Predicting water consumption habits for seven arsenic-safe water options in Bangladesh

Background: In Bangladesh, 20 million people are at the risk of developing arsenicosis because of excessive arsenic intake. Despite increased awareness, many of the implemented arsenic-safe water options are not being sufficiently used by the population. This study investigated the role of social-cognitive factors in explaining the habitual use of arsenic-safe water options. Methods: Eight hundred seventy-two randomly selected households in six arsenic-affected districts of rural Bangladesh, which had access to an arsenic-safe water option, were interviewed using structured face-to-face interviews in November 2009. Habitual use of arsenic-safe water options, severity, vulnerability, affective and instrumental attitudes, injunctive and descriptive norms, self-efficacy, and coping planning were measured. The data were analyzed using multiple linear regressions. Results: Linear regression revealed that self-efficacy (B = 0.42, SE = .03, p < .001), the instrumental attitude towards the safe water option (B = 0.24, SE = .04, p < .001), the affective attitude towards contaminated tube wells (B = -0.04, SE = .02, p = .024), vulnerability (B = -0.20, SE = .02, p < .001), as well as injunctive (B = 0.08, SE = 0.04, p = .049) and descriptive norms (B = 0.34, SE = .03, p < .001) primarily explained the habitual use of arsenic-safe water options (R-2 = 0.688). This model proved highly generalizable to all seven arsenic-safe water options investigated, even though habitual use of single options were predicted on the basis of parameters estimated without these options. Conclusions: This general model for the habitual use of arsenic-safe water options may prove useful to predict other water consumption habits. Behavior-change interventions are derived from the model to promote the habitual use of arsenic-safe water options.