Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country
Abstract Background Globally, diarrhea is a leading cause of child morbidity and mortality. Although latrines are integral for reducing enteric pathogen transmission, several studies have shown no evidence that latrine ownership improved child health. There are a number of explanations for these res...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-01-01
|
| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12889-018-6373-x |
| _version_ | 1819078151680032768 |
|---|---|
| author | V. K. Lopez B. T. West P. J. Clarke E. Quentin J. N. S. Eisenberg |
| author_facet | V. K. Lopez B. T. West P. J. Clarke E. Quentin J. N. S. Eisenberg |
| author_sort | V. K. Lopez |
| collection | DOAJ |
| description | Abstract Background Globally, diarrhea is a leading cause of child morbidity and mortality. Although latrines are integral for reducing enteric pathogen transmission, several studies have shown no evidence that latrine ownership improved child health. There are a number of explanations for these results. One explanation is that latrine access does not equate to latrine use. Latrine use, however, is difficult to accurately ascertain, as defecation behavior is often stigmatized. To address this measurement issue, we measure latrine use as a latent variable, indicated by a suite of psychosocial variables. Methods We administered a survey of 16 defecation-related psychosocial questions to 251 individuals living in rural Ecuador. We applied latent class analysis (LCA) to these data to model the probability of latrine use as a latent variable. To account for uncertainty in predicted latent class membership, we used a pseudo-class approach to impute five different probabilities of latrine use for each respondent. Via regression modeling, we tested the association between household sanitation and each imputed latrine use variable. Results The optimal model presented strong evidence of two latent classes (entropy = 0.86): consistent users (78%) and inconsistent users (22%), predicted by 5 of our 16 psychosocial variables. There was no evidence of an association between the probability of latrine use, predicted from the LCA, and household access to basic sanitation (OR = 1.1, 95% CI = 0.6–2.1). This suggests that home access to a sanitation facility may not ensure the use of the facility for every family member at all times. Conclusion Effective implementation and evaluation of sanitation programs requires accurate measurement of latrine use. Psychosocial variables, such as norms, perceptions, and attitudes may provide robust proxy-measures. Future longitudinal studies will help to strengthen the use of these surrogate measures, as many of these factors may be subject to secular trends. Additionally, subgroup analyses will elucidate how our proxy indicators of latrine defecation vary by individual-level characteristics. |
| first_indexed | 2024-12-21T19:08:32Z |
| format | Article |
| id | doaj.art-6f4666265b5444178a00e3f32df7ae4b |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-21T19:08:32Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-6f4666265b5444178a00e3f32df7ae4b2022-12-21T18:53:16ZengBMCBMC Public Health1471-24582019-01-0119111110.1186/s12889-018-6373-xLatent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income countryV. K. Lopez0B. T. West1P. J. Clarke2E. Quentin3J. N. S. Eisenberg4Department of Epidemiology, University of Michigan School of Public HealthInstitute for Social Research, University of MichiganDepartment of Epidemiology, University of Michigan School of Public HealthInstituto Nacional de Investigación en Salud Pública, Centro de Investigación EpiSIGDepartment of Epidemiology, University of Michigan School of Public HealthAbstract Background Globally, diarrhea is a leading cause of child morbidity and mortality. Although latrines are integral for reducing enteric pathogen transmission, several studies have shown no evidence that latrine ownership improved child health. There are a number of explanations for these results. One explanation is that latrine access does not equate to latrine use. Latrine use, however, is difficult to accurately ascertain, as defecation behavior is often stigmatized. To address this measurement issue, we measure latrine use as a latent variable, indicated by a suite of psychosocial variables. Methods We administered a survey of 16 defecation-related psychosocial questions to 251 individuals living in rural Ecuador. We applied latent class analysis (LCA) to these data to model the probability of latrine use as a latent variable. To account for uncertainty in predicted latent class membership, we used a pseudo-class approach to impute five different probabilities of latrine use for each respondent. Via regression modeling, we tested the association between household sanitation and each imputed latrine use variable. Results The optimal model presented strong evidence of two latent classes (entropy = 0.86): consistent users (78%) and inconsistent users (22%), predicted by 5 of our 16 psychosocial variables. There was no evidence of an association between the probability of latrine use, predicted from the LCA, and household access to basic sanitation (OR = 1.1, 95% CI = 0.6–2.1). This suggests that home access to a sanitation facility may not ensure the use of the facility for every family member at all times. Conclusion Effective implementation and evaluation of sanitation programs requires accurate measurement of latrine use. Psychosocial variables, such as norms, perceptions, and attitudes may provide robust proxy-measures. Future longitudinal studies will help to strengthen the use of these surrogate measures, as many of these factors may be subject to secular trends. Additionally, subgroup analyses will elucidate how our proxy indicators of latrine defecation vary by individual-level characteristics.http://link.springer.com/article/10.1186/s12889-018-6373-xSensitive behaviorsSanitationLatrine useLatent class analysisMeasurement |
| spellingShingle | V. K. Lopez B. T. West P. J. Clarke E. Quentin J. N. S. Eisenberg Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country BMC Public Health Sensitive behaviors Sanitation Latrine use Latent class analysis Measurement |
| title | Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country |
| title_full | Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country |
| title_fullStr | Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country |
| title_full_unstemmed | Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country |
| title_short | Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country |
| title_sort | latent variable modeling to develop a robust proxy for sensitive behaviors application to latrine use behavior and its association with sanitation access in a middle income country |
| topic | Sensitive behaviors Sanitation Latrine use Latent class analysis Measurement |
| url | http://link.springer.com/article/10.1186/s12889-018-6373-x |
| work_keys_str_mv | AT vklopez latentvariablemodelingtodeveloparobustproxyforsensitivebehaviorsapplicationtolatrineusebehavioranditsassociationwithsanitationaccessinamiddleincomecountry AT btwest latentvariablemodelingtodeveloparobustproxyforsensitivebehaviorsapplicationtolatrineusebehavioranditsassociationwithsanitationaccessinamiddleincomecountry AT pjclarke latentvariablemodelingtodeveloparobustproxyforsensitivebehaviorsapplicationtolatrineusebehavioranditsassociationwithsanitationaccessinamiddleincomecountry AT equentin latentvariablemodelingtodeveloparobustproxyforsensitivebehaviorsapplicationtolatrineusebehavioranditsassociationwithsanitationaccessinamiddleincomecountry AT jnseisenberg latentvariablemodelingtodeveloparobustproxyforsensitivebehaviorsapplicationtolatrineusebehavioranditsassociationwithsanitationaccessinamiddleincomecountry |