitted that they did not use toilets or latrines for disposing of faeces. Of the respondents who claimed they did use toilets or latrines, the researchers were in most cases unable to visually verify the existence of these toilets;

7) Of the 34% who admitted not to use toilets or latrines, 14% claimed they were too poor to build a toilet, and 13% responded that they were too lazy.


8) 78% of respondents claimed that they punished their children with their hand, a stick or another object;

9) There was no significant statistical difference in responses on Practice between the three geographic areas (Coastal, Plains and Highlands) or between the six communities surveyed;

10) 89% of the respondents claimed to wash their hands with soap and water after defecating, urinating or handling garbage; 98% claimed to have soap at home;

11) 90% of respondents agreed that it was always necessary to wash their hands after defecating, urinating or handling garbage;

17. Modified Key Messages The following messages have been drawn from those provided initially by UNICEF, as well as a list provided by the Solomon Islands Ministry of Health and Medical Services. They have been modified to address the gaps identified through the research data.

1. All faeces should be disposed of safely. Using a toilet or latrine is the best disposal method.

2. Hands should be washed with soap and water: a. After defecating b. Before eating c. Before cooking

3. Flies and unwashed hands are the most common carrier of faecal material to food. This can cause diarrhoeal diseases.

4. Drinking water should be from a safe water source such as: a. Rainwater b. Boiled water c. Tap

5. Food and drinking water should be stored in a safe, covered containers;

6. Cooked food should be eaten without delay or reheated thoroughly before eating;

7. When a woman is pregnant, violence against her is dangerous to both she and her baby;

8. Babies should be exclusively breastfed for the first six months. Breastfeeding should continue for at least the first two years.

9. Parents and siblings should spend time with younger children. This helps in their development;

10. Every child should complete the recommended series of immunisations.

17. Conclusion Despite a delay in commencing the survey, and difficulties conducting the surveys due to severe weather resulting in the inaccessibility of some


communities, the survey was conducted efficiently and without incident in March 2014. Although the survey addressed multiple family health issues, one of the primary lines of questioning involved water, sanitation and hygiene issues (WASH). Previous research and statistics on the prevalence of toilets and access to water supply in rural and peri-urban areas were fairly consistent with the findings obtained in this current research. Since it was a survey of Knowledge, Attitudes/belief and Practice, there was no physical verification of the responses (such as identifying toilets that were claimed to be used, or soap that was claimed to exist in homes). The data analysis verified that the responses were consistent enough to be considered accurate which supports the observations made from this data. In general, a number of key family health practices clearly require communication support in order to improve the public’s Practice as well as their Knowledge. The data verified that there was little differentiation between ages, communities and geographical locations. There was some differentiation between gender, owing primarily to male respondents’ lack of knowledge on breastfeeding, immunisation and other “family related” questions. Otherwise, the data collected reflected a fairly homogenous sampling, which increased the reliability of the quantitative and qualitative statistics collected. The data gathered for this survey will lead into the development of a Communication Strategy, which will identify the messages, communication channels and provide a framework for distribution of communication materials developed. It provides useful baseline data to enable some general assumptions to be made about Solomon Island rural and peri-urban communities and allows the further development of communication materials to address gaps in the public’s perceptions and practices. Dale Hermanson Pasifika Communications April 2014

Appendix 2

1

Knowledge, Attitudes and Practices (KAP) Survey Questionnaire

Informed Consent Hello, my name is Melinda Kii. I am an Interviewer working for Pasifika Communications on a project funded by UNICEF. We are interested in learning about your level of knowledge, attitudes and practices on a variety of family health, water‐related issues, sanitation and hygiene matters in your home. Morne/ivinin/aftanun, nem blo mi ..................... Mi wanfala intaviua wea waka fo Pasifika Komiunikeison lo wanfala project wea UNICEF na fandim. Mifala bae stori weitim iu noma en intres lo wat iu save, hao iu duim en wat iu duim lo saed lo helt blo family, saed lo wata iumi usim, saniteison en saed lo haijin lo haushol blo iu. I am grateful for your participation in this survey. The interview will take about 30 minutes to complete. Whatever information you provide will be kept strictly confidential and will not be disclosed to other people. Mi bara hapi dat iu save sitdoan en tek pat lo disfala sevei. Intaviu ia bae kasem noma 30 minit den umi finis na. Wat iu talem o eni ansa blo iu bae hem konfidensol, minim dat bae mifala no talem aut dat iu na stori osem en no eni wan moa bae save wat iu talem tudei.

Section A: Socio‐Demographic Characteristics

1 Respondent Name (optional) Nem blo iu?

2 Community Name Nem blo komiuniti blo iu?

Maravovo Leosa‐Veuru Barana Gilbert Camp Pitukoli Papangu

3 Gender Man/Mere

Male Female

4 Age Iu hao ol na distaem?

14 – 18 years 18 – 30 years 31 – 40 years 41 – 50 years Over 50 years

5 Number in Household? Hao meni pipol na stei insaed lo haus blo iu?

Adults Children

6 Marital Status Iu marit?

Married/living together Separated Widowed Divorced Single/Never Married

7 What is the key source of income for your family (i.e., occupation of Farming/Agriculture

Appendix 2

2

the breadwinner)? Wat na mein sos blo inkam blo family blo iu?

Full‐time Employment Small Business Others (Please specify) …………………………………………..

8 How long have you lived in this community? Hao long na iu stap lo disfala komuniti?

Years

9 What is your highest level of education? Iu skul kasem?

Never attended Primary Secondary Tertiary

10 How many times have you been pregnant? (females only) Hao meni taem na iu bin babule?

11 How old were you when you first became pregnant? (females only) Iu hao ol taem iu fest babule?

12 How long does it take to walk to the closest health centre? Hao long na fo iu wakabaut go kasem klinic blo iufala?

13 What is your source of water for drinking at home? Wea na iu save tekem wata fo drink lo haus?

River Water tap Well Rainwater Other

14 What is your source of water for bathing at home? Wea na iu save swim?

River Water tap Well Rainwater Other

15 How often do you read a newspaper? Hao meni taems na iu save ridim niuspepa?

Never Once a month Once a week Twice in a week Other

16 Which newspaper do you read? Wat kaen niuspepa na iu save ridim?

17 How often do you listen to radio? Hao meni taems na iu save here here lo redio?

Never Once a month Once a week Twice in a week Other

18 Which station do you listen to? Wat kaen steison na iu save here here lo hem?

19 Do you own a mobile phone? Iu garem mobael fon?

Yes No

20 Which network do you use? Wat kaen netwok na iu iusim?

Bemobile Telikom

21 Can you access internet on your mobile? Iu save intanet lo mobael blo iu tu?

Yes No

Appendix 2

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Section B: Knowledge and Awareness Statement or Question Rating Scale

Birth – 6 Months Strongly Disagree

Disagree

Not Sure Agree

Strongly

Agree

1 Breastfeeding is healthier for your baby than bottle feeding.Susu blo mami hem helti winim iu susum beibi lo botol.

2 Immunising children helps prevent death from diarrhoea or other diseases. Nila blo beibi hem helpem katem daon daeria en olketa nara siki wea bae stopem olketa fo dae.

3 Properly disposing of human or baby faeces (shit) will help keep your family healthy Torowem o putim gud toilet blo olketa pikinini en big man bae help kipim family blo iu helti.

4 Toilets are expensive to build and maintain and are not that necessary Olketa toelet hem ekspensiv fo wakem en hem no impotent fo garem

5 Using toilets or a latrine for faeces (shitting) helps avoid diseases and keeps your family healthy Iusim propa toelet hem kipim family blo iu helti

6 If there are no toilets, all faeces, even from babies, should be buried. If no eni toelet den olketa toelet blo big man en pikinini umi sud berim

7 Defecation (shitting) in the bushes away from my house is okay to do and does not affect anyone. Toelet lo bus farawei from haus blo iu hem olraet en bae hem no afektim eniwan noma.

8 It is always necessary to wash your hands after defecating or handling garbage Iu mas wasim han blo iu olowe afta iu go lo toelet en holem rabis

9 Washing hands with soap (or ash) and water before touching/preparing food helps prevent diarrhoea Wasim han blo iu lo soup en wata bifoa iu redim o holem kakai bae stopem iu fo garem daeria

10 When you wash your hands, it should always be with soap or ash and water. Taem u wasim han blo iu, iu mas wasim olowe weitem soup, asis en wata

11 Diarrhoea amongst young children can often be treated with ORS (oral rehydration salts) Daeria blo olketa pikinini iumi save tritim weitim ORS,

Appendix 2

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(disfala solt wea olketa klinik save givim taem pikinini daeria ia)

12 Children who have rapid, difficult breathing or continuing diarrhoea should be examined at hospital Olketa pikinini wea stragol olowe fob rid o daeria olowe sud go lo hospitol fp olketa tsekem hem

6 Months – 2 Years Strongly Disagree

Disagree

Not Sure

Agree

Strongly

Agree

13 To have a healthy baby, breast feeding should stop after six months Fo beibi blo iu hem helti, susu blo mami mas stop taem hem kasem six manis

14 Complementary foods, as well as breastfeeding, should be given to your baby from 6 months of age Iu mas stat fidim pikinini blo iu plas susu blo mami taem hem kasem six manis

15 Using clean containers to store drinking water and covering them helps prevent contamination Iusim olketa kiln konteina fo kipim wata fo drink en kavam olketa helpem katem daon kontaminason

Section C: Attitudes and Beliefs

Statement or Question Rating Scale

Birth – 6 Months Strongly Disagree

Disagree

Not Sure Agree

Strongly

Agree

1 Violence against pregnant women can cause problems with the baby’s birth Vaelens lo olketa babule mere save kosim problem fo olketa taem bonem pikinini

2 Babies should be breastfed since breast milk has everything they need for the first few months. Olketa beibi sud susu from mami bikos susu blo mami na garem evriting beibi nidim fo olketa fest manis olketa bi bik kam

3 Breastfeeding can prevent the mother from getting breast cancer Susum beibi save help stopem mami fo garem brest kansa

4 Proper disposal of human or baby shit (faeces) can keep your family healthy Putim gud o torowem gud olketa toelet blo beibi en big man save kipim family blo iu helti

5 Using toilets/latrines for excreta disposal (human or baby) will avoid diseases and may keep your family healthy Iusim olketa toelet save stopem olketa siki en helpem kipim family blo iu helti

Appendix 2

5

6 If there are no toilets, it is okay to defecate (shit) in your compound as long it is away from the front door. If iu no garem propa toelet hem olraet nomoa fo iu toelet raunim haus blo iu bat hem mas farawei from doa blo haus blo iu

7 Defecating (shitting) in the bushes is ok if it is at least 20 meters from your house Toelet lo bus hem set noma as long as hem 20 mtr from haus blo iu

8 You should wash your hands with soap (or ash) after urinating or defecating or handling garbage Iu mas wasim han blo iu weitim soap o asis afta iu go bi, toelet o holem rabis

6 Months – 2 Years Strongly Disagree

Disagree

Not Sure

Agree

Strongly

Agree

9 Breastfeeding should continue for at least the first 2 years of the child’s life. Mami mas susum beibi blo hem go go hem kasim 2 ias

10 Apart from breastfeeding, complementary foods should be introduced beginning at 6 months of age Susu blo mami plus kakai blo beibi mas stat taem beibi 6 manis

11 Food for the infant should be stored safely (in a cooler or sealed container) to prevent from diseases like diarrhoea Kakai blo beibi mas stei gud lo eni konteina wea garem gud lid fo helpem beibi no garem daeria

12 Parents and siblings should not play or interact with their child(ren) Mami en dadi sud no tok o plei weitem pikinini blo hem

13 Your child’s brain doesn’t develop until after 3 years of age Beibi blo iu no stat fo tingting kasem hem 3 ias

14 Boiling or disinfecting drinking water with sunlight or chlorine can help reduce waterborne diseases Boelem o disinfektim wata fo drink weitim san o klorin save helpem katem daon olketa siki wea kam from wata

2 Years – 5 Years Strongly Disagree

Disagree

Not Sure

Agree

Strongly

Agree

15 Children should be sent to pre‐school to develop mentally and socially Olketa pikinini mas go lo pri‐skul fo olketa save divelop lo tingting blo olketa en sosol wei blo olketa

5 Years – 10/13 Years Strongly Disagree

Disagree

Not Sure Agree

Strongly

Agree

16 If parents care for their children they should discipline them accordingly, even if it means smacking or hitting them. If olketa mami en dadi kea fo olketa pikinini blo tufala olketa mas disiplinim pikininini blo tufala, tufala save

Appendix 2

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smakim o hitim olketa

17 If your child(ren) wash their hands with soap (or ash) before touching food it can prevent diarrhoea If olketa pikinini blo iu wasim hand blo olketa weitim soup o asis bifoa olketa holem kakai hem save help katem daon daeria

18 Children should be taught at school how to keep themselves healthy. Olketa skul mas lanem olketa pikinini hao fo kipim olketa seleva helti

19 Young adults should be informed how to have safe sex to prevent getting HIV or another STD. Olketa mas talem olketa iuts o iang pipol abaut seif seks fo katem daon HIV or olketa nara STDs.

Section D: Practices Statement or Question Responses

Birth – 6 Months Yes No Not Sure

1 Did you get your baby immunised in their first and second year? Bebei blo iu tekem nila blo olketa pikinini lo fest en sekon ia blo hem tu?

2 Did you exclusively breastfeed your baby for the first 6 months? Bebei blo iu susu fultaem lo fest 6 manis blo hem tu?

3 Has your baby ever gotten diarrhoea or a respiratory illness? Bebei blo iu eva daeria o siki lo lang o had fo brit tu (sotwind)?

4 Do you use toilets or latrines for faeces disposal (adult or baby)? Iu iusim toelet en toelet blo beibi iu torowem lo toelet?

If #5 is no, explain why you don’t. If qstn 5 hem noma, den wae?

5 Do you dispose of human or baby faeces by burying it in a pit? Olketa toelet blo pikinini en big man iu save berim?

6 Do you or your family members defecate in your compound near your home? (If “no” skip to Question 10) Iufala toelet lo eni eria raunim haus blo iufala?

7 If “yes” to previous question, is it close (within 5‐10 metres) of your home? If ‘ies’, hem kolsap lo haus blo iu? (5‐10mtrs)

8 Do you or your family defecate in an outside area, over 20‐30 metres from your home? Iufala go go toelet lo eni plas autsaed from haus blo iufala? 20‐30mtrs

9 Do you and your family members wash your hands with soap and water after urinating or defecating or handling garbage? Iu o olketa lo family blo iu save wasim han blo iufala weitim soup afta iufala toelet, bi o holem rabis?

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10 If #11 is “no”, what is the reason? If noma, wae?

11 Do you have soap at home? Iu garem soup lo haus blo iu tu?

6 Months – 2 Years Yes No Not Sure12 Did you continue breastfeeding your last child for at least the first 2 years?

Las pikinini blo iu iu susum go go kasem tu ias?

13 Apart from breastfeeding, did you introduce other foods beginning at 6 months of age? Iu fifidim beibi blo iu weitim susum hem taem hem kasem 6 manis?

14 When your child suffers from diarrhoea, what do you give them? Taem pikinini blo iu daeria wat na iu save givim hem?

15 Do you, or did you store food for your baby in a sealed container? Iu save putim kakai blo beibi lo kontaina wea hem tait gud?

16 Do you boil or disinfect your drinking water? Iu save boilem o disinfektim wata fo drink blo iufala tu?

17 If #20 is yes, how do you disinfect it? If ia, hao na iu save disinfektim?

18 Do you use clean containers to store drinking water & cover or seal them? Iu iusim olketa kiln konteina fo wata fo drink blo iufala en kavam gud tu?

2 Years – 5 Years Yes No Not Sure 19 Do you or did you send your children to pre‐school?

Olketa pikinini blo iu go lo pri skul tu?

20 How often do you wash your face? Iu save wawasim feis blo iu tu? Hao meni taems?

21 How often do you cut your fingernails? Iu save katem olketa neil blo iu tu? Hao meni taems?

5 Years – 10/13 Years Yes No Not Sure 22 Have you ever seen anyone in your household smack or hit any of the

children in the household either with their hand, stick or another object? Eni wan lo haus blo iu save smakim o hitim pikinini weitim han blo hem o eni stik o nara samting moa?

23 Have you or anyone in the family ever verbally abused your child(ren) as a form of discipline for instance? Iu o eniwan lo haus save swea lo olketa pikinini blo iu o tok nogud lo olketa fo saed lo disiplin?

24 Did your child drop out of school before completing their education? Eni wan lo olketa pikinini blo iu no finisim skul blo hem?

25 Do you talk to your older children (12 years onwards) about sex and how they can protect themselves? Iu save stori weitim pikinini blo iu wea ovam 12 ias finis abaut seks en hao olketa save kipim olketa seif?

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That concludes our interview for today – we value your contribution. Thank you for your time and

cooperation.

Hem noma stori blo iumi fo tudei, tagio tumas fo imta stori!!

Appendix 3

CONSENT FORM The subject matter of this community survey is on water, sanitation, hygiene and other family health issues. The purpose of this survey is to find out what you know, what you believe and what some of your current practices are in relation to the subject. The end purpose of this survey is to develop educational materials that may help everyone in Solomon Island communities enjoy better health and prevent serious illness for children. I ……………………….. agree to be interviewed in this WASH Survey conducted

by Pasifika Communications on this …………………….. day of ………….,

…………… after having been thoroughly informed of the content and objectives

of this survey and assured of the confidentiality of my responses.

………………………………….. Respondent Signature …………………………………. Parents Signature, if Respondent is under 18 years Thumbprint

Appendix 4

SUMMARY AND OBSERVATIONS OF KAP SURVEY CONSULTANT

KAP SUMMARY In March 2014, Phase 1 of the Water Sanitation and Hygiene (WASH) Communication project Community Survey was conducted in 6 communities in Guadalcanal Province. Phase 1 was to obtain data primarily on the knowledge, attitude and practices (KAP) of individuals on water, sanitation and hygiene related issues. The KAP survey was the first phase of a three phase project to identify effective communication materials for the nationwide WASH campaign for the Ministry of Health and Medical Services, UNICEF and other stakeholders. METHODOLGY The main research method used was using questionnaire and interviewing. Respondents were randomly recruited by selecting one individual from a household in each community. Three female and three male youths, and three male and three female adults were selected in the six communities. A total of 72 respondents were interviewed within a timeframe of two weeks. All female respondents were interviewed by a female interviewer; likewise all male respondents were interviewed by a male interviewer. Each respondent acknowledged their consent to be interviewed by signing a consent form. Youths under the age of 18 provided a signed consent form from their parents/guardian. Both interviewers are of Guadalcanal origin. Community consultations with village chiefs and elders were completed in the initial stages to raise awareness of the survey’s purpose and to get permission for conducting the interviews in their communities. This activity also included identifying the interviewees and arranging times for the interviews. The estimated time of the KAP survey was a week but due to heavy rainfalls and disturbance from election registration, this was extended to 2 weeks. Turarana was replaced by Barana Community because Turarana was not accessible due to heavy rain the week the survey was due to be conducted there. COMMUNITY CONTEXT Communities were selected in collaboration with WASH stakeholders. Selection of communities was based on the following criteria:

their geographical locations (plains, highlands, coast), a 25 mile radius within Honiara, and no WASH intervention had been done previously within the community.

Two communities situated in the plains of East Guadalcanal are Pitukoli and Papangu. Pitukoli is a 20 km drive from Honiara, and sits in the back of the oil palm plantation. It has a clinic and primary school right at the center of the community. Papangu, also situated at the end of the oil palm plantations, is a 14km drive from Honiara. It has a health care center and a primary school, which is a 45-60 minute walk outside the village. A bus ride into town is $15.00 from both communities.

Appendix 4

Gilbert Camp sits on the mountains immediately outside of Honiara on North West Guadalcanal. The nearest health center is in Honiara, which is 15-20 minutes away by foot. Gilbert Camp is serviced by 2 Primary Schools and a Community High School. Barana is a 3 km drive from Honiara further up from Gilbert Camp. Villagers use the same clinic as Gilbert Camp which is another 35-40 minutes’ walk downhill but are fortunate to have a Primary School within the vicinity of the village. Public buses reach Gilbert Camp with a fare of $3 into town whilst Barana has no access to public buses besides cabs. Individuals from Barana have to walk another 3 km in order to catch a bus, which is also a $3 fare. The last two communities are Maravovo and Leosa-Veuru. These two villages lay on the coast of West Guadalcanal. Maravovo is a 40 km drive west from Honiara and is fortunate to have Selwyn College’s school clinic available to them, which surrounding villages also have access to. Leosa-Veuru lies 15 km from Marovovo towards town and is near the Visale Catholic Mission station, thus they have access to the Mission’s health center, Primary and Secondary Schools. It is just a 10-15 minutes’ walk from their homes. Public bus fare to Honiara town from Maravovo is $30 p/head and Leosa-Veuru is $25. FINDINGS COMMUNICATION All six communities have access to various communication methods. Radio, particularly the Solomon Islands Broadcasting Corporation (SIBC), is accessible to all the communities and is commonly heard by most individuals who have a radio or device which plays radio. Guadalcanal FM is a Provincial broadcasting station, operated and funded by the Goldridge Mining Company. It is heard by those in the Plains, mainly the youth. ZFM 100 is also heard by youths in the Highlands and Coastal areas. Those who own radios are often a source of information to those that do not own one. Bemobile and Telekom are the only two telecommunication networks in the Solomon Islands. They provide access to whichever community is within range of their towers. Pitukoli has access to both Bemobile and Telekom, and Telekom is commonly used by most individuals. Papangu only has access to Bemobile. Gilbert Camp and Barana have access to both Telekom and Bemobile. Where both networks are accessible, Telekom is most commonly used by individuals who have mobile handsets. Maravovo and Leosa-Veuru have no access to either network. But, during the interviews, Telekom was reportedly going to be putting up a tower nearby which would provide access to both communities. Individuals who have handsets use it where availability of the networks is accessible, which is usually along the road towards town and in the Honiara town area. Accessing the Internet through mobile phones is not a common practice amongst the individuals interviewed.

Appendix 4

The Solomon Star is the most read newspaper in all 6 communities. A few in the coastal areas at times also read the Island Sun. Both newspapers are accessible only when individuals come to town and buy one and then return with it to the villages. It is then passed around to anyone interested. SOURCES OF INCOME Most individuals from the 6 communities rely heavily on selling of vegetables and root crops for their daily income. The men also harvest copra and cocoa and the women sell their farm produce at the Central Market when there is a surplus as well as at market outlets along the main road when their produce volume s small. Although landowners from the Plains have a 20% share of the oil palms export value, individuals do not rely on that as a source of income. Their main source of income comes from subsistence farming. Individuals at Gilbert Camp rely mainly on full time employment. The women sell produce from their gardens for extra income, because full time employment is not always available. A few men also sell betelnut in stalls along the road for extra money for daily sustenance. The men and young boys at Barana also depend on selling timber for their income, plus through selling produce from their gardens by the women and young girls during the holidays. The men and women respondents in Maravovo and Leosa-Veuru harvest cocoa and copra for their needs. The women also contribute to family income by selling their produce from their gardens at the Central Market in Honiara. KNOWLEDGE General WASH knowledge appears to be known amongst the respondents. But their attitude and practice contradicts what they know. Most of the WASH knowledge was gained from nurses working in the clinics and personal interaction with other individuals within their respective communities. Respondents know the basic health rules, but women have more in-depth knowledge on child hygiene and health. It is not common for men to know about children’s welfare. Men do not take their children to clinics unless under special circumstances. Men stated that they need more awareness on children’s welfare. Women tend to either forget to share information when they return from clinics or fathers are too busy to listen. Male youths have less knowledge on children’s health than female youths. Although women get firsthand information from clinics on health and hygiene they are not involved in the planning process of infrastructure such as toilets and shower facilities within a household or community. Men are the builders in the family and in the community, and although women have some knowledge of proper hygiene, there is no collaboration between the two when it comes to planning for sanitation. This results in poor hygiene. When available, toilet facilities are usually separate for males and females, and there is no proper setup where a hand basin or standpipe is located near the toilet. Common health messages and information on water, sanitation and hygiene is known but there is clear evidence that it is not practiced. Open defecation is still practiced by both coastal

Appendix 4

communities along the seashore, as well as Barana in the Highlands and Papangu in the Plains. Only Pitukoli and Gilbert Camp have latrines and/or toilets. No latrines or toilets were observed in Papangu although the respondents stated they had them. Sanitation is poor, although risks are recognised. Hygiene for individuals is known but proper practice such as washing hands after going to the toilet is not practiced. This is because the location of the toilets is far from where water is available as well as forgetfulness to wash hands right after defecating. ATTITUDE and BELIEFS In the findings, it was highlighted that attitudes towards water, sanitation and hygiene is becoming an increasing issue. The research findings stated that there was knowledge about having a proper and clean water supply, as well as proper sanitation in the communities and in households, and having a hygienic environment within communities and households. However, the findings show that attitudes and beliefs of both male and female were influenced by cultural attitudes and beliefs, behavioural attitudes and daily routines. The cultural setup in most communities visited tend to be similar, with two separate toilet zones for both male and females in an identified spot. Both communities in the plains and coastal areas have this kind of set-up. The structure of the toilets is open, there is no enclosed roof or hut. Those who do not have toilets use the shoreline and surrounding bushes for defecating. Most communities have access to water, usually not too far from the community area. With their communal setups, the behavioural attitude towards having proper household toilets is increasingly becoming an issue but is not a priority. The research also highlighted that the absence of proper water stand pipes within the communities and households influenced people’s attitude to constructing proper sanitation facilities. Individuals were brought up in their communities having a river, well and/or small streams nearby, so their attitude is that these water sources are fine, as they have always been used. Thus, the idea or concept of building proper standpipes or bathroom indoor is not an issue for many individuals. Men are more focused on income generating activities instead of improving the standard of living for their families and communities. The attitude and cultural perception that men are the ‘breadwinners’ keep them more occupied with looking after and harvesting their food crops, timber milling and other income generating activities. PRACTISE Attitude leads to practice. However, the practise of situating toilet areas away from water sources leads to the practice of not washing hands after defecation. Water is not available in the toilet areas. The attitude that women are the managers of the household make them so occupied that they do not have time to teach and show proper practice towards sanitation and hygiene to their children. It is also a common attitude that women are expected to be responsible for ensuring that decent hygiene is practised. It is also regarded as a woman’s duty to take a sick child to the clinic. Most men are reluctant to do this, which explains why they lack the basic knowledge that is usually given by the nurses to the women.

Appendix 4

It is acknowledged that water is an essential need for daily life. In communities where there are standpipes, the source is either from a borehole or stream further up from settlements where there is no contamination. Boreholes are powered by generator; thus when there are no funds to buy fuel for the generator, then no water will be available. In communities that use open defecation, it is common practice for males and females to be allocated their own places to defecate. Open defecation is commonly practiced where there is no water supply. However, some communities that have access to water supply still practice open defecation. There are some issues that people are not willing to discuss/share openly. This includes sanitation and hygiene related topics. It is not a practice to discuss such issues with each other in a community mainly because of cultural beliefs and attitudes. Almost everyone is related in a community, and cultural barriers do not allow men and women to discuss certain sensitive issues together. CONCLUSION All of the communities involved in this survey had access to a health center by road. Despite this, some individuals choose to walk to get medical treatment because it is close enough or they do not have money for public transportation. Nurses usually are the ones who provide information on health issues such as personal hygiene. However, proper personal hygiene is not often practiced. The communities appear to need more awareness on the importance of proper health practices. Since most of the people interviewed were illiterate, communicating with them will have to be done through means other than print materials with text. Lack of access to water supply also contributes to having a poor state of sanitation and hygienic practices. Communities without water supply use open defecation. They appear to have the knowledge of the health risks associated with open defecation, but due to lack of facilities, they choose this as the easiest method. A lack of information on WASH also prevents many individuals from having much in-depth knowledge about hygiene. The closest place for access to information is either a clinic or school. Respondents in these communities tend to disregard activities that do not generate income. Such activities include constructing sanitation facilities and getting formal education. Proper education and good health leads to wealth. Individuals need to know that education and good health are the keys to a wealthier life. One approach of having good health is to practice proper hygiene and sanitation. Attitudes towards sanitation may improve when this correlation is appreciated. Melinda Kii Honiara, Solomon Islands

Appendix 5

1

Final Report 16th April 2014

WASH Communication Project

Findings of a Baseline KAP (Knowledge, Attitudes and Practices) Survey conducted in Six Communities of

Guadalcanal, Solomon Islands

Prepared by:

Mr. Karuna Reddy Research Data Analyst

For

Pasifika Communications

A UNICEF Pacific funded Project

Appendix 5

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Table of Contents

Executive Summary ……………………………………………………3

1.0 Introduction ……………………………………………………...4

2.0 Objectives of KAP Survey ………………………………………..5

3.0 Sampling Design …………………………………………………6

4.0 Methodology ……………………………………………………..7

5.0 Data Collection and Management ……………………………....8

6.0 Limitations of the Survey ………………………………………..9

7.0 Findings and Discussions ………………………………………..10

7.1 Socio‐Demographic Characteristics …………………………....10

7.2 Knowledge and Awareness …………………………………….16

7.3 Attitudes and Beliefs …………………………………………....25

7.4 Practices………………………….……………………………...34

8.0 Conclusion………………………….…………………………....44

9.0 References ……………………………………………………...46

Appendix 5

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Executive Summary This Knowledge, Attitudes and Practices (KAP) survey of in six communities of Guadalcanal, Solomon Islands was designed as a baseline survey seeking to understand the strengths and obstacles with respect to child nutrition, water, sanitation, and hygiene. The survey encompasses both qualitative and quantitative information and aims at identifying the levels of knowledge, attitudes and practices in household water handling and cooking practices, sanitation problems, child feeding and nurturing practices. The overall goal of the study was to serve as baseline information for measuring interventional impacts and also to serve as a planning instrument for the WASH Communication Project for the Solomon Islands Ministry of Health and Medical Services (MHMS) with funding and technical support provided by UNICEF Pacific.

The Data collection tool included structured household questionnaires with KAP questions measured on a Likert‐scale, as well as other quantitative and qualitative questions. Data collection took place in March 2014. A total of 72 households, 12 from each of the six nominated communities, were surveyed in an area outside of Honiara on the island of Guadalcanal. The data collected using the household questionnaires was coded, entered, cleaned and analysed using the software Statistical Package for Social Sciences (SPSS). Descriptive or exploratory data analysis, together with inferential statistics, was drawn with their respective interpretations. This formed the basis of the findings presented in this Report.

On the issue of child nutrition and health, research has shown that the exclusive breastfeeding for the first six months after birth is crucial in child survival and development as recommended. However, according to this study, only about 30% of the children of respondents were exclusively breast fed, other respondents were simply not sure, which means that they lacked knowledge and didn’t have the right attitude to practice it. About 63% of mothers did not, or were not sure if they should have introduced other solid foods beginning at 6 months of age. It was found that about 38% gave coconut water, tap water, lime or fruit juice to their children. Approximately 10% gave home or herbal medicine (some kind of tree leaves) while only 3% indicated that they used Oral Rehydration Salts (ORS) when their children suffered from diarrhoea.

Regarding the issues of sanitation and hygiene, the extent of open defecation in this study was very high at approximately 53% of the respondents. 43.5% of these practiced open defecation within 5‐10 metres of their home. It was established that about 34% did not use toilets or latrines at all for the disposal of faeces from adults and children. Out of this 34%, about 40% do not bury the faeces in a pit either.

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Hand washing with soap during critical moments, such as before eating, after defecating and before preparing food was generally practiced by 89% of the respondents. According to the study, about 58% of the households used water from taps while 19 used water from wells. About 46% of the respondents disinfected their drinking water, while about 53% did not. The main method of disinfecting water was through boiling.

1.0 Introduction

KAP‐based studies have been used extensively worldwide for well over 40 years by the World Bank, United Nations agencies, and by both government and non‐governmental agencies in areas of family development, education, public health, and water supply and sanitation (Eckman et. al., 2008). KAP surveys are mostly designed to enlighten us on how individuals or groups feel about specific things, what they know, and how they act. It is used to gauge changes in what people know of a particular topic, as well as their attitudes and practices in relation to a particular intervention such as education programs or the introduction of new technologies. KAP studies concentrate on Knowledge, Attitudes and Practices of a particular topic and are carried out twice, before and after the intervention, in order to evaluate the appropriateness and effectiveness of the intervention. There is increasing recognition within the international aid community that improving the health of poor people across the world depends upon adequate understanding of the socio‐cultural, health and economic aspects of the context in which public health programmes are implemented. Such information has typically been gathered through various types of cross‐sectional surveys, the most popular and widely used being the Knowledge, Attitudes and Practices (KAP) survey, also called the Knowledge, Attitude, behaviour and practice (KABP) survey. This Report is the output of a KAP baseline survey that sought to understand the Knowledge, Attitudes and Practices of Solomon Islanders with respect to water, sanitation, hygiene and child nutrition. The study examined current sexual reproductive health of women, household water handling and cooking, basic hygiene, sanitation, and infant and young children feeding practices.

This report provides both quantitative as well as qualitative information with the sample size drawn from six communities, which were purposively selected in an attempt to ascertain baseline information on a variety of different subjects mentioned above. This report describes the results, analysis of findings and the conclusions and, wherever possible, presents a hypothesis and interpretations of inferences.

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The study was conducted after receiving written approval from the Ministry of Health’s Ethics and Research Committee. The study could serve as baseline information for measuring interventional impacts in the coming years for relevant line Ministries of the Government as well as for donor and implementing agencies. It was envisioned that findings from the study would also support and serve as a planning instrument for long‐term sustainable programming strategies and action plans. It will enable a more efficient process of awareness creation that will form a strong basis for effective interventions tailored more appropriately to the needs of the community.

2.0 Objectives of KAP Survey The KAP survey’s primary goal is to obtain data on the Knowledge, Attitudes and Practices of those in peri‐urban and rural communities in relation to WASH and other family health issues. The data collected will be analysed and interpreted in order to provide insight into the various behavioural determinants that lead to water, sanitation and hygiene practices that put both children’s and adults’ health at risk. It will also help identify gaps in people’s awareness of the importance of specific sanitation and hygiene practices that are related to health risks. The survey findings will inform the development of communication materials to advocate WASH best practices. These materials will be trialled in the communities to test their appropriateness and clarity in communicating the key messages. The materials are intended to not just raise awareness, but to begin the longer‐term process of behavioural change. The results of this Report will form part and aid the materials that will be developed so that effective communication strategies in WASH‐related best practices can be disseminated to these communities. The communication materials that are developed are expected to help health workers in both MHMS as well as various NGOs who are engaged in WASH‐related advocacy efforts. The Study gathered data among the households in six different communities, taking into consideration the various cultural groupings, livelihood, economies and geographical locations. The main objectives of this KAP study could be stated as follows:

To describe the socio‐demographic information of respondents in the communities;

To identify specific areas where intervention is necessary to increase knowledge or lead to specific behavioural changes for better health;

To identify the distribution of Knowledge, Attitudes and Practices among topics related to water, sanitation, hygiene and child nutrition;

To quantify and interpret Knowledge, Attitudes and Practices and to also find out if there are differences between them;

Appendix 5

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To ascertain if the six communities behave differently with regards to Knowledge, Attitudes and Practices relating to a particular variable like child nutrition, sanitation, health, etc.

3.0 Sampling Design This will be a two‐part KAP survey (a pre and post study) conducted in six different communities in the surrounding rural and peri‐urban areas outside of Honiara . Based on recommendations from RDLP, communities were chosen from the three basic geographic types of communities – coastal, highland and plains. To obtain untainted responses, care has been taken to identify communities which have not yet had any WASH‐related interventions undertaken there. Twelve households were to be randomly chosen in each of the six communities with one person from each household to be interviewed. An effort will be made to have a balance of males and females, as well as to involve some younger persons as respondents, but this will be dependent on cultural and other sensitivities when the household members are approached. This survey uses a very small sampling of communities, and is limited to only one of the islands in Solomon Islands, so results cannot be considered representative of “national” Knowledge, Attitudes and Practices. These limitations are primarily budget‐driven. Nevertheless, the sampling will examine different types of communities as well as different ages and genders in order to gauge differentiation and similarities in responses. A structured questionnaire has been developed which has both quantitative and qualitative questions. To maximise the participation of each respondent, the questionnaire has been designed to take no more than 30 minutes to complete. As can be seen from the attached questionnaire form, the study will first obtain basic socio‐demographic information on each respondent. This is designed to correlate any potential significance between WASH behaviours and geographic location. The survey then measures the Knowledge of respondents to specific WASH related topics, as well as their Attitudes and Practices to specific activities, including open defecation. The qualitative questions will allow less structured responses to be recorded, adding further value to the integrity of the data.

4.0 Methodology

Probability sampling was applied for the data collection whereby each unit of the population had an equal chance of being selected. The main advantage of this design is that it is

Appendix 5

7

undertaken in natural settings and permits researchers to employ random probability samples while selecting the households to conduct the face‐to‐face interviews. We are therefore able to make statistical inferences and generalise findings for the population. However, this research design type also has the disadvantages of an increased chance of error or bias; increased costs with more subjects and so on.

To reduce increased chances of error, the research team thoroughly trained the field researchers, did a pre‐test or a pilot run of the questionnaire and used the results to further refine the questions. Questions were fine‐tuned and modified so that an interview could fit into a particular timeframe, considering the overall time within which to complete the entire survey. All questions were also translated into Pidgin English (local idiom in Solomon Islands) to avoid confusion and to better help Respondents to understand the questions.

The sample size was 72 (12 households from each community), which represents a significant percentage of the total households in most of the target communities. The total number of households in each village is noted in the chart below.

No. Name of Community

Geographical Settings Male Female Youth Children Total

Male Female

1 Maravovo Coastal 50 63 57 64 81 315

2 Leosa – Veuru

Coastal 156 171 124 98 205 754

3 Turarana Highlands 230 220 250 250 300 1200

4 Gilbert camp Highlands 200 200 300 250 150 1,100

5 Pitukoli Plains 103 106 54 61 131 455

6 Papangu Plains 129 105 46 35 57 372

The total number in the sample was decided on the basis of human resources and funding. Random sampling was applied for the selection of households to increase the chances of representativeness of the sample. To ensure homogeneity, the field researchers were instructed to cover the entire communities by following systematic random sampling, which is a method of choosing a random sample by first selecting a fixed starting point in the larger population and then obtaining subsequent observations by using a constant interval between samples taken. Hence, if the total population were 60 households, a random systematic sampling of 12 units within that population would involve observing every 5th data unit.

Appendix 5

8

5.0 Data Collection and Management Data was collected by using the KAP survey questionnaire (see Appendix A) employed for the baseline survey during March 2014. Standard procedures were followed to ensure quality data collection in all components of the survey. Formal consent from the respondents was obtained after explaining the purpose of the study. The survey subjects were aware of their right to refuse participation in the survey and to withdraw from the survey at any time. Key‐stakeholders were involved ‐ ethics approval was obtained from the Government and the village headman who was also informed and his approval taken for each community survey. The survey manager was informed regularly regarding the progress of data collection in the field, as well as of any problems so that solutions could be implemented in a swift manner. The field researchers were well trained and used the native Pidgin language for data collection so that respondents would more easily understand the questions before responding. This ensured more accuracy and honesty in the data, especially when it is taken to be the norm in the Pacific Islands that respondents do not normally feel secure imparting sensitive personal issues of family health, sanitation and hygiene.

All data was originally recorded in hand‐written responses on the questionnaires. After collection, it was dispatched to the Data Analyst who entered, in coded form, directly into SPSS to minimize chances of respondent/interviewer bias or errors. A code‐book or data dictionary was created to keep track of the codes in SPSS. This did not allow for immediate double‐checking of suspect data or the ability to re‐measure a participant of course. Hence, some of the erroneous or suspect data or even missing values could not be treated as anything other than a missing value or a non‐response.

The supplied questionnaires were taken to be in the final form. Rapid data entry allowed the survey manager and the research team to identify erroneous data collection procedures early in the survey that allowed corrective action. Therefore, it is always recommended that no more than one week should pass between data collection and data entry.

The data was entered in coded form, cleaned and validated so that it could be used to run the statistical analyses – to find answers to some of the key questions we wanted to ask the data set. After correcting data entry errors by comparing double‐entered data, further data cleaning was performed to identify potentially erroneously recorded data, which usually cannot be verified and corrected. This usually means performing a frequency of every variable to assure that the values are within an acceptable range, which should be defined in the data dictionary. Missing values or erroneous entries were identified and treated to see if they could be replaced. Any errors found were corrected or deleted from the database and the cleaning process repeated until the data was considered to be “clean.” The number of missing responses for each variable was investigated. If there were a large number of

Appendix 5

9

missing values for a particular question, it was made sure that it was not a result of data entry.

SPSS was used to manage the entire data set, to transform and compute variables, to draw appropriate tables, charts/graphs in order to explore the data and to run Descriptive and Inferential Statistics. Appropriate interpretations and conclusions were made after running a variety of exploratory data analyses and statistical tests.

6.0 Limitations of the Survey

Sample size is an issue since the desired sample size should have been more than 72; a bigger sample size may have given a much more accurate estimate of the population’s KAP, but not all of the populations of these communities were large. However, since this is a baseline survey and we have no intentions of extrapolating the survey results to the entire Solomon Islands population, a total sample of 72 is good enough to establish the existing situation of the communities. The 72 that were decided upon were chosen due to the budgetary and logistical constraints of the survey. In this case, it is the chosen target group for a very specific context; hence, both the sample size and sampling method were conveniently determined.

It is always better to have the data meet the central limit theorem (sample size >= 30) so that if data follows normal distribution, powerful descriptive statistics like mean and standard deviation would be good unbiased estimators of the population. Here, because of the nature of the sample, non‐parametric statistics would be suitable with reasonable power and accuracy. However, one would always want to use parametric analysis on continuous variables to make conclusions about the population.

Although considerable care was taken in designing the KAP questionnaire to avoid ambiguity, the quality of the responses to a number of questions was highly dependent on the skills of the field researchers. Clear instructions were given in the survey form when to prompt and when to probe for answers so that accurate information could be elicited; nevertheless it is expected that some mistakes might have happened in the field. Baseline surveys are generally used to establish the current existing situation with regards to a particular topic. Greater probing might later be required in this research project, perhaps through a qualitative study in the form of focus group discussions in all the communities. It might help better clarify the findings in regards to a particular pattern or distribution seen in the quantitative KAP data. The qualitative study is normally done after results of a quantitative survey have been established, if one wants to further investigate the reasons and opinions of the respondents.

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7.0 Findings and Discussions

7.1 Socio-Demographic Characteristics

7.1.1 Gender

There were 6 males and 6 females out of the 12 respondents from each of the six communities. The communities and their geographical locations are as follows.

Geographical Location Community Male Female

Coastal

Maravovo 6 6

Leosa‐Veuru 6 6

Highlands

Barana 6 6

Gilbert Camp 6 6

Plains

Pitukoli 6 6

Papangu 6 6

7.1.2 Age

About 38% of the respondents were from the age group 18‐30; and about 24% were from age group 31‐40 – hence the cumulative 61% for age group 18‐40. We expected a greater percentage to be in this category. The study included about 22% teenagers and about 17% in the category of over 41 years old.

7.1.3 Number of Adults and Children in Household

Out of the 67 valid responses, about 87% of the households had 2 adults and 9% of the households had more than or equal to 3 adults while a mere 4% had only 1 adult. Out of 66 valid responses, about 17% of the households had 1 or 2 children, about 46% had 3 to 5 children, and about 64% had 3‐6 children, while about 38% had 6 or more children. The six communities had an average of 5 children per household. Refer to the histogram provided below and Appendix B for more detailed tables.

Age Category Frequency Per cent

14‐18 years 16 22.2

19‐30 years 27 37.5

31‐40 years 17 23.6

41‐50 years 10 13.9

Over 51 2 2.8

Total 72 100.0

Appendix 5

11

Out of 66 valid responses, the total number of adults and children ranged from 5 to 18 and the average was about 7 per household. Refer to the detailed table and histogram in Appendix B.

7.1.4 Marital Status

Out of the 72 respondents, about 51% were single/never married; about 47% were married/living together while about 1% were separated. 7.1.5 Key Sources of Income for Family

Of the 7s respondents, 61% were involved in farming/agriculture, about 24% were employed

full‐time while 15% ran their own small businesses.

Source of Income Frequency Per cent

Farming/Agriculture 44 61.1

Full‐time Employment 17 23.6

Small Business 11 15.3

Total 72 100.0

Marital Status Frequency Per cent

Married/living together 34 47.2

Separated 1 1.4

Single/Never Married 37 51.4

Total 72 100.0

Appendix 5

12

7.1.6 Length of living in the Community

The respondents have lived in their respective communities for an average of 20 years. However, the number of years ranged from 1 year to 60 years. A detailed distribution is provided in Appendix B.

7.1.7 Education Levels

The frequency and percentage distributions appear as follows, with about 85% attaining primary or secondary education. Only 7% attended tertiary while about 8% did not have any education at all.

7.1.8 Number of Times Pregnant

33 females out of the 36 responded. The number of times they were pregnant ranged from none to 7 times. About 42% of the females never became pregnant while about 58% (19 out of 33) became pregnant at least once. About 12% became pregnant only once while about 46% became pregnant twice or more times. See Appendix C for details.

7.1.9 Age When First Pregnant

Of the 19 women who were pregnant at least once, the age of their first pregnancy ranged from 15 to 27. Approximately 21% of those were teenage pregnancies, about 37% of the first pregnancies occurred when they were 20‐22 years old and about 32% occurred in the age category of 23‐27. Refer to Appendix D for details.

7.1.10 Time Taken to walk to the Closest Health Centre

68 out of 72 responded that the time taken to walk to the closest health centre ranged from 2 minutes to 3 hours. About 10% of the respondents would take under 15 minutes to walk to

Education Frequency Per cent

Never attended 6 8.3

Primary 16 22.2

Secondary 45 62.5

Tertiary 5 6.9

Total 72 100.0

Appendix 5

13

the nearest health centre; about 16% would take 15‐30 minutes while a large percentage – 74% – would take between one to 3 hours.

Due to the non‐normal nature of responses, a non‐parametric test was carried out where mean ranks (which can be viewed as medians) are compared, not the means. It reveals that a statistically significant difference exists overall in the time taken to walk to the closest health centre between the 3 different geographical locations (chi‐square = 14.082, df = 2, p‐value = 0.001).

Results also indicate that Highlands region (Barana and Gilbert Camp) could be considered to having the highest time taken (mean rank = 44.89) overall, because it has the highest mean rank. The second ranked region is the Plains (Pitukoli and Papangu) with a mean rank of 35.27 followed by the Coastal region (Maravono and Leosa‐Veuru) with a mean rank of 23.37.

Upon comparing the 3 regions, it was further found that significant differences existed between Coastal and Plains (p‐value = 0.039), Coastal and Highlands (p‐value = 0.000) but no difference was observed between Highlands and Plains (p‐value = 0.095). In other words, the Coastal region was more quickly accessible for the respondents than the Highlands or Plains regions. To be more specific, we can also express the average time taken for the 6 communities to be as follows (note we cannot rely on these means when it comes to generalising to the population since the distribution of time taken is non‐normal in nature, however, it does give us values that are similar to the mean ranks).

Region Community Mean Time (Minutes)

Coastal Maravovo 32.27

Leosa‐Veuru 20.23

Highlands Barana 64.55

Gilbert Camp 46.25

Plains Pitukoli 30.45

Papangu 48.65

All detailed tables are provided in Appendix E.

Appendix 5

14

7.1.11 Source of Drinking Water at Home

About 58% used tap water, about 19% well water, about 10% river water and a mere 3% used rainwater. Out of the 10% in Other, 3% used bore holes for drinking water while 7% used streams.

A cross‐tabulation of the drinking water source and community revealed that the two communities in the Coastal region (Maravono and Leosa‐Veuru) used mostly tap water, with a couple of them using rain water. The two communities in the Highlands region (Barana and Gilbert Camp) used mostly taps, rain, river or stream as their drinking water source, with a couple of them using bore holes and also wells. The Plains (Pitukoli and Papangu) region used mostly tap water and wells as their drinking water sources. See Appendix F.

7.1.12 Source of Bathing Water at Home

The sources of bathing water were mostly the same as the sources of drinking water. It was however noted that only in Barana wells were used for bathing and not drinking. See Appendix F for greater detail.

7.1.13 Reading Newspaper

About 56% of the Respondents never read newspapers; about 14% read once a month, about 14% read once a week and about 14% read twice a week. Only 1% read newspapers daily. A more detailed outlook is provided in Appendix G.

7.1.14 Which Newspaper?

27 out of 72 people responded. Out of the people who read newspapers once a month, once a week or twice a week, about 89% of their choice was solely Solomon Star; otherwise it was either Solomon Star or Island Sun (11%). See Appendix table in G.

Source Frequency Per cent

River 7 9.7

Tap Water 42 58.3

Well 14 19.4

Rainwater 2 2.8

Other 7 9.7

Total 72 100.0

Appendix 5

15

7.1.15 Listening to Radio

About 13% never listened to radio; about 3% listened once a month, about 13% listened once a week, about 52% listened twice a week and about 19% listened to radio daily. A more detailed outlook is provided in Appendix H.

7.1.16 Radio Station

Out of the people who listened to radio (63 out of 72), about 65% of the respondents listened to SIBC Radio, about 10% listened to Goldridge Mining, and about 7% listened to Z FM while only 6% of respondents listened to PAOA FM. See Appendix H for details with regards to how it’s distributed in all six communities.

7.1.17 Owning a Mobile Phone

About 57% owned a mobile phone while 43% did not own a mobile phone. A more detailed table for the six different communities is given in Appendix I.

7.1.18 Mobile Phone network

Out of the 41 respondents who owned a mobile phone, about 29% solely used the BeMobile network; about 34% used solely Telikom, while about 32% used both BeMobile and Telikom. A more detailed table relating to mobile network distribution for the six different communities is given in Appendix J.

7.1.19 Internet Access on Phone

Out of the 57 who responded, about 18% accessed the Internet on their mobile phones. In terms of real numbers, only a few from each of the six communities (except Maravono where there was none) accessed the Internet on their mobile phones.

Appendix 5

16

7.2 Knowledge and Awareness 7.2.1 Reliability Analysis of Knowledge and Awareness Reliability analysis by using Cronbach's alpha is a measure of internal consistency; that is, how closely related a set of items are as a particular group. A reliability of 0.5 indicates that about half of the variance of the observed responses is attributable to truth and half is attributable to error. A reliability of 0.8 means the variability is about 80% true ability and 20% error, and so on. Why a particular group did or did not consistently respond to the set of times can be due to multiple factors.

Low Cronbach's alpha does mean that group of people did not respond to a set of items consistently. So, what meaning we ascribe to such a metric comes from our theory and what we believe about it. It does not measure heterogeneity of a construct (the many variables that make up Knowledge) but it surely is affected by it. It may be that a sub‐group responded differently to the items than other sub‐groups. All we know is that this group of people did not respond consistently to this set of items for a particular construct. Normally, one or more of the items could be deleted to increase the reliability. For a good strong reliability, we would want it to have a value more than 0.9.

In the present situation, the reliability responses in the 15 items in Knowledge and awareness are acceptable and sizeable enough for us to proceed. The responses are internally consistent.

Refer to Appendix L, which provides the item statistics. This provides the means and

standard deviations of the 15 questions being investigated.

7.2.2 Frequency Tables for Likert-Scale Knowledge-Related Questions

The 15 five‐point Likert‐scale questions that assessed knowledge and awareness with regards to child nutrition, basic sanitation and hygiene issues related to water, disposal of human faeces, washing hands with soap and water and covering food and water can be very simply examined by frequency tables.

Reliability Statistics

Cronbach's Alpha N of Items

0.767 15

Appendix 5

17

The frequency tables of the responses for the 15 different specific questions are provided below.

Breastfeeding is healthier for your baby than bottle feeding

Frequency Per cent

Cumulative Per cent

Strongly Disagree 1 1.5 1.5

Not Sure 7 10.4 11.9

Agree 30 44.8 56.7

Strongly Agree 29 43.3 100.0

Total 67 100.0

About 88% seem to agree or strongly agree.

Immunising children helps prevent death from diarrhoea or other diseases

Frequency Per cent Cumulative Per cent

Disagree 3 4.5 4.5

Not Sure 9 13.6 18.2

Agree 38 57.6 75.8


Total 66 100.0


Properly disposing of human or baby faeces will help keep your family healthy



Disagree 16 22.2 23.6

Not Sure 5 6.9 30.6

Agree 21 29.2 59.7


Total 72 100.0

About 70% seem to agree or strongly agree while 24% disagree or strongly disagree.

Toilets are expensive to build and maintain and are not that necessary



Disagree 31 43.7 64.8

Appendix 5

18

Not Sure 7 9.9 74.6

Agree 16 22.5 97.2


Total 71 100.0

About 23% seem to agree while 65% disagree or strongly disagree.

Using toilets or a latrine for faeces helps avoid diseases and keeps your family healthy



Disagree 2 2.8 4.2

Not Sure 1 1.4 5.6

Agree 37 51.4 56.9


Total 72 100.0


If there are no toilets, all faeces, even from babies, should be buried


Disagree 3 4.2 4.2

Not Sure 1 1.4 5.6

Agree 41 56.9 62.5


Total 72 100.0


Defecation in the bushes away from my house is okay to do and does not affect anyone



Disagree 37 52.1 80.3

Not Sure 2 2.8 83.1

Agree 10 14.1 97.2


Total 71 100.0

Appendix 5

19

About 80% seem to disagree or strongly disagree.

It is always necessary to wash your hands after defecating or handling garbage


Disagree 5 6.9 6.9

Not Sure 2 2.8 9.7

Agree 31 43.1 52.8


Total 72 100.0


Washing hands with soap (or ash) and water before touching or preparing food helps prevent diarrhoea


Disagree 2 2.8 2.8

Agree 39 54.2 56.9


Total 72 100.0


When you wash your hands, it should always be with soap or ash and water


Disagree 4 5.6 5.6

Agree 42 58.3 63.9


Total 72 100.0


Diarrhoea amongst young children can often be treated with ORS (oral

rehydration salts)



Disagree 4 5.6 8.3

Not Sure 10 13.9 22.2

Agree 41 56.9 79.2


Total 72 100.0

Appendix 5

20


Children who have rapid, difficult breathing or continuing diarrhoea should be examined at hospital


Agree 40 55.6 55.6


Total 72 100.0

100% agree or strongly agree.

To have a healthy baby, breast feeding should stop after six months



Disagree 19 26.8 47.9

Not Sure 16 22.5 70.4

Agree 18 25.4 95.8


Total 71 100.0

About 48% seem to disagree or strongly disagree while 30% agree or strongly agree.

Complementary foods, as well as breastfeeding, should be given to your baby from 6 months of age



Disagree 4 5.6 11.3

Not Sure 14 19.7 31.0

Agree 36 50.7 81.7


Total 71 100.0


Using clean containers to store drinking water and covering them helps prevent contamination


Not Sure 1 1.4 1.4

Agree 42 58.3 59.7


Total 72 100.0

Appendix 5

21

About 69% seem to agree or strongly agree. To visualise how a particular item stands compared to other items in the Knowledge construct, presented in Appendix H is the net‐stacked bar graphs. In the first graph, notice the fact that most respondents answered the knowledge‐related questions mostly on a scale of 4 or 5 – but there were also those who have responses on the lower scales. The net‐staked bar plots are arranged according to highest‐scaled responses on the top and the lowest at the bottom. The percentage responses are also given. A heat map diagram is also given to indicate the scale chosen by respondents for all the 15 questions.

Using these, it can be summarised that generally for the respondents, Knowledge is quite limited on the following issues that were investigated (respondents mostly disagreed, disagreed strongly or were not sure at all), in order from least to low knowledge:

1. To have a healthy baby, breast feeding should stop after six months;

2. Toilets are expensive to build or maintain and are not that necessary to have;

3. Properly disposing of human or baby faeces will help keep your family healthy;

4. Complementary foods, as well as breastfeeding, should be given to your baby

from 6 months of age;

5. Diarrhoea amongst young children can often be treated with ORS (oral

rehydration salts);

6. Defecation in the bushes away from my house is okay to do and does not affect

anyone;

7. Immunising children helps prevent death from diarrhoea or other diseases.

7.2.3 Quantifying Total Knowledge and Awareness

Single‐item questions pertaining to a construct like Knowledge have been analysed individually in the previous section and can be used to make quick references to the kind of common scale chosen by the respondents; however, they are mostly not used in drawing generalised conclusions. A whole new data set may yield a totally different sort of frequencies and percentages. Hence, by comparing the reliability of a summated, multi‐item scale versus a single‐item question, the single item is highly unreliable; and therefore it is not appropriate to make inferences based upon the analysis of single‐item questions, which are used in measuring a construct. The specific responses to the items are combined by summation so that individuals with the most favourable Attitudes will have the highest scores while individuals with the least favourable (or unfavourable) Attitudes will have the lowest scores.

Hence, the total Knowledge is quantified by adding the responses from the 15 Knowledge‐related questions. It would be a scaled continuum ranging from a minimum of 15 to a

Appendix 5

22

maximum of 15 x 5 = 75 and expressed over a consistent 100% scale. This is only possible here when all questions are taken to have a response of 5 to be the most expected response if the respondent had complete Knowledge of that question.

Normally, the questionnaire is built in such a manner that there is a mixture of questions (where a 1 could also be the expected response to indicate that the respondent were truly Knowledgeable) that would help eliminate respondent bias. In this case, reverse coding is done to bring about consistency in the meaning of total Knowledge – the higher the total value, the greater the Knowledge.

Various summary and inferential statistics can then be carried out to ascertain the distribution of total Knowledge and also to answer some of the hypotheses.

7.2.4 Distribution of Total Knowledge

To test for differences in the ensuing hypotheses (between different regions, communities, gender and age categories), normality tests were conducted. They were all found to be non‐normal; hence, non‐parametric tests like the Kruskall‐Wallis test and Mann‐Whitney test were carried out as part of the inferential hypothesis tests. The histogram of Knowledge is given below, which looks to be short of normality.

Appendix 5

23

7.2.5 Hypothesis Tests

Hypothesis 1: Is there statistically significant difference in Knowledge between the three

regions (Coastal, Highlands and Plains)?

Among the 3 regions, Knowledge is found to be significantly different from normal distribution. Hence, non‐parametric tests are used to find out that there is statistically no significant difference in mean ranks of total Knowledge between respondents from the 3 regions (Chi‐Square = 1.656, df = 2, p‐value = 0.437). See Appendix N for detailed results. The mean Knowledge levels (over 100%) could also be presented to find out if there is a difference between the 3 regions. It can be seen that there is negligible difference, as we concluded above.

Geographical Location

Total Knowledge of all 15 Questions (100%)

Mean

Coastal 79.45

Highlands 82.35

Plains 81.63

Hypothesis 2: Is there statistical difference in Knowledge between the six communities?

Among the 6 communities, Knowledge is again found to be non‐normally distributed. Using non‐parametric tests it was found out that there is statistically no significant differences in mean ranks of total Knowledge between respondents from the 6 communities (Chi‐Square = 1.656, df = 2, p‐value = 0.437). See Appendix O for detailed results. The mean Knowledge levels (over 100%) could also be presented to find out if there is a difference between the 6 communities. Again, there is negligible difference, as we concluded above.

Community


Mean

Maravovo 81.33

Leosa‐Veuru 77.56

Barana 81.79

Gilbert Camp 82.91

Pitukoli 82.53

Papangu 80.73

Appendix 5

24

Hypothesis 3: Is there statistical difference in Knowledge between males and females

irrespective of the communities they belong to?

Among males and females, Knowledge is again found to be non‐normally distributed. Non‐parametric tests are used to find out if there is a statistically significant difference in mean ranks of total Knowledge between males and females (p‐value = 0.000). See Appendix P for detailed results. The mean Knowledge levels (over 100%) are also presented below and it reveals that there is considerable difference, with females having higher amount of total Knowledge compared to males. This is consistent with the mean ranks provided in Appendix P.

Hypothesis 4: Is there statistical difference in Knowledge between the 5 different age

categories?

Again being non‐normally distributed, using non‐parametric tests it was found out that there is statistically no significant difference in mean ranks of total Knowledge between the 5 age categories (Chi‐Square = 2.404, df = 4, p‐value = 0.662). See Appendix Q for detailed results. The mean Knowledge levels (over 100%) are also presented below and it reveals there is no major difference between the different age groups.

Gender


Mean

Male 75.08

Female 87.21

Age Total Knowledge (100%)

14‐18 years 80.80

18‐30 years 79.99

31‐40 years 82.32

41‐50 years 83.97

Over 51 75.33

Appendix 5

25

7.3 Attitudes and Beliefs 7.3.1 Reliability Analysis for Attitude and Beliefs The reliability analysis for Attitude is conducted similar to the one for Knowledge. Here, the

Cronbach’s Alpha (0.863) is much better than Knowledge, which means that there is a high

internal consistency with regards to the responses to all 19 questions that measure Attitude.

So we can say that the respondents did respond consistently to this set of items for

Attitude.

7.3.2 Frequency Tables for Likert-Scale Attitude-Related Questions

Violence against pregnant women can cause problems with the baby’s birth



Disagree 2 2.8 7.0

Not Sure 4 5.6 12.7

Agree 36 50.0 63.4


Total 71 98.6

About 86% agree or strongly agree.

Babies should be breastfed since breast milk has everything they need for

the first few months



Disagree 2 2.8 4.2

Not Sure 17 23.6 27.8

Agree 19 26.4 54.2


Total 72 100.0




0.863 19

Appendix 5

26

Breastfeeding can prevent the mother from getting breast cancer


Disagree 4 5.6 5.6

Not Sure 38 52.8 59.2

Agree 19 26.4 85.9


Total 71 98.6

About 40% agree or strongly agree while about 53% are not sure.

Proper disposal of human or baby faeces can keep your family healthy



Disagree 20 27.8 29.2

Not Sure 2 2.8 31.9

Agree 20 27.8 59.7


Total 72 100.0

About 68% agree or strongly agree while about 29% disagree or strongly disagree.

Using toilets/latrines for faeces disposal (human or baby) will avoid diseases

and may keep your family healthy


Disagree 2 2.8 2.8

Not Sure 8 11.1 13.9

Agree 28 38.9 52.8


Total 72 100.0


Appendix 5

27

If there are no toilets, it is okay to defecate in your compound as long it is away from the front door



Disagree 27 38.6 87.1

Not Sure 1 1.4 88.6

Agree 6 8.6 97.1


Total 70 100.0

About 87% disagree or strongly disagree.

Defecating in the bushes is ok if it is at least 20 meters from your house



Disagree 28 38.9 65.3

Not Sure 3 4.2 69.4

Agree 21 29.2 98.6


Total 72 100.0

About 65% disagree or strongly disagree while about 31% agree or strongly agree.

You should wash your hands with soap after urinating or defecating or

handling garbage


Disagree 3 4.2 4.2

Not Sure 2 2.8 6.9

Agree 35 48.6 55.6


Total 72 100.0


Appendix 5

28

Breastfeeding should continue for at least the first 2 years of the child’s life



Disagree 10 15.2 16.7

Not Sure 8 12.1 28.8

Agree 30 45.5 74.2


Total 66 100.0


Apart from breastfeeding, complementary foods should be introduced

beginning at 6 months of age



Disagree 3 4.5 6.0

Not Sure 13 19.4 25.4

Agree 31 46.3 71.6


Total 67 100.0


Food for the infant should be stored safely (in a cooler or sealed container) to prevent from diseases like diarrhoea


Disagree 1 1.4 1.4

Not Sure 2 2.8 4.2

Agree 39 54.2 58.3


Total 72 100.0


Appendix 5

29

Parents and siblings should not play or interact with their child(ren)



Disagree 29 42.0 85.5

Not Sure 4 5.8 91.3

Agree 3 4.3 95.7


Total 69 100.0

About 86% disagree or strongly disagree.

Your child’s brain doesn’t develop until after 3 years of age

Frequency Per cent

Cumulative Per cent


Disagree 20 28.6 44.3

Not Sure 15 21.4 65.7

Agree 18 25.7 91.4


Total 70 100.0

About 44% disagree or strongly disagree; about 34% agree or strongly agree while about 21%

are not sure.

Boiling or disinfecting drinking water with sunlight or chlorine can

help reduce waterborne diseases



Disagree 8 11.1 15.3

Not Sure 2 2.8 18.1

Agree 37 51.4 69.4


Total 72 100.0


Appendix 5

30

Children should be sent to pre‐school to develop mentally and socially


Not Sure 2 2.9 2.9

Agree 39 55.7 58.6


Total 70 100.0


Parents should physically punish or inflict pain on their child(ren) in order to

discipline them



Disagree 25 34.7 43.1

Not Sure 3 4.2 47.2

Agree 31 43.1 90.3


Total 72 100.0

About 53% agree or strongly agree while about 43% disagree or strongly disagree.

If your child(ren) wash their hands with soap and water before

touching food it can prevent diarrhoea


Disagree 1 2.4 2.4

Agree 24 57.1 59.5


Total 42 100.0


Children should be taught at school how to keep themselves healthy


Disagree 1 1.4 1.4

Not Sure 1 1.4 2.8

Agree 37 51.4 54.2


Total 72 100.0


Appendix 5

31

Young adults should be informed how to have safe sex to prevent getting HIV or another STD


Disagree 1 1.4 1.4

Not Sure 1 1.4 2.8

Agree 40 55.6 58.3


Total 72 100.0


To visualise how a particular item stands compared to other items in the Attitudes construct, presented in Appendix R is the net‐stacked bar graphs. In the first one, notice the fact that most respondents answer the Attitudes‐related questions mostly on scales of 4 or 5 – but there are also those that have responses on the lower scales. The net‐staked bar plots are arranged according to highest‐scaled responses on the top and the lowest at the bottom. The percentage responses are also given. A heat map diagram is also given to indicate the scale chosen by respondents for all the 15 questions.

Using these, it can be summarised that generally for the respondents, Attitudes are quite bad on the following issues that were investigated (respondents mostly disagreed, disagreed strongly or were not sure at all), in order from very bad to bad Attitude:

1. Defecating in the bushes is ok if it is at least 20 meters from your house;

2. Breastfeeding can prevent the mother from getting breast cancer;

3. Parents should physically punish or inflict pain on their child(ren) in order to

discipline them;

4. Your child’s brain develops until after 3 years of age;

5. Proper disposal of human or baby faeces can keep your family healthy;

6. Breastfeeding should continue for at least the first 2 years of the child’s life;

7. Babies should be breastfed since breast milk has everything they need for the

first few months;

8. Apart from breastfeeding, complementary foods should be introduced beginning

at 6 months of age.

7.3.3 Quantifying Total Attitude and Beliefs

In this section, single‐item questions pertaining to the Attitude construct are analysed individually using frequency tables and can be used to make quick references to the kind of common scale chosen by the respondents; however, they are mostly not used in drawing

Appendix 5

32

generalised conclusions. So, again the total Attitude is quantified by adding the responses from the 19 Attitude‐related questions. It would be a scaled continuum ranging from a minimum of 19 to a maximum of 19x5 = 95 and expressed over a consistent 100% scale, so, the higher the total value, the better the Attitude. Various summary and inferential statistics are presented below.

7.3.4 Distribution of Total Attitude

Similar to total Knowledge, data for total Attitude was also found to be non‐normal. Hence, non‐parametric tests were again used to do the hypotheses tests. It seems to be partially normal, especially in the middle, but for each category of regions, communities, and age, it is not normally distributed.

Hypothesis 1: Is there a statistical difference in Attitude between the three regions (Coastal,

Highlands and Plains)?

Among the 3 regions, total Attitude is found to be significantly different from normal distribution. Hence, non‐parametric tests are used to find out that there is statistically no significant difference in mean ranks of total Knowledge between respondents from the 3 regions (Chi‐Square = 1.372, df = 2, p‐value = 0.504). See Appendix S for detailed results that provide the mean ranks. The mean Knowledge levels (over 100%) could also be presented for the 3 regions. It’s consistent with the mean ranks; the 3 regions have a negligible difference even in the means, as we concluded above.

Appendix 5

33

Geographical Location

Total Attitude of all 15 Questions (100%)

Mean

Coastal 78.55

Highlands 79.03

Plains 75.47

Hypothesis 2: Is there a statistical difference in Attitude between the six communities?

For the 6 communities, there is statistically no significant difference in mean ranks of total Attitude between respondents from the 6 communities (Chi‐Square = 9.021, df = 5, p‐value = 0.108). Appendix T provides the mean ranks. The mean Knowledge levels (over 100%) could also be presented for the 6 communities. It’s consistent with the mean ranks; the 6 communities have a negligible difference even in the means, as we concluded above.

Community


Mean

Maravovo 81.88

Leosa‐Veuru 75.22

Barana 79.95

Gilbert Camp 78.11

Pitukoli 79.55

Papangu 71.39

Hypothesis 3: Is there a statistical difference in Attitude between males and females


For males and females, there is a statistically significant difference in mean ranks of total Attitude between males and females (p‐value = 0.000). See Appendix U for detailed results. The mean Knowledge levels (over 100%) are also presented below and it reveals there is considerable difference, with females having higher amount of total Knowledge compared to males. This is consistent with the mean ranks provided in Appendix U.

Gender


Mean

Male 70.85

Female 84.51

Appendix 5

34

Hypothesis 4: Is there a statistical difference in Knowledge between the 5 different age

categories?

For different age categories, there is statistically no significant difference in mean ranks of total Attitude between the 5 age categories (Chi‐Square = 1.035, df = 4, p‐value = .904). See Appendix V for detailed results. The mean Knowledge levels (over 100%) are also presented below and it reveals there is no major difference between the different age groups.

Age Total Knowledge (100%)

14‐18 years 76.81

19‐30 years 77.67

31‐40 years 78.89

41‐50 years 78.18

Over 51 72.11

7.4 Practices

From a very general standpoint, it is better to have more points in a scale because it provides you with more insight about the perception that you are trying to measure. An important consideration is that if you have a small sample of respondents in your study, using a 3‐point scale will affect the validity of your findings due to the fact that 3 point samples polarise your results into items that denote very good, average, or very bad; but nothing in between. After the pilot run, however, it was found out that respondents Practices are a clear‐cut ‘yes’, ‘no’ and ‘not sure’. So, a 3‐point Likert scale is used in all questions under Practices. In other words, if we were to match these onto a 5‐point Likert scale, those that responded with a ‘No’ would mean either ‘Disagree’ or ‘Strongly Disagree’, those with ‘Not Sure’ would lie on ‘Neutral’ while those with a ‘Yes’ would indicate ‘Agree or ‘Strongly Agree’. So, the values in all items under Practices construct are recoded as above.

The questionnaire contained, in unorganised fashion, many Practices‐related questions. There were some qualitative questions in between so that we could elicit or probe for more details. There were 19 questions/items that were taken out and bundled together as Practice construct, similar to what we have done for Knowledge and Attitudes. There were some questions that required a response of ‘Yes’ to indicate that their Practice is good while there were also questions whereby a response of a ‘No’ could mean good Practice. For adding them up, we needed to recode and map them all into a consistent scale. That is, the highest value would mean the best Practice while lowest would be the worst. All of these help contribute towards eliminating potential bias in their responses.

Appendix 5

35

7.4.1 Reliability Analysis for Practices The reliability analysis for Practice, which is on a 3‐point Likert scale, is conducted in a similar

manner. The Cronbach’s Alpha (0.864) is much better than Knowledge and similar to

Attitude, which means that there is higher internal consistency with regards to the

responses to all 19 questions that measure Practices. So we can say that the respondents did

respond consistently to this set of 19 items for Practices.

7.3.2 Frequency Tables for Likert-Scale Practice-Related Questions

Did you get your baby immunised in their first and second year?


Yes 25 35.2 35.2

Not Sure 46 64.8 100.0

Total 71 100.0

About 35% said ‘yes’ while about 65% were ‘not sure’.

Did you exclusively breastfeed your baby for the first 6 months?


Yes 21 29.6 29.6

Not Sure 50 70.4 100.0

Total 71 100.0

About 30% said ‘yes’ while about 70% were ‘not sure’.

Has your baby ever gotten diarrhoea or a respiratory illness?


Yes 16 22.9 22.9

No 9 12.9 35.7

Not Sure 45 64.3 100.0

Total 70 100.0



0.864 20

Appendix 5

36

About 23% said ‘yes’, about 13% said ‘no’ while 65% were ‘not sure’.

Do you use toilets or latrines for faeces disposal (adult or baby)?


Yes 46 64.8 64.8

No 24 33.8 98.6

Not Sure 1 1.4 100.0

Total 71 100.0

About 34% do not use toilets or latrines for faeces disposal. Content analysis to the next follow‐up question of “If Not, Why?” revealed that about 14% of the respondents claimed to be poor people and did not have the finances to build toilets; about 7% defecate on the beach or seaside, and about 13% responded that they are just lazy to build toilets (in other words they defecate in the bushes, compounds, etc.). This needs further probing – the next few tables elicit more details. Note also that 64.5% actually claim that they use toilets.

Do you dispose of human or baby faeces by burying it in a pit?


Yes 39 54.2 54.2

No 29 40.3 94.4

Not Sure 4 5.6 100.0

Total 72 100.0


Do you or your family members defecate in your compound near your home?


Yes 38 52.8 52.8

No 32 44.4 97.2

Not Sure 2 2.8 100.0

Total 72 100.0

About 53% said ‘yes’, 44% said ‘no’ while a mere 3% were ‘not sure’.

If “yes” to previous question, is it close (within 5‐10 metres) of your home?


Yes 27 43.5 43.5

No 28 45.2 88.7

Not Sure 7 11.3 100.0

Total 62 100.0

Appendix 5

37


Do you or your family defecate in an outside area,

over 20‐30 metres from your home?


Yes 28 40.6 40.6

No 37 53.6 94.2

Not Sure 4 5.8 100.0

Total 69 100.0


Do you and your family members wash your hands with soap and water

after urinating or defecating or handling garbage?


Yes 63 88.7 88.7

No 6 8.5 97.2

Not Sure 2 2.8 100.0

Total 71 100.0

About 89% said ‘yes’, 9% said ‘no’ while 3% were ‘not sure’.

Do you have soap at home?


Yes 63 98.4 98.4

No 1 1.6 100.0

Total 64 100.0

About 98% said ‘yes’ and about 2% said ‘no’.

Did you continue breastfeeding your last child for at least the first 2 years?


Yes 27 38.0 38.0

No 7 9.9 47.9

Not Sure 37 52.1 100.0

Total 71 100.0

About 38% said ‘yes’, 10% said ‘no’ while 52% were ‘not sure’.

Appendix 5

38

Apart from breastfeeding, did you introduce other foods beginning at 6 months of age?


Yes 26 37.1 37.1

No 8 11.4 48.6

Not Sure 36 51.4 100.0

Total 70 100.0


When your child suffers from diarrhoea, what do you give them? 34 out of 72 people responded. Upon content analysis of the qualitative data, it was found that 38% gave coconut water, tap water lime or fruit juice to their children, about 10% said that they give home or herbal medicine (some kind of tree leaves) while 3% indicated that they used ORS. 4% indicated that they gave antibiotics. See Appendix U for details.

Do you, or did you store food for your baby in a sealed container?


Yes 37 52.1 52.1

No 3 4.2 56.3

Not Sure 31 43.7 100.0

Total 71 100.0


Do you boil or disinfect your drinking water?


Yes 33 45.8 45.8

No 38 52.8 98.6

Not Sure 1 1.4 100.0

Total 72 100.0

46% said ‘yes’ while about 53% said ‘no’. Out of the 46% who said ‘yes’, in 18 out of 72 that responded, 23% indicated in the follow‐up question (“If yes, how do you disinfect your water?”) that they disinfected their drinking water (especially if it’s rain water) by boiling. Others did not respond with any clear‐cut method.

Appendix 5

39

Do you use clean containers to store drinking water & cover or seal them?


Yes 67 93.1 93.1

No 4 5.6 98.6

Not Sure 1 1.4 100.0

Total 72 100.0


Do you or did you send your children to pre‐school?


Yes 33 47.8 47.8

No 3 4.3 52.2

Not Sure 33 47.8 100.0

Total 69 100.0


How often do you wash your face? Content analysis revealed that about 77% wash their faces once in a day, mostly in the mornings. About 13% wash twice a day while about 10% wash 3 times in a day.

How often do you cut your fingernails? Content analysis reveals that about 31% cut fingernails once in a week, about 20% cut fingernails every 2 weeks and about 29% cut daily. Other 20% of the responses were like ‘once in a while’, ‘sometimes’, etc., which were quite vague.

Do you punish your child with your hand, a stick or another object?


Yes 56 77.8 78.9

No 15 20.8 100.0

Total 71 98.6


Appendix 5

40

Have you or anyone in the family ever physically punished or inflicted pain on your child(ren) as a form of discipline?


Yes 42 58.3 58.3

No 30 41.7 100.0

Total 72 100.0


Did your child drop out of school before completing their education?


Yes 12 17.6 17.6

No 16 23.5 41.2

Not Sure 40 58.8 100.0

Total 68 100.0

About 18% said ‘yes’, about 24% said ‘no’ while 59% were not sure.

Do you talk to your older children (12 years onwards) about sex and

how they can protect themselves?


No 7 10.4 38.8

Not Sure 41 61.2 100.0

Total 67 100.0

About 10% said ‘no’ and about 61% were ‘not sure’. To visualise how a particular item stands compared to other items in the Practices construct, presented in Appendix Y is the net‐stacked bar graphs. Compared to Knowledge and Attitudes, the responses for Practices seem be a lot on the lower end of the scaled‐ratings. The net‐staked bar plots could be referred to for discussing the issues that have a poor rating.

Using the plots, it can be summarised that generally for the respondents, Practices are quite bad on the following issues that were investigated (respondents mostly disagreed, disagreed strongly or were not sure at all), in order from very bad to bad Attitude. Note that if a respondent was not sure of a particular practice, it can be assumed to be lack of knowledge or awareness to the issue. Greater percentages of respondents seem to on the bad to very bad scales in Practices when we compare it with Knowledge or Attitudes.

1. Do you punish your child with your hand, a stick or another object?

Appendix 5

41

2. Did your child drop out of school before completing their education?

3. Do you talk to your older children (12 years onwards) about sex and how they can

protect themselves?

4. Did you exclusively breastfeed your baby for the first 6 months?

5. Did you get your baby immunised in their first and second year?

6. Apart from breastfeeding, did you introduce other foods beginning at 6 months of

age?

7. Did you continue breastfeeding your last child for at least the first 2 years?

8. Do you or your family defecate in an outside area, over 20‐30 metres from your

home?

9. Have you or anyone in the family ever physically punished or inflicted pain on your

child(ren) as a form of discipline?

10. Do you or your family members defecate in your compound near your home?

11. Is the defecation close (within 5‐10 metres) of your home?

12. Do you or did you send your children to pre‐school?

7.3.3 Quantifying Total Practice

In this section, single‐item questions pertaining to the Practices construct are analysed individually using frequency tables and can be used to make quick references to the kind of common scale chosen by the respondents; however, they are mostly not used in drawing generalised conclusions. So, again the total for Practices is quantified by adding the responses from the 19 Practice‐related questions. It would be a scaled continuum ranging from a minimum of 19 to a maximum of 19 x 5 = 95 and expressed over a consistent 100% scale, so, the higher the total value, the better the Practice. Various summary and inferential statistics are presented below.

7.3.4 Distribution of Total Practice

The total Practice is assumed to be normally distributed. Please refer to the histogram below and results table in the Appendix Z which helps us conclude that it is normal.

Appendix 5

42

So, we would be able to use parametric t‐tests (and hence ANOVA) if Practice is again normally distributed within each category of the variables that we have in the ensuing hypotheses. If they are not, then we’ll have to go back to non‐parametric alternatives.

Hypothesis 1: Is there a statistical difference in Practice between the three regions (coastal, highlands and plains)?

Using the ANOVA results from Appendix AA, the means of total Practice is found to be statistically not significantly different between the 3 regions (F = 0.226, p‐value = 0.798). The mean Practice levels (over 100%) are presented below for the 3 regions. It can be seen that they are quite close to each other.

Descriptives for Practice

Geography N Mean Std. Deviation

Std. Error

95% Confidence Interval for Mean

Minimum Maximum

Lower Bound

Upper Bound

Coastal 24 68.4631 8.95714 1.82837 64.6808 72.2454 53.68 87.37

Highlands 24 70.3750 8.06844 1.64696 66.9680 73.7820 51.58 89.33

Plains 24 69.4014 12.05113 2.45993 64.3127 74.4902 49.47 87.37

Total 72 69.4132 9.73360 1.14712 67.1259 71.7005 49.47 89.33

Appendix 5

43

Hypothesis 2: Is there a statistical difference in Practice between the six communities?

For each community, Practice is found to be following approximately normal distribution. Hence, ANOVA was used again. Please see Appendix BB for the normality test and other tables. For the 6 communities, there is statistically no significant difference in the means of total Attitude between respondents from the 6 communities (F = 0.207, p‐value = 0.958).

The mean Practice levels (over 100%) are presented below for the 6 communities. It can be seen that they are very close to each other.

Descriptives for total Practice

Community N Mean Std. Deviation

Std. Error


Minimum Maximum

Lower Bound

Upper Bound

Maravovo 12 67.0236 8.53385 2.46351 61.6015 72.4458 53.68 78.95

Leosa‐Veuru 12 69.9025 9.50825 2.74480 63.8613 75.9438 55.56 87.37

Turarana 12 70.9864 4.77342 1.37797 67.9535 74.0193 63.33 78.95

Gilbert Camp 12 69.7636 10.60738 3.06209 63.0240 76.5032 51.58 89.33

Pitukoli 12 69.1538 13.64961 3.94030 60.4812 77.8263 49.47 87.37

Papangu 12 69.6491 10.82666 3.12539 62.7702 76.5281 53.68 85.26

Total 72 69.4132 9.73360 1.14712 67.1259 71.7005 49.47 89.33

Hypothesis 3: Is there a statistical difference in Practice between males and females


For males and females, Practice is again normal and hence we again use t‐test. It can be said that there is a statistically no significant difference in means of total Practice between males and females (t = ‐0.458, p‐value = 0.648). See Appendix CC for detailed tables. The means and other descriptives are provided below:

Group Statistics

Gender N Mean Std. Deviation Std. Error Mean

TOTAL_PRACTICE Male 36 68.8845 8.66055 1.44342

Female 36 69.9418 10.79873 1.79979

Hypothesis 4: Is there a statistical difference in Practice between the 5 different age categories? For different age categories, there is a statistically significant difference in mean Practices

Appendix 5

44

between the 5 age categories (F = 5.832, p‐value = 0.000). See Appendix DD for detailed results. The mean Practice levels are presented below.

Descriptives for Total Practice

Age N Mean Std. Deviation

Std. Error


Minimum Maximum

Lower Bound

Upper Bound

14‐18 years 16 63.6842 6.63520 1.65880 60.1486 67.2199 51.58 72.63

19‐30 years 27 66.8555 10.11264 1.94618 62.8551 70.8559 49.47 89.33

31‐40 years 17 74.4077 7.95758 1.93000 70.3163 78.4991 57.50 87.37

41‐50 years 10 74.2456 8.31092 2.62814 68.3003 80.1909 62.11 87.37

Over 51 2 83.1579 5.95458 4.21053 29.6581 136.6577 78.95 87.37

Total 72 69.4132 9.73360 1.14712 67.1259 71.7005 49.47 89.33

Multiple comparisons results reveal that the statistically significant differences exist between the Practices in teenagers with the Practices in other age categories. It can be seen that differences also exist between 18‐30 age group and 31‐40 age group.

Appendix 5

45

8.0 Conclusion Individual frequency tables pertaining to a particular question or attribute can be compared for levels of Knowledge, Attitudes and Practices. This can be used while planning for interventions or even help one to decide whether an intervention is necessary. Using the levels, one can also determine whether the intervention is required for knowledge‐growth or dissemination or to improve Attitudes or to even improve the Practices.

In any KAP survey, it’s important to find out if there are gaps between Knowledge, Attitudes and Practices in the respondents – and also determine if it is statistically significant. To test this hypothesis, Dependent t‐tests are used to find out if there are statistically significant differences between Knowledge, Attitudes and Practices. Since total Practice is the only construct that is normally distributed and the other two are not, it is proper and correct to use non‐parametric test.

It is found out that there is a statistically significant difference in mean ranks of total Knowledge, Attitude and Practices (Chi‐Square = 47.778, df = 2, p‐value = 0.000). This is just an overall conclusion that a difference exists, without any reference to which combinations. See Appendix EE.

Descriptive Statistics

N Mean Std. Deviation Minimum Maximum

Total Knowledge 72 81.1438 8.74640 66.15 98.67

Total Attitudes 72 77.6817 9.68788 54.74 96.84

Total Practices 72 69.4132 9.73360 49.47 89.33

To find out if differences exist between individual combinations (Knowledge and Attitudes, Knowledge and Practices and between Attitudes and Practices), we carry out multiple comparisons tests. Using the table below (derived from various statistical tests, results are presented in appendix EE), it can be concluded that a statistically significant difference exists between all combinations with the biggest difference between Knowledge and Practices, and then comes between Attitudes and Practices and then Knowledge and Attitudes.

Note that this test compares mean ranks (which is provided in the Appendix) in determining the p‐values but consistent results are derived even by using parametric tests. Hence, the table above also contains the mean differences, which is a statistic that we can use to compare how much difference exists. We also present the following descriptive statistics to

Constructs Mean Difference Z P‐value

Knowledge and Attitudes 3.46208 ± 0.74097 ‐4.206 0.000

Knowledge and Practices 11.73058 ± 1.31516 ‐6.459 0.000

Attitudes and Practices 8.26849 ± 1.53604 ‐4.632 0.000

Appendix 5

46

see that there is an indeed considerable difference between the 3 constructs, Knowledge being the highest, followed by Attitude and then Practice – all of them significantly different from each other.

So, we can say with 95% certainty that all the respondents in the 3 regions have a high level of Knowledge with regards to specific WASH practices, but their Attitude is letting them down. Practices are even lower (worse) than their Attitudes. Interventions of whatever kind could target key areas, which were identified throughout this report (ones that have high prevalence – for eg., it was found that about 70% of respondents were not sure that they need to exclusively breastfeed their baby for the first 6 months). More emphasis should go into Practices (since we have seen it is the Practices that are more flawed than the other two), followed by Attitudes and then Knowledge. The most common source of access to health and nutrition information can be the radio receiver (87% listenership, based on the findings). These findings imply certainly that for the desired knowledge‐growth, behaviour‐change and better practices to be achieved, the community must be empowered to become active participants of the communication process rather than passive recipients.

Construct Minimum Maximum Mean Std. Error Std. Deviation

Total Knowledge 66.15 98.67 81.1438 1.03077 8.74640

Total Attitude 54.74 96.84 77.6817 1.14173 9.68788

Total Practice 49.47 89.33 69.4132 1.14712 9.73360

Appendix 5

47

9.0 References

1. Bechu, J., & Hermanson, D. (2014). Research Proposal for WASH Communication

Project, Pasifika Communications, Suva.

2. Carmines, E. G., & Zeller, R. A. (1979). Reliability and validity assessment. Thousand

Oaks, CA: Sage.

3. George, D., & Mallery, P. (2003). SPSS for Windows step by step: A simple guide and

reference. 11.0 update (4th Edition.). Boston: Allyn & Bacon.

4. Likert, R. (1931). A technique for the measurement of Attitudes. Archives of

Psychology. New York: Columbia University Press.

5. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York:

McGraw‐Hill.

6. Spector, P. (1992). Summated rating scale construction. Thousand Oaks, CA: Sage.

7. Warmbrod, J. R. (2001). Conducting, interpreting, and reporting quantitative

research. Research Pre‐Session, New Orleans, Louisiana.

8. Albaum, G. (1997). The Likert scale revisited: An alternate version. Journal of the

Market Research Society, 39, 331‐349.

9. Allen, E., & Seaman, C. A. (2007). Likert Scales and Data Analyses. Quality Progress,

40, 64‐65.

10. DJ Sheskin, Handbook of parametric and nonparametric statistical procedures, 4th

edition, 2007, ISBN=1584888148.

Appendix 6

1

Appendices

Appendix A

Number of Adults in Household?

Frequency Percent Valid Percent Cumulative Percent

Valid 1 3 4.2 4.5 4.5 2 58 80.6 86.6 91.0 3 1 1.4 1.5 92.5 4 4 5.6 6.0 98.5 8 1 1.4 1.5 100.0 Total 67 93.1 100.0

Missing System 5 6.9 Total 72 100.0

Number of Children in Household?


Valid 1 5 6.9 7.6 7.6 2 6 8.3 9.1 16.7 3 12 16.7 18.2 34.8 4 8 11.1 12.1 47.0 5 10 13.9 15.2 62.1 6 12 16.7 18.2 80.3 7 6 8.3 9.1 89.4 8 3 4.2 4.5 93.9 9 1 1.4 1.5 95.5 10 2 2.8 3.0 98.5 12 1 1.4 1.5 100.0 Total 66 91.7 100.0


Number of Children in Household? (Binned)


Valid 1 to 2 Children 11 15.3 16.7 16.7 3 to 5 Children 30 41.7 45.5 62.1 More than 6 Children 25 34.7 37.9 100.0 Total 66 91.7 100.0


Appendix 6

2

Appendix B

How long have you lived in this community? No. of Years Frequency Percent Cumulative Percent1 6 8.3 8.3 2 2 2.8 11.1 3 1 1.4 12.5 4 3 4.2 16.7 5 1 1.4 18.1 6 2 2.8 20.8 8 1 1.4 22.2 9 2 2.8 25.0 12 1 1.4 26.4 13 3 4.2 30.6 14 5 6.9 37.5 15 3 4.2 41.7 16 2 2.8 44.4 17 2 2.8 47.2 18 2 2.8 50.0 19 1 1.4 51.4 20 6 8.3 59.7 21 2 2.8 62.5 27 4 5.6 68.1 28 2 2.8 70.8 29 1 1.4 72.2 30 5 6.9 79.2 31 2 2.8 81.9 32 3 4.2 86.1 35 3 4.2 90.3 37 1 1.4 91.7 40 2 2.8 94.4 41 1 1.4 95.8 47 1 1.4 97.2 49 1 1.4 98.6 60 1 1.4 100.0 Total 72 100.0

Appendix 6

3

Appendix C How many times have you been pregnant? (females only)


Valid 0 14 19.4 42.4 42.4 1 4 5.6 12.1 54.5 2 3 4.2 9.1 63.6 3 3 4.2 9.1 72.7 4 2 2.8 6.1 78.8 5 3 4.2 9.1 87.9 6 3 4.2 9.1 97.0 7 1 1.4 3.0 100.0 Total 33 45.8 100.0


How many times have you been pregnant? (females only) Total

0 1 2 3 4 5 6 7

Gender Female Count 14 4 3 3 2 3 3 1 33

% 42.4% 12.1% 9.1% 9.1% 6.1% 9.1% 9.1% 3.0% 100.0%

Appendix 6

4

Appendix D

Appendix E TimeHealth_Centre_Min


Valid 2.00 1 1.4 1.5 1.5 3.00 2 2.8 2.9 4.4 5.00 4 5.6 5.9 10.3 10.00 9 12.5 13.2 23.5 15.00 2 2.8 2.9 26.5 19.80 1 1.4 1.5 27.9 20.00 5 6.9 7.4 35.3 30.00 19 26.4 27.9 63.2 37.50 2 2.8 2.9 66.2 40.00 1 1.4 1.5 67.6 40.20 1 1.4 1.5 69.1 45.00 2 2.8 2.9 72.1 60.00 11 15.3 16.2 88.2 90.00 3 4.2 4.4 92.6 120.00 3 4.2 4.4 97.1 180.00 2 2.8 2.9 100.0 Total 68 94.4 100.0


How old were you when you first became pregnant? (females only)


Valid 15 1 1.4 5.3 5.3

19 3 4.2 15.8 21.1

20 3 4.2 15.8 36.8

21 5 6.9 26.3 63.2

22 1 1.4 5.3 68.4

23 3 4.2 15.8 84.2

24 1 1.4 5.3 89.5

25 1 1.4 5.3 94.7

27 1 1.4 5.3 100.0

Total 19 26.4 100.0 Missing System 53 73.6 Total 72 100.0

How old were you when you first became pregnant? (females only) Total

15 19 20 21 22 23 24 25 27

Gender Female Count 1 3 3 5 1 3 1 1 1 19

% 5.3% 15.8% 15.8% 26.3% 5.3% 15.8% 5.3% 5.3% 5.3% 100.0%

Appendix 6

5

TimeHealth_Centre_Min (Binned)


Valid Under 5 Minutes 1 1.4 1.5 1.5 5-15 Minutes 6 8.3 8.8 10.3 15 - 30 Minutes 11 15.3 16.2 26.5 30-60 Minutes 25 34.7 36.8 63.2 Over 1 Hour 25 34.7 36.8 100.0 Total 68 94.4 100.0


Overall difference between the 3 regions Ranks

Geographical Location N Mean Rank Time taken to walk to closest health centre

Coastal 23 23.37 Highlands 23 44.89 Plains 22 35.27 Total 68

Test Statisticsa,b

TimeHealth_Centre_Min

Chi-Square 14.082 df 2 Asymp. Sig. .001 a. Kruskal Wallis Test b. Grouping Variable: Geographical Location

Multiple comparisons between 2 regions Ranks

Geographical Location N Mean Rank Sum of Ranks TimeHealth_Centre_Min Coastal 23 16.26 374.00

Highlands 23 30.74 707.00 Total 46

Test Statisticsa


Mann-Whitney U 98.000 Wilcoxon W 374.000 Z -3.722 Asymp. Sig. (2-tailed) .000 a. Grouping Variable: Geographical Location

Ranks

Geographical Location N Mean Rank Sum of Ranks TimeHealth_Centre_Min Coastal 23 19.11 439.50

Plains 22 27.07 595.50 Total 45

Appendix 6

6

Ranks

Geographical Location N Mean Rank Sum of Ranks TimeHealth_Centre_Min Highlands 23 26.15 601.50

Plains 22 19.70 433.50 Total 45

Test Statisticsa




Mean Geographical Location Coastal 25.99

Highlands 55.00 Plains 39.55

Appendix F What is your source of water for drinking at home? Crosstabulation

What is your source of water for drinking at home? Total River Water tap Well Rainwater Other

Community Maravovo Count 2 10 0 0 0 12 % 16.7% 83.3% 0.0% 0.0% 0.0% 100.0%

Leosa-Veuru Count 0 12 0 0 0 12 % 0.0% 100.0% 0.0% 0.0% 0.0% 100.0%

Turarana Count 5 0 0 2 5 12 % 41.7% 0.0% 0.0% 16.7% 41.7% 100.0%

Gilbert Camp Count 0 9 1 0 2 12 % 0.0% 75.0% 8.3% 0.0% 16.7% 100.0%

Pitukoli Count 0 11 1 0 0 12 % 0.0% 91.7% 8.3% 0.0% 0.0% 100.0%

Papangu Count 0 0 12 0 0 12 % 0.0% 0.0% 100.0% 0.0% 0.0% 100.0%

Total Count 7 42 14 2 7 72 % 9.7% 58.3% 19.4% 2.8% 9.7% 100.0%

Test Statisticsa



Appendix 6

7

Appendix G

How often do you read a newspaper?


Valid Never 39 54.2 55.7 55.7

Once a month 10 13.9 14.3 70.0

Once a week 10 13.9 14.3 84.3

Twice in a week 10 13.9 14.3 98.6

Daily 1 1.4 1.4 100.0

Total 70 97.2 100.0

Missing System 2 2.8

Total 72 100.0

How often do you read a newspaper? Crosstabulation

How often do you read a newspaper? Total Never Once a

month Once a week

Twice in a week

Daily


Leosa-Veuru

Count 6 4 2 0 0 12 % 50.0% 33.3% 16.7% 0.0% 0.0% 100.0%

Turarana Count 9 1 1 1 0 12 % 75.0% 8.3% 8.3% 8.3% 0.0% 100.0%

Gilbert Camp

Count 5 1 2 4 0 12 % 41.7% 8.3% 16.7% 33.3% 0.0% 100.0%

Pitukoli Count 5 1 3 1 0 10 % 50.0% 10.0% 30.0% 10.0% 0.0% 100.0%

Papangu Count 8 2 1 1 0 12 % 66.7% 16.7% 8.3% 8.3% 0.0% 100.0%

Total Count 39 10 10 10 1 70 % 55.7% 14.3% 14.3% 14.3% 1.4% 100.0%

Source of water for drinking at home? Source of water for bathing at home?

Community River Water Well Rain Other River Tap Well Rain Other

Maravovo 2 10 0 0 0 2 9 0 1 0

Leosa-Veuru 0 12 0 0 0 0 12 0 0 0

Turarana 5 0 0 2 5 6 0 5 1 0

Gilbert Camp 0 9 1 0 2 0 9 1 1 1

Pitukoli 0 11 1 0 0 0 11 1 0 0

Papangu 0 0 12 0 0 1 0 11 0 0

Appendix 6

8

How often do you read a newspaper? * Which Newspaper? Crosstabulation

Which Newspaper? Total

Solomon Star

Solomon Star/Island Sun

How often do you read a newspaper?

Never Count 39 0 0 39 % 100.0% 0.0% 0.0% 100.0%

Once a month Count 2 8 0 10 % 20.0% 80.0% 0.0% 100.0%

Once a week Count 1 8 1 10 % 10.0% 80.0% 10.0% 100.0%

Twice in a week Count 1 7 2 10 % 10.0% 70.0% 20.0% 100.0%

Daily Count 0 1 0 1 % 0.0% 100.0% 0.0% 100.0%

Total Count 43 24 3 70 % 61.4% 34.3% 4.3% 100.0%

Which Newspaper? Crosstabulation

Which Newspaper? Total Solomon Star Solomon

Star/Island Sun Community Maravovo Count 4 2 6

% 66.7% 33.3% 100.0% Leosa-Veuru

Count 4 1 5 % 80.0% 20.0% 100.0%

Turarana Count 2 0 2 % 100.0% 0.0% 100.0%

Gilbert Camp

Count 6 0 6 % 100.0% 0.0% 100.0%

Pitukoli Count 4 0 4 % 100.0% 0.0% 100.0%

Papangu Count 4 0 4 % 100.0% 0.0% 100.0%

Total Count 24 3 27 % 88.9% 11.1% 100.0%

Appendix H How often do you listen to radio?


Valid Never 9 12.5 13.0 13.0 Once a month 2 2.8 2.9 15.9 Once a week 9 12.5 13.0 29.0 Twice in a week 36 50.0 52.2 81.2 Daily 13 18.1 18.8 100.0 Total 69 95.8 100.0


Appendix 6

9

Which radio station?


Valid missing 9 12.5 12.5 12.5

Goldridge Mining Station 7 9.7 9.7 22.2

POAO FM 4 5.6 5.6 27.8

SIBC Radio 47 65.3 65.3 93.1

Z FM 5 6.9 6.9 100.0

Total 72 100.0 100.0

Community * Which radio station? Crosstabulation

Which radio station? Total

Goldridge Mining Station

POAO FM

SIBC Radio

Z FM


Leosa-Veuru

Count 2 0 0 10 0 12 % 16.7% 0.0% 0.0% 83.3% 0.0% 100.0%

Turarana Count 2 0 0 8 2 12 % 16.7% 0.0% 0.0% 66.7% 16.7% 100.0%

Gilbert Camp

Count 0 1 4 6 1 12 % 0.0% 8.3% 33.3% 50.0% 8.3% 100.0%

Pitukoli Count 2 0 0 10 0 12 % 16.7% 0.0% 0.0% 83.3% 0.0% 100.0%

Papangu Count 2 6 0 2 2 12 % 16.7% 50.0% 0.0% 16.7% 16.7% 100.0%

Total Count 9 7 4 47 5 72 % 12.5% 9.7% 5.6% 65.3% 6.9% 100.0%

Appendix I Do you own a mobile phone?


Valid Yes 41 56.9 56.9 56.9

No 31 43.1 43.1 100.0

Total 72 100.0 100.0

Community * Do you own a mobile phone? Crosstabulation

Do you own a mobile phone? Total Yes No

Community Maravovo Count 5 7 12 % 41.7% 58.3% 100.0%

Leosa-Veuru Count 3 9 12 % 25.0% 75.0% 100.0%

Turarana Count 10 2 12 % 83.3% 16.7% 100.0%

Gilbert Camp Count 8 4 12 % 66.7% 33.3% 100.0%

Pitukoli Count 9 3 12 % 75.0% 25.0% 100.0%

Papangu Count 6 6 12

Appendix 6

10

% 50.0% 50.0% 100.0% Total Count 41 31 72

% 56.9% 43.1% 100.0%

Appendix J Do you own a mobile phone? * Which network? Crosstabulation

Which network? Total

BeMobile BeMobile, Telikom Telikom

Do you own a mobile phone?

Yes Count 2 12 13 14 41 % 4.9% 29.3% 31.7% 34.1% 100.0%

No Count 30 0 1 0 31 % 96.8% 0.0% 3.2% 0.0% 100.0%

Total Count 32 12 14 14 72 % 44.4% 16.7% 19.4% 19.4% 100.0%

Community * Which network? Crosstabulation

Which network? Total

BeMobile BeMobile, Telikom Telikom

Community Maravovo Count 7 2 0 3 12 % 58.3% 16.7% 0.0% 25.0% 100.0%

Leosa-Veuru

Count 10 0 0 2 12 % 83.3% 0.0% 0.0% 16.7% 100.0%

Turarana Count 3 2 6 1 12 % 25.0% 16.7% 50.0% 8.3% 100.0%

Gilbert Camp

Count 4 1 2 5 12 % 33.3% 8.3% 16.7% 41.7% 100.0%

Pitukoli Count 2 2 6 2 12 % 16.7% 16.7% 50.0% 16.7% 100.0%

Papangu Count 6 5 0 1 12 % 50.0% 41.7% 0.0% 8.3% 100.0%

Total Count 32 12 14 14 72 % 44.4% 16.7% 19.4% 19.4% 100.0%

Appendix K

Can you access internet on your mobile?


Valid Yes 10 13.9 17.5 17.5 No 47 65.3 82.5 100.0 Total 57 79.2 100.0


Appendix 6

11

Community * Can you access internet on your mobile? Crosstabulation Can you access internet on

your mobile? Total

Yes No Community Maravovo Count 0 7 7

% 0.0% 100.0% 100.0% Leosa-Veuru Count 1 11 12

% 8.3% 91.7% 100.0% Turarana Count 2 8 10

% 20.0% 80.0% 100.0% Gilbert Camp

Count 3 7 10 % 30.0% 70.0% 100.0%

Pitukoli Count 2 8 10 % 20.0% 80.0% 100.0%

Papangu Count 2 6 8 % 25.0% 75.0% 100.0%

Total Count 10 47 57 % 17.5% 82.5% 100.0%

Appendix L Item Statistics

Question Mean Std. Deviation N

Q1 Breastfeeding is healthier for your baby than bottle feeding. 4.34 .750 61

Q2 Immunising children helps prevent death from diarrhoea or other diseases. 4.03 .752 61

Q3 Properly disposing of human or baby faeces (shit) will help keep your family healthy

3.93 1.237 61

Q4 Toilets are NOT expensive to build and maintain and are not that necessary 3.64 1.141 61

Q5 Using toilets or a latrine for faeces (shitting) helps avoid diseases and keeps your family healthy

4.43 .694 61

Q6 If there are no toilets, all faeces, even from babies, should be buried. 4.38 .610 61

Q7 Defecation (shitting) in the bushes away from my house is NOT okay to do and does not affect anyone.

3.85 1.138 61

Q8 It is always necessary to wash your hands after defecating or handling garbage

4.38 .840 61

Q9 Washing hands with soap (or ash) and water before touching/preparing food helps prevent diarrhoea

4.46 .594 61

Q10 When you wash your hands, it should always be with soap or ash and water. 4.31 .720 61

Q11 Diarrhoea amongst young children can often be treated with ORS (oral rehydration salts)

3.92 .936 61

Q12 Children who have rapid, difficult breathing or continuing diarrhoea should be examined at hospital

4.51 .504 61

Q13 To have a healthy baby, breast feeding should NOT stop after six months 3.31 1.259 61

Q14 Complementary foods, as well as breastfeeding, should be given to your baby from 6 months of age

3.84 .969 61

Q15 Using clean containers to store drinking water and covering them helps prevent contamination

4.44 .533 61

Appendix 6

12

Appendix M

Appendix 6

13

Appendix N Ranks

Geographical Location N Mean Rank

Total knowledge of available responses on a scale of 0-100%

Coastal 24 32.02

Highlands 24 38.65

Plains 24 38.83

Total 72

Test Statisticsa,b


Chi-Square 1.656

df 2

Asymp. Sig. .437

a. Kruskal Wallis Test

b. Grouping Variable: Geographical Location

Appendix O Ranks

Community N Mean Rank


Maravovo 12 37.42

Leosa-Veuru 12 26.63

Turarana 12 36.71

Gilbert Camp 12 40.58

Pitukoli 12 40.04

Papangu 12 37.63

Total 72

Appendix 6

14

Test Statisticsa,b


Chi-Square 3.543

df 5

Asymp. Sig. .617


b. Grouping Variable: Community

Appendix P Ranks

Gender N Mean Rank Sum of Ranks


Male 36 22.01 792.50

Female 36 50.99 1835.50

Total 72

Test Statisticsa


Mann-Whitney U 126.500

Wilcoxon W 792.500

Z -5.883

Asymp. Sig. (2-tailed) .000

a. Grouping Variable: Gender

Appendix Q Ranks

Age N Mean Rank


14-18 years 16 36.47

18-30 years 27 33.48

31-40 years 17 38.59

41-50 years 10 43.40

Over 51 2 25.25

Total 72

Test Statisticsa,b


Chi-Square 2.404

df 4

Asymp. Sig. .662


b. Grouping Variable: Age

Appendix 6

15

Appendix R

Appendix 6

16

Appendix S

Ranks

Geographical Location N Mean Rank

Average of available ones on a scale of 0-100%

Coastal 24 38.63

Highlands 24 38.46

Plains 24 32.42

Total 72

Test Statisticsa,b

Average of Total Attitude on a scale of 0-100%

Chi-Square 1.372

df 2

Asymp. Sig. .504


b. Grouping Variable: Geographical Location

Appendix 6

17

Appendix T Ranks

Community N Mean Rank

Total Attitude on a scale of 0-100%

Maravovo 12 47.13

Leosa-Veuru 12 30.13

Turarana 12 39.83

Gilbert Camp

12 37.08

Pitukoli 12 40.50

Papangu 12 24.33

Total 72

Test Statisticsa,b


Chi-Square 9.021

df 5

Asymp. Sig. .108


b. Grouping Variable: Community

Appendix U Ranks

Gender N Mean Rank Sum of Ranks


Male 36 21.43 771.50

Female 36 51.57 1856.50

Total 72

Test Statisticsa


Mann-Whitney U 105.500

Wilcoxon W 771.500

Z -6.112


a. Grouping Variable: Gender

Appendix 6

18

Appendix V Ranks

Age N Mean Rank


14-18 years 16 35.28

18-30 years 27 36.46

31-40 years 17 39.12

41-50 years 10 36.60

Over 51 2 24.00

Total 72

Test Statisticsa,b


Chi-Square 1.035

df 4

Asymp. Sig. .904


b. Grouping Variable: Age

Appendix W

When your child suffers from diarrhoea, what do you give them?

Frequency Percent Cumulative Percent

Valid 34 47.2 47.2

antibiotic given 1 1.4 48.6

antibiotics 1 1.4 50.0

banana cooked over hot stones

1 1.4 51.4

boil water 1 1.4 52.8

bush lime, warm water 1 1.4 54.2

Bushlime juice 1 1.4 55.6

coconut 1 1.4 56.9

coconut juice 1 1.4 58.3

coconut juice, pawpaw juice and warm water

1 1.4 59.7

coconut liquid 2 2.8 62.5

coconut water 1 1.4 63.9

coconut water, breast milk 2 2.8 66.7

diarrhoea medicine 1 1.4 68.1

fruit juice 1 1.4 69.4

fruits and boiled water 1 1.4 70.8

give antibiotic 1 1.4 72.2

green coconut 1 1.4 73.6

green coconut juice 3 4.2 77.8

Home medicine and ORS 1 1.4 79.2

liquid water 2 2.8 81.9

local medicine, vines 1 1.4 83.3

medication 1 1.4 84.7

Appendix 6

19

more liquid water 1 1.4 86.1

natural leaf 1 1.4 87.5

natural trees 2 2.8 90.3

ORS from clinic 1 1.4 91.7

warm water 3 4.2 95.8

warm water, coconut juice 1 1.4 97.2

water liquid 1 1.4 98.6

young coconut water heated 1 1.4 100.0

Total 72 100.0

Appendix X

How often do you wash your face?

Frequency Percent Cumulative Percent

Valid 2 1 1.4 1.4 2 times a day 1 1.4 2.8 3 times 4 5.6 8.3 3 times a day 3 4.2 12.5 daily 47 65.3 77.8 every morning

4 5.6 83.3

everyday 1 1.4 84.7 mornings 1 1.4 86.1 no 1 1.4 87.5 once 2 2.8 90.3 twice daily 7 9.7 100.0 Total 72 100.0

Appendix Y

Appendix 6

20

Appendix 6

21

Appendix Z Tests of Normality

Kolmogorov-Smirnova Shapiro-Wilk

Statistic df Sig. Statistic df Sig.

TOTAL_PRACTICE .075 72 .200* .980 72 .313

*. This is a lower bound of the true significance.

a. Lilliefors Significance Correction

Since p‐value > 0.05, we can say that the distribution of TOTAL_PRACTICE is not statistically

significantly different from Normal, i.e., assumed to be Normal.

Appendix AA

ANOVA

TOTAL_PRACTICE Sum of Squares df Mean Square F Sig.

Between Groups 43.869 2 21.935 .226 .798

Within Groups 6682.876 69 96.853 Total 6726.745 71

Appendix BB

Tests of Normality

Community Kolmogorov-Smirnova Shapiro-Wilk


TOTAL_PRACTICE Maravovo .146 12 .200* .941 12 .517

Leosa-Veuru .142 12 .200* .969 12 .903

Turarana .128 12 .200* .967 12 .877

Gilbert Camp

.138 12 .200* .971 12 .923

Pitukoli .197 12 .200* .905 12 .183

Papangu .221 12 .107 .908 12 .202



ANOVA


Between Groups 104.042 5 20.808 .207 .958


Appendix 6

22

Appendix CC

Tests of Normality

Gender Kolmogorov-Smirnova Shapiro-Wilk


TOTAL_PRACTICE Male .083 36 .200* .968 36 .364

Female .091 36 .200* .971 36 .441



Appendix DD Tests of Normality

Age Kolmogorov-Smirnova Shapiro-Wilk


TOTAL_PRACTICE 14-18 years .161 16 .200* .938 16 .326

18-30 years .122 27 .200* .968 27 .539

31-40 years .105 17 .200* .977 17 .922

41-50 years .108 10 .200* .970 10 .887

Over 51 .260 2 . *. This is a lower bound of the true significance.


ANOVA


Between Groups 1737.185 4 434.296 5.832 .000


Independent Samples Test

Levene's Test for Equality of Variances

t-test for Equality of Means

F Sig. t df Sig. (2-tailed)

Mean Difference

Std. Error Difference

95% Confidence Interval of the Difference Lower Upper

TOTAL_PRACTICE Equal variances assumed

2.753 .102 -.458 70 .648 -1.05731 2.30710 -5.65868 3.54406

Equal variances not assumed

-.458 66.848 .648 -1.05731 2.30710 -5.66249 3.54788

Appendix 6

23

There is a statistically significant difference between at least two different age groups.

Multiple Comparisons

Dependent Variable: TOTAL_PRACTICE Tukey HSD (I) Age (J) Age Mean

Difference (I-J)

Std. Error

Sig. 95% Confidence Interval

Lower Bound

Upper Bound

14-18 years 18-30 years -3.17130 2.72261 .771 -10.8040 4.4614

31-40 years -10.72346* 3.00584 .006 -19.1502 -2.2967

41-50 years -10.56140* 3.47873 .027 -20.3139 -.8090

Over 51 -19.47368* 6.47225 .029 -37.6183 -1.3291

18-30 years 14-18 years 3.17130 2.72261 .771 -4.4614 10.8040

31-40 years -7.55216* 2.67186 .047 -15.0426 -.0617

41-50 years -7.39011 3.19457 .153 -16.3459 1.5657

Over 51 -16.30239 6.32406 .086 -34.0316 1.4268

31-40 years 14-18 years 10.72346* 3.00584 .006 2.2967 19.1502

18-30 years 7.55216* 2.67186 .047 .0617 15.0426

41-50 years .16205 3.43915 1.000 -9.4794 9.8035

Over 51 -8.75023 6.45106 .657 -26.8355 9.3350

41-50 years 14-18 years 10.56140* 3.47873 .027 .8090 20.3139

18-30 years 7.39011 3.19457 .153 -1.5657 16.3459

31-40 years -.16205 3.43915 1.000 -9.8035 9.4794

Over 51 -8.91228 6.68451 .672 -27.6520 9.8274

Over 51 14-18 years 19.47368* 6.47225 .029 1.3291 37.6183

18-30 years 16.30239 6.32406 .086 -1.4268 34.0316

31-40 years 8.75023 6.45106 .657 -9.3350 26.8355

41-50 years 8.91228 6.68451 .672 -9.8274 27.6520

*. The mean difference is significant at the 0.05 level.

Appendix EE

Ranks

Mean Rank

Total knowledge of available responses on a scale of 0-100% 2.53

Total Attitude on a scale of 0-100% 2.06

TOTAL_PRACTICE 1.42

Test Statisticsa

N 72

Chi-Square 44.778

df 2

Asymp. Sig. .000

a. Friedman Test

Appendix 6

24

Knowledge vs Attitude Ranks

N Mean Rank Sum of Ranks

Total Attitude on a scale of 0-100% - Total knowledge of available responses on a scale of 0-100%

Negative Ranks

49a 42.11 2063.50

Positive Ranks 23b 24.54 564.50

Ties 0c Total 72

a. Total Attitude on a scale of 0-100% < Total knowledge of available responses on a scale of 0-100%

b. Total Attitude on a scale of 0-100% > Total knowledge of available responses on a scale of 0-100%

c. Total Attitude on a scale of 0-100% = Total knowledge of available responses on a scale of 0-100%

Test Statisticsa

Total Attitude on a scale of 0-100% - Total knowledge of available responses on a scale of 0-100%

Z -4.206b


a. Wilcoxon Signed Ranks Test

b. Based on positive ranks.

Paired Samples Test

Paired Differences t df Sig. (2-tailed)

Mean Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference

Lower Upper

Pair 1

Total knowledge of available responses on a scale of 0-100% - Total Attitude on a scale of 0-100%

3.46208 6.28734 .74097 1.98463 4.93954 4.672 71 .000

Knowledge vs Practice Ranks

N Mean Rank

Sum of Ranks

TOTAL_PRACTICE - Total knowledge of available responses on a scale of 0-100%

Negative Ranks 61a 40.41 2465.00


Ties 0c Total 72

a. TOTAL_PRACTICE < Total knowledge of available responses on a scale of 0-100%

Appendix 6

25

b. TOTAL_PRACTICE > Total knowledge of available responses on a scale of 0-100%

c. TOTAL_PRACTICE = Total knowledge of available responses on a scale of 0-100%

Test Statisticsa

TOTAL_PRACTICE - Total knowledge of available responses on a scale of 0-100%

Z -6.459b

Asymp. Sig. (2-tailed)

.000



Paired Samples Test


Mean Std. Deviation

Std. Error Mean


Lower Upper

Pair 1

Total knowledge of available responses on a scale of 0-100% - TOTAL_PRACTICE

11.73058 11.15951 1.31516 9.10822 14.35293 8.920 71 .000

Attitude vs Practice Ranks

N Mean Rank

Sum of Ranks

TOTAL_PRACTICE - Total Attitude on a scale of 0-100%

Negative Ranks

53a 40.37 2139.50


Ties 0c Total 72

a. TOTAL_PRACTICE < Total Attitude on a scale of 0-100%

b. TOTAL_PRACTICE > Total Attitude on a scale of 0-100%

c. TOTAL_PRACTICE = Total Attitude on a scale of 0-100%

Test Statisticsa

TOTAL_PRACTICE - Total Attitude on a scale of 0-100%

Z -4.632b

Asymp. Sig. (2-tailed)

.000



Appendix 6

26

Paired Samples Test


Mean Std. Deviation

Std. Error Mean


Lower Upper

Pair 1

Total Attitude on a scale of 0-100% - TOTAL_PRACTICE

8.26849 13.03374 1.53604 5.20572 11.33127 5.383 71 .000

wash communication project

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