Unravelling context: a formative photovoice study of Indian youth perspectives of sanitation and hygiene practices

Water, sanitation, and hygiene are issues of substantial public health importance. Community-based participatory research approaches such as photovoice can help explore and identify determinants that influence sanitation and hygiene-related behaviours. This study aimed to use photovoice as part of the formative research process to increase understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours in Thirumalaikodi, India. First, a school was recruited using convenience sampling; next, 10 participants were purposively selected to participate in an information meeting, seven photo discussion sessions, and one wrap-up session over a three-week period. In each photo discussion session, participant groups selected one ‘trigger’ photograph, and through a structured discussion using SHOWED mnemonic questions (a series of questions that ask participants to describe and reflect upon a chosen photograph), generated a new understanding of issues related to water, sanitation, and hygiene. All sessions were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyse photo discussion session text. Findings revealed that factors such as social structure, education, and culture influence behaviours that determine the sanitary conditions of an individual’s private and public spaces. Furthermore, participants described how descriptive norms generated practices (e.g. littering) that were reinforced and maintained by limited access to waste management systems, attitudinal indifference, and generational beliefs. Findings yielded an in-depth understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours. This study also contributes to the advancement of participatory applications in formative research and intervention adaptation processes.