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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : LC23 - LC28 Full Version

Household Survey on the Role of Social Norms in Defecation Practices in Aurangabad, Bihar, India


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57984.17147
Imteyaz Ahmad

1. PhD Scholar, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Imteyaz Ahmad,
PhD Scholar, School of Health Systems Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Deonar, Mumbai, Maharashtra, India.
E-mail: imteyazahmad777@gmail.com

Abstract

Introduction: In the recent decade, the study of social norms has become popular as it can explain and change harmful social behaviours, such as Open Defecation (OD). Open defecation is a threat to public health. It can cause diarrheal infections. Households formed the unit of study as they constitute an essential social institution to adopt and use latrines.

Aim: To compare the social norms of the latrine user and OD practitioners of households with regard to disgust, purity and pollution, latrine and OD beliefs, and the preference for latrines that differ in cost.

Materials and Methods: The cross-sectional study was conducted among 486 participants at Aurangabad district, Bihar, India, from July 2019 to January 2020. The district is one of the worst performers in latrine adoption in the country, according to the census of India 2011, Swachh Bharat Mission 2016, and NFHS-5 2019-21 data. A pretested questionnaire prepared by Research Institute for Compassionate Economics (RICE) was used as a tool for data collection. Data collected were entered into Statistical Package for Social Sciences (SPSS) version 25.0. Descriptive data analysis was performed and represented in tabular forms. The categories of households were made on the basis of the defecation practices (latrine user and OD practitioners).

Results: The study found that social norms regarding purity and pollution were the same across the two groups. Both the groups (latrine user and OD practitioners) agreed that OD was disgusting and polluting behaviour. The two groups were coherent in the preference for latrines based on cost.

Conclusion: The social norms are evolving in the study setting. Households have recognised the relevance of latrine use in contemporary times. The gap in practice is the only difference between the two groups of households.

Keywords

Belief, Community, Comfort, Cost, Health, Illiteracy, Motivation, Poverty, Pollution

Social norms are an integral part of any community. A community is built by a group of individuals who share and abide by unwritten rules (1),(2),(3). These rules govern the social behaviours of individuals without the force of law (3),(4). These norms are outcomes of social interactions between individuals; the norms may or may not be expressed explicitly, and any sanctions for deviation from norms are imposed through social networks and not by the legal system (3).

Social norms operate at collective as well as personal levels (1). People living together get benefitted from social norms as they maintain social order and facilitate co-operation in the social sphere (5). The health and well-being of individuals in a community are directly determined by the social norms (5),(6),(7),(8). Individuals live to fulfill behavioural standards that exist in their community (9) determined by gender, age, caste, socio-economic conditions. However, it does not always tell about the positive impacts of social norms. Health and development practitioners worry about the persistence of harmful practices and behaviours backed by social norms (1),(10).

Behaviour change led by new social norms can help stop harmful practices/behaviour. The study of norms can reveal why people adhere to harmful norms and how they can be changed. It would enhance the policy intervention strategies to deal with poor health conditions (1).

In Open Defecation (OD), behaviour change in all households living in the neighborhood is necessary. Latrine construction has an externality effect benefiting neighborhood areas (11). However, the chain of fecal-oral transmission will sustain if a few or a single individual continues to defecate in the open. It is a negative externality of OD (12). Hence, the social norm is both a collective matter where individuals play an important role.

The interrelatedness of perceptions is driven by behavioural standards an individual tries to live. Behavioural standards are societal standards that make individuals self-aware to get along well with others (13). It implies that a typical individual who lives in OD prevalent area would also be practicing OD. He would not like to appear different from the rest of the people living in his neighborhood (14).

The behavioural requirements of excretion demand the separation of feces from human contacts so efficiently that one never has to care about it. It is the minimum and utmost criteria to adopt a latrine. It is well perceived that only a costlier large concrete pit or conventional latrine can fulfill that condition (15). In anthropological explanations of purity, the concept includes taboo and purification rituals. Taboos are mystically sanctioned prohibitions or kinds of disapprobation. At the same time, purification rituals are rites to remove perceived contextual or categorical pollution from a person, group, or object (16).

The concept of pollution is contextual or categorical as it is used in a wide variety of phenomena. Pollution results from illegitimate mixing or conflation of two or more separate entities. For example, a dead body retains the quality of a living person, but the body cannot move or breathe. Therefore, the body conflates human qualities and is typically considered dangerous. Similarly, blood outside the body, excrement, vomit, nail clippings, is polluting because such entities breach their appropriate boundaries (17). Therefore, they need to be separated from humans and houses. A person gets temporarily impure when bodily entities come out of his body. He is supposed to separate himself from the community until he regains purity by bath or ablution (18).

Disgust is a moral emotional response to contamination caused to the purity (19),(20). Predecessor of modern human beings possessed a distaste system that protected them against toxins ingestion and contaminants. In the process of evolution, distaste system developed as disgust that guards the body and soul against contamination, impurity, and degradation. Therefore, anything that may contaminate the self physically or spiritually or cause threat to the status of being civilised is rejected as a result of disgust (20).

The present study attempted to investigate the norms controlling defecation practices. It will include disgust and perceived purity and impurity of individuals.The study considers behaviour and perception of individuals as determinants of social norms. The study is based on individuals’ perceptions, opinions, and beliefs.

Material and Methods

The cross-sectional study was conducted among 486 participants at Aurangabad district, Bihar, India, from July 2019 to January 2020. Aurangabad is a high OD prevalent district (78.2% of households without a sanitary latrine on the premises) according to the census of India 2011 (21). The study is affiliated with the Tata Institute of Social Sciences (TISS), Mumbai. The TISS’s Ethical Committee’s guidelines were followed to ensure the rights of human subjects taking part in the study. All the participants were explained and provided with the participants’ information sheets. Additionally, all the participants had provided written consent forms to participate in the study. The district is one of the worst performers in latrine adoption in the country, according to the census of India 2011 (22), and Swachh Survekshan Grameen 2022 (23).

Participants were not informed prior to the visit. The objective of the visit was to investigate the households’ defecation practices and socio-economic conditions; therefore, a cross-sectional design was the most appropriate method for the study.

Sample size calculation: The sample size was calculated using a formula for prevalence. There are 11 blocks in the district; all of them were selected for the study. Block-wise lists of villages were drawn from the census of India (2011) (21). Two villages were selected from each block; one village was of maximum (coded 1) in (Table/Fig 1), and another one had minimum (coded 2) in (Table/Fig 1) latrine ownerships.

The following formula used for sample calculation:

n= 1/α2*q/P*D2
Where, α2=(0.1)2
D2=1.5

Sample calculated using the above formula was 476.

Data Collection

All the households in selected villages were considered potential participants. If any household refused to participate, their neighboring household was given a chance to participate. The researcher himself engaged in data collection; he was well versed in the local language. All the participants were above 18 years of age and taking part in household activities and decision-making.

The data collection was carried out in a detailed questionnaire of the Research Institute for Compassionate Economics (RICE) (24). The questionnaire sections used in this paper were ‘disgust and purity’, ‘latrine use behaviour’, ‘open defecation behaviour’, and ‘knowledge about latrines/motivation to construct.’ Participants were categorised into two groups;

• Latrine users
• Open defecation practitioners

The responses were categorised and assigned codes and compared with the two groups. Participants were free to make multiple choices in several inquiries.

Participants were free to make more than one response and could emphasise a cause by repetitively mentioning it. During analysis, four broad categories were identified that were presented and accordingly, a total number of responses were counted and reported. The categories were:

1. Cost and poverty,
2. Pleasure, comfort and convenience,
3. Habit, tradition, and always do so
4. Policy failure.

Responses with the least frequencies violating Chi-square assumptions were removed from the test. Similarly, nine categories were identified for benefits of latrine use and causes of latrine adoption: (1) comfort and convenience, (2) latrine improves health, (3) status and social relations, (4) For the sake of women in the family, (5) good for old and disabled people, (6) peace, privacy, and being alone, (7) lack of space for OD, (8) pressurised, (9) keeps environment clean.

The household wealth index was prepared using the methodology provided by World Food Programme (25). Assets owned by households and their housing characteristics are combined together using Principal Component Analysis (PCA). The economic characteristics of households are converted into one proxy indicator called the wealth index.

Statistical Analysis

After data collection, Statistical Package for Social Sciences (SPSS) version 25.0 was used for data entry and analysis. Data entry was checked, and discrepancies in the entries were rectified thoroughly in two rounds of data cleaning. Incomplete or contradictory information cases were sorted and discarded from the analysis.

Results

The majority of the respondents were males. Most females who participated in the survey belonged to OD practicing households. Overall female representation was 88 (18%) in the data. Two hundred ninety one (60%) participants were above 35 years of age. Less than or equal to 10th grade educated respondents were 205 (42%) in the total sample. About 121 (25%) of respondents were illiterate.

Other backward castes households were the highest in the sample (45.3%), while general and scheduled caste households were almost equal (27%). General category participants had maximium latrine use and minimum open defecation compared to other social groups. At the same time, scheduled caste households were engaged in maximum open defecation and minimum latrine use compared to other social groups (Table/Fig 2).

Rich households used maximum toilets, while poor household used minimum toilets and vice-versa (Table/Fig 2).

Most of the participants (295) refrained from talking about disgust. They did not find items mentioned in the disgust section of the questionnaire were appropriate to be named in a formal interview or survey. Only 191 participants spoke about the disgust they feel from various impure and disgusting things.

The study found that the norms of purity and pollution do not vary across the groups. Seeing someone poop in the field was disgusting to both; latrine users and OD-practicing individuals. Impure things such as someone’s vomit, a dead rat, a dirty dog, and a dirty man were lesser impure than someone’s poop in the field (Table/Fig 3). Latrine users’ disgust was greater than OD practicing individuals regarding poop in the field. However, it was statistically significant only in two instances out of four inquiries on poop versus other disgusting things. In the rest of the instances, the two groups were not significantly different, or both held a similar level of disgust.

House, sources of drinking water (well), and places of worship held the highest moral and social worth in societies and individuals’ life. These entities strived to be pure and free from any impurity. Proximity was a matter of concern about defecation practices. (Table/Fig 4) suggests that OD is extremely disliked if it is practiced near a house, a well, or a place of worship. However, latrine use was also disliked if it was constructed near a well and a place of worship. Both the groups of households were not significantly different regarding the proximity of OD and latrine from the spaces of importance. However, latrine construction was encouraged near and far from the house. However, nearly half of the sample disagree that a latrine can be built inside the house. Also, a small group considered OD as pure if practiced far from the house. Among the two groups, social norms were not significantly different concerning the proximity of defecation spots.The Chi-square test (Table/Fig 4) was found to be significant where some OD-practicing households had a different opinion than most of the latrine-using households about the practice of OD near the house. But the association was statistically nullified due to a violation of a Chi-square assumption where it was shown that more than 20% of cells had less than five expected counts. Also, the two groups remain largely against OD near the house. Hence, the two groups were not different in terms of social norms regarding defecation practices.Chi-square test findings showed that notions of purity and impurity were similar across latrine users and OD practitioners.

Causes and motivations for defecation behaviours: An examination of opinion on defecation practices revealed that nearly fifty percent (48.8%) of latrine users think OD happens due to cost and poverty. ‘Cost and poverty’ is a category drawn from statements such as; “they are poor people who do not have a house that can accommodate a latrine,” “OD is not a choice one has to practice it due to lack of money”, “people are not having land how they are supposed to own a latrine and stop OD.” While the statements that highlighted OD as a choice (8%) were made as “they (OD practitioners) enjoy walking to the fields”, “they get fresh air.” The third category was identified as ‘habit and tradition’ (39.3%). According to this category, latrine users believe that OD is a result of long-held beliefs that people do not want to give up or they do not want to change their behaviour. “These people are demeaning the government’s efforts by holding their backward thinking”, “backward castes practice OD”, and “they (OD practitioners) do not care about sanitation” were some of the statements. Some latrine users had an opinion (4%) that it is a structural or policy failure that is lacking to make people shift failurefrom OD to latrine use. They mentioned that “there are widespread misconceptions about latrines”, and “they (OD practitioners) do not know the benefits of the latrine.” Hence, latrine users as a group are not homogenous in perceiving the cause of OD.

On the other hand, OD practitioners were coherent in mentioning the cause of their behaviour. It is ‘cost and poverty’ compelling them to OD (76%). “We are ‘Nat’; what option do we have.” This was the response of a household to the question of why they were practicing OD. ‘Nat’ is a community that migrates from one place to another; they do not own land and house; they live in tents.

Less than twenty percent (19.4%) of OD practitioners appreciated OD behaviour by counting the perceived benefits of OD. In this relatively smaller category, participants mentioned that “the early morning walk to reach OD spot is good for health” in another instance, a participant said, “the walk for OD saves people from the risk of diabetes.” The two groups’ perceived causes of OD are statistically significant (Table/Fig 5). It means the two groups widely differ in opinion regarding OD. The norms that shape opinions to establish the cause of OD are situational for latrine users but experiential for OD practitioners.

For latrine users, latrine use is important mainly for three reasons; viz. comfort and convenience (21.9%), good health (27.8%), and women’s dignity (21.2%). The response of latrine users when asked about the cause and motivation to adopt latrine, they stated, “latrine use is a healthy practice,” and “there is no trouble in monsoon.” Some other latrine owners said, “constructed out of fear that police will arrest,” and “ward members were constantly pressurising to build a latrine.” On the other hand, OD practicing households consider comfort and convenience as the most significant benefit of latrine use (32.1%). Then women’s dignity (20.4%) and health benefits (19%) were mentioned most by OD practitioners as the benefits of latrine use. They stated that “in an emergency, one does not have to go outside,” “it (latrine) can stop the scuffles due to OD,” and “the space for OD is declining due to expansion of population, it (latrine) is need of contemporary time.” The association is statistically significant (Table/Fig 5). It shows that the two groups (latrine users and OD practitioners) have different sets of opinions regarding the cause of latrine and the benefits of latrine adoption. However, the attitude towards latrines was positive for both groups.

Indian public sanitation scheme provides INR 12000 as assistance to construct an individual household latrine (26). This assistance is enough to build a kutcha latrine. (Table/Fig 6) represents two questions; the first was asked to latrine users, and the second was asked to OD practitioners. The nature of the questions was the same. It was intended to know the desirability of latrines based on cost. INR 12000 was considered a separating point for two types of latrines; with INR 12000 or less, one can build a kutcha latrine, and with more than INR 12000, one can build a pukka concrete pit latrine.

Latrine users who already own a latrine were asked whether they wanted it to be made some other way. It is asked whether they were satisfied or dissatisfied with their latrine. The cost of making those latrines was categorised into two and cross-tabulated. It gave a statistically significant result that shows that 47.6% of participants were not satisfied with the latrine they had that cost them INR 12000 and less, and they mentioned that they wanted to build the latrine some other way. At the same time, 90.4% of participants were satisfied with the latrine they owned that cost more than INR 12000 and did not want it to be another way.

At the same time, OD practitioners were asked how much a good latrine costs and whether they will adopt a latrine of that cost. Their responses were again categorised into two categories: latrines costing less than or equal to INR 12000 and more than INR 12000. The preference or desire for OD practitioners for latrines is also based on cost. Of those who said a good latrine could be built with INR 12000 and less, 61.5% did not want to accept it, while those participantswho said a good latrine would cost more than INR 12000, 88.1% said they would accept that latrine.The Chi-square test was found significant. It means social norms control preferences that are indirectly related to cost, but there are other factors beyond the scope of the present study that can be studied in future research.

Discussion

Social norms are embedded in behaviours (4). If a group’s collective conscience is that the open defecation is impure, the group will act effectively to adopt a latrine. There would be a lesser chance that group members deviate from latrine use despite having a latrine (27). If the latrine is regarded as essential by the group, it will make efforts to own the latrine. The present study found that households have moved away from approving OD, unlike the households in 2014 who were approving OD by saying that latrine would not improve their health (26). However, this realisation of latrine benefits and usefulness did not result in OD free households, as seen in the present study. It is because conventional and expensive latrines are most desirable than low-cost latrines, these findings are supported study done by Nawab B et al., (15).

Open defecation practicing households and latrine-using households share almost the same social norms regarding purity and pollution in the current study. However, OD households find it difficult to adopt latrines due to a lack of resources. In the past five years (2014-19), beliefs regarding latrine use and open defecation have changed, but practices have not changed correspondingly. It is only due to a lack of financial resources. Social norms are changing, and defecation behaviours are also shifting towards latrine use. The shift in beliefs were faster than shift in behaviour. However, perceived causes of OD (by latrine users) and experiential causes of OD (by OD practitioners) differ. It reflects a rift in social norms in two groups where they were similar in perceiving ritual purity and impurity but different in perceptions of the cause of problematic behaviour.

The cause of latrine adoption (by latrine users) and the perceived benefits of latrine adoption (by OD practitioners) are also mutually distancing the opinions of the two groups,although the two groups responded in favor of latrine despite the different reasons.

Social norms of purity and impurity are strongly holding the attainment of ODF goals of the Swachh Bharat Mission (SBM). The interconnected factors of social and economic nature are interwoven through social norms that affect latrine adoption in Aurangabad. The new twin pit latrine, which is cost-effective, has to be legitimised in the community so that it should not be disliked like other impure things. Also, poverty is a real factor affecting the goal of SBM. It is hard to envisage households with latrines but without house and land ownership.

Limitation(s)

Representation of women is lacking in the data. Women play essential roles in household decision-making. Their world view regarding latrine use and open defecation is much anticipated. Being a male, the researcher was not a preferred individual to interview the women in the field. The study is about a district in Bihar. It reveals the issues of households of that particular district, while other districts in the same state and other states can reveal further issues related to the topic.

Conclusion

The comparison of the two groups, latrine users and OD practitioners, about social norms revealed that the two groups criticised OD equally and supported latrine use. Despite this consensus across the population, there is a contention about the existence of OD and reasons to adopt a latrine between the two groups. Households in the field were aware of latrine use, but not for appropriate reasons. The motivation to shift towards latrine comes from a comfort point of view (for OD practitioners) but not from a health point of view. Similarly, OD is considered an individual’s and a group’s problem (by latrine users) and not a community’s problem. At the same time, the expensive latrine is idealised through social norms where the cheapest twin pit latrines are not preferred. Hence, the progress toward an open defecation-free community is a long process unless the social norm is corrected from considering latrine a luxury to a necessity.

References

1.
Legros S, Cislaghi B. Mapping the social-norms literature: An overview of reviews. Perspect Psychol Sci. 2020;15(1):62-80. [crossref] [PubMed]
2.
Hechter M, Opp KD. Introduction. In: Hechter M, Opp KD, editors. Social Norms. Russell Sage Foundation; 2001:xi-xx. [cited 2021 Oct 10]. Available from: https://bit.ly/3mUPri2.
3.
Cialdini RB, Trost MR. Social influence: Social norms, conformity, and compliance. In: Gilbert DT, Fiske ST, Lindzey G, editors. The Handbook of Social Psychology. McGraw-Hill; 1998:151-92.
4.
Reese G, Amir R, Cameron JE. The interplay between social identities and globalization. In: The Psychology of Globalization. Elsevier; 2019:71-99. [cited 2022 Apr 7]. Available from: https://linkinghub.elsevier.com/retrieve/pii/C2016003228X. [crossref]
5.
Anderson JE, Dunning D. Behavioural norms: Variants and their identification: Norms and their variants. Soc Personal Psychol Compass. 2014;8(12):721-38. [crossref]
6.
Dannals JE, Miller DT. Social Norms in Organizations. In: Oxford Research Encyclopedia of Business and Management . Oxford University Press; 2017 [cited 2022 Apr 7]. Available from: http://business.oxfordre.com/view/10.1093/acrefore/9780190224851.001.0001/acrefore-9780190224851-e-139. [crossref]
7.
Mahmoud MA, Ahmad MS, Mohd Yusoff MZ, Mustapha A. A review of norms and normative multiagent systems. Sci World J. 2014;2014:01-23. [crossref] [PubMed]
8.
Young HP. The evolution of social norms. Annu Rev Econ. 2015;7(1):359-87. [crossref]
9.
O’Connell K. What Influences Open Defecation and Latrine Ownership in Rural Households? Findings from Global Review [Internet]. Water and Sanitation Program; 2014. Available from: https://www.wsp.org/sites/wsp/files/publications/WSP-What-Influences-Open-Defecation-Global-Sanitation-Review.pdf.
10.
Mackie G. What are Social Norms? How are They Measured? UNICEF/University of California; 2015.
11.
Andres LA, Briceño B, Chase C, Echenique JA. Sanitation and externalities: Evidence from early childhood health in rural India. The World Bank; 2014 [cited 2022 Apr 12]. (Policy Research Working Papers). Available from: http://elibrary. worldbank.org/doi/book/10.1596/1813-9450-6737. [crossref]
12.
Coffey D, Gupta A, Hathi P, Spears D, Srivastav N, Vyas S. Understanding open defecation in rural India: Untouchability, pollution, and latrine pits. Econ Polit Wkly. 2017;52(1):59-66.
13.
Wiekens CJ, Stapel DA. Self-awareness and saliency of social versus Individualistic Behavioural Standards. Soc Psychol. 2010;41(1):10-19. [crossref]
14.
Helbing D, Yu W, Opp KD, Rauhut H. The emergence of homogeneous norms in heterogeneous populations [Internet]. Santa Fe Institute; 2022 [cited 2022 Aug 10]. Available from: https://www.santafe.edu/research/results/working-papers/the-emergence-of-homogeneous-norms-in-heterogeneou.
15.
Nawab B, Nyborg ILP, Esser KB, Jenssen PD. Cultural preferences in designing ecological sanitation systems in North West Frontier Province, Pakistan. J Environ Psychol. 2006;26(3):236-46. [crossref]
16.
Forth G. Purity, Pollution, and Systems of Classification. In: Callan H, editor. The International Encyclopedia of Anthropology [Internet]. 1st ed. Wiley; 2017 [cited 2022 Apr 12]. 1-13. Available from: https://onlinelibrary.wiley.com/doi/10. 1002/9781118924396.wbiea2003. [crossref]
17.
Douglas M. Purity and danger an analysis of concept of pollution and taboo. London: Routledge; 1966.
18.
Dumont L. Homo Hierarchicus: The caste system and its implication. Oxford University Press; 1982.
19.
Haidt J. The Moral Emotions. In: Davidson RJ, Scherer KR, Goldsmith, editors. Handbood of affective sciences. Oxford: Oxford University Press. 2003;852-70.
20.
Horberg EJ, Oveis C, Keltner D, Cohen AB. Disgust and the moralization of purity. J Pers Soc Psychol. 2009;97(6):963-76. [crossref] [PubMed]
21.
Census. Percentage of Households to Total Households by Amenities and Assets [Internet]. New Delhi: Registrar General of India, Ministry of Home Affairs, Government of India; 2011 [cited 2022 Aug 11]. Report No.: PC11_HL14. Available from: https://censusindia.gov.in/census.website/data/census-tables.
22.
Census. Percentage of Households to Total Households by Amenities and Assets [Internet]. New Delhi: Registrar General of India, Ministry of Home Affairs, Government of India; 2011 [cited 2022 Aug 11]. Report No.: PC11_HL14. Available from: https://censusindia.gov.in/census.website/data/census-tables.
23.
Swachh Survekshan Grameen 2022 [Internet]. Department of Drinking Water and Sanitation, Ministry of Jal Shakti, Government of India; 2022 [cited 2022 Nov 17]. Available from: https://swachhbharatmission.gov.in/sbmcms/writereaddata/ Portal/Images/pdf/SSG-2022-report.pdf.
24.
SQUAT survey. Research Institute for Compassionate Economics (RICE); 2014.
25.
Hjelm L, Mathiassen A, Miller D, Wadhwa A. VAM Guidance Paper: Creation of a Wealth Index. wfp.org; 2017. Available from: https://www.wfp.org/publications/ creation-wealth-index-june-2017.
26.
Government of India. Swachh Bharat Mission- Grameen: World’s Largest Behaviour Change Programme [Internet]. Ministry of Information and Broadcasting; 2021 [cited 2022 Aug 15]. Available from: https://swachhbharatmission.gov.in/SBMCMS/ writereaddata/portal/images/pdf/SBM_G_booklet.pdf.
27.
Gauri V, Rahman T, Sen IK. Shifting social norms to reduce open defecation in rural India. Behav Public Policy. 2020:01-25. [crossref]
28.
Coffey D, Gupta A, Hathi P, Khurana N, Spears D, Srivastav N, et al. Revealed preference for open defecation: Evidence from a new survey in rural north India. Econ Polit Wkly. 2014;49(38):43-55.

DOI and Others

DOI: 10.7860/JCDR/2022/57984.17147

Date of Submission: May 24, 2022
Date of Peer Review: Jul 13, 2022
Date of Acceptance: Sep 19, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 17, 2022
• Manual Googling: Sep 13, 2022
• iThenticate Software: Sep 15, 2022 (5%)

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