Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis

• Published in: Social science & medicine (1982) 2018-11, Vol.217, p.121-134
• Main Authors: Sclar, G.D., Penakalapati, G., Caruso, B.A., Rehfuess, E.A., Garn, J.V., Alexander, K.T., Freeman, M.C., Boisson, S., Medlicott, K., Clasen, T.
• Format: Article
• Language: English
• Subjects: Anxiety; Assaults; Conceptual model; Conceptual models; Defecation; Diarrhea; Disease; Embarrassment; Females; Gender identity; Health care policy; Health problems; Health research; Human dignity; Humans; Illnesses; Infectious diseases; Infrastructure; Malnutrition; Medical research; Mental Disorders - classification; Mental Disorders - epidemiology; Mental health; Mental well-being; Open defecation; Privacy; Public health; Qualitative Research; Qualitative synthesis; Quality of care; Quantitative analysis; Safety; Sanitation; Sanitation - classification; Sanitation - statistics & numerical data; Shame; Social psychology; Social well being; Systematic review; Well being; Women
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2018.09.016

The WHO defines health not as the absence of disease but as a “state of complete physical, mental, and social well-being.” To date, public health research on sanitation has focused mainly on the impact of sanitation on infectious diseases and related sequelae, such as diarrhea and malnutrition. This review focuses on the mental and social well-being implications of sanitation. We systematically searched leading databases to identify eligible studies. Qualitative studies were assessed using a 17-point checklist adapted from existing tools, while quantitative studies were assessed using the Liverpool Quality Appraisal Tool. We followed a best-fit framework synthesis approach using six a priori well-being dimensions (privacy, shame, anxiety, fear, assault, and safety), which were examined using line-by-line coding. Two additional dimensions (dignity and embarrassment) inductively emerged during coding for a total of eight well-being outcomes. We then synthesized coded text for each dimension into descriptive themes using thematic analysis. For quantitative studies, we extracted any measures of association between sanitation and well-being. We identified 50 eligible studies covering a variety of populations and sanitation contexts but many studies were conducted in India (N = 14) and many examined the sanitation experience for women and girls (N = 19). Our synthesis results in a preliminary conceptual model in which privacy and safety, including assault, are root well-being dimensions. When people perceive or experience a lack of privacy or safety during open defecation or when using sanitation infrastructure, this can negatively influence their mental and social well-being. We found that perceptions and experiences of privacy and safety are influenced by contextual and individual factors, such as location of sanitation facilities and user's gender identity, respectively. Privacy and safety require thorough examination when developing sanitation interventions and policy to ensure a positive influence on the user's mental and social well-being. •First systematic review on how sanitation influences mental and social well-being.•Lack of privacy or safety can negatively influence a sanitation user's well-being.•Sanitation strategies should focus on user perceptions of privacy and safety.•More research needed on ways to measure mental and social well-being outcomes.•Future research should explore sanitation experience of different populations.