Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya
Abstract Background Household flooring is increasingly being investigated as a determinant of health, however the pathways through which flooring may impact health and wellbeing are not yet well understood. The SABABU study is a cluster-randomised controlled trial evaluating the impact of an improve...
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2025-02-01
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| Online Access: | https://doi.org/10.1186/s12889-025-21469-1 |
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| author | Stella Kepha Hugo Legge Katherine E. Halliday Victoria Ochwal Lynne Elson Jacinta Mwongeli William E. Oswald Beatrice Kakoi James Wambua Charles Mwandawiro Ulrike Fillinger Rachel Pullan Doris Njomo |
| author_facet | Stella Kepha Hugo Legge Katherine E. Halliday Victoria Ochwal Lynne Elson Jacinta Mwongeli William E. Oswald Beatrice Kakoi James Wambua Charles Mwandawiro Ulrike Fillinger Rachel Pullan Doris Njomo |
| author_sort | Stella Kepha |
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| description | Abstract Background Household flooring is increasingly being investigated as a determinant of health, however the pathways through which flooring may impact health and wellbeing are not yet well understood. The SABABU study is a cluster-randomised controlled trial evaluating the impact of an improved flooring intervention on soil-transmitted helminthiasis, tungiasis, and enteric infections in Bungoma and Kwale counties, Kenya. This paper presents the findings from a theory of change development process that was undertaken as part of the formative research phase of the SABABU project. Methods A co-creation workshop (n = 1), stakeholder meetings (n = 2), and community meetings (n = 2) were held with a range of participants including community members (n = 36), village-level leaders (n = 28), and local government stakeholders (n = 14) to draft and refine the theory of change framework. These meetings were informed by a previous formative research phase conducted in study communities – comprised of household observations, in-depth interviews, and focus group discussions with community members – to investigate daily routines, use of space within homes, and attitudes towards home improvement. Results The theory of change framework demonstrates how the improved household flooring intervention aims to reduce prevalence of soil-transmitted helminthiasis, enteric infections and tungiasis and improve psychological wellbeing among children and caregivers. Reductions in infections are predicated on limited contact between improved floors and animals, regular floor cleaning, and household members conducting their daily routines on the new floors. Gains in psychological wellbeing are tied to increased feelings of pride, self-efficacy, and social progress, as well as improved quality of life through reduced morbidity from enteric and parasitic infections. Conclusion This study presents a theory of change framework mapping the pathways through which an improved flooring intervention may impact health and wellbeing. The results can be of use to researchers or programmes that are in the design or evaluation phase of a household flooring project in Kenya or other settings where access to improved floors is limited. |
| format | Article |
| id | doaj-art-bedc0ab1cd9a44d8bce79c57a54e6525 |
| institution | DOAJ |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| spelling | doaj-art-bedc0ab1cd9a44d8bce79c57a54e65252025-08-20T03:13:14ZengBMCBMC Public Health1471-24582025-02-012511910.1186/s12889-025-21469-1Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, KenyaStella Kepha0Hugo Legge1Katherine E. Halliday2Victoria Ochwal3Lynne Elson4Jacinta Mwongeli5William E. Oswald6Beatrice Kakoi7James Wambua8Charles Mwandawiro9Ulrike Fillinger10Rachel Pullan11Doris Njomo12Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research InstituteDepartment of Disease Control, London School of Hygiene & Tropical MedicineDepartment of Disease Control, London School of Hygiene & Tropical MedicineInternational Centre of Insect Physiology and EcologyKEMRI-Wellcome Trust Research ProgrammeJomo Kenyatta University of Agriculture and TechnologyDepartment of Disease Control, London School of Hygiene & Tropical MedicineJomo Kenyatta University of Agriculture and TechnologyJomo Kenyatta University of Agriculture and TechnologyEastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research InstituteInternational Centre of Insect Physiology and EcologyDepartment of Disease Control, London School of Hygiene & Tropical MedicineEastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research InstituteAbstract Background Household flooring is increasingly being investigated as a determinant of health, however the pathways through which flooring may impact health and wellbeing are not yet well understood. The SABABU study is a cluster-randomised controlled trial evaluating the impact of an improved flooring intervention on soil-transmitted helminthiasis, tungiasis, and enteric infections in Bungoma and Kwale counties, Kenya. This paper presents the findings from a theory of change development process that was undertaken as part of the formative research phase of the SABABU project. Methods A co-creation workshop (n = 1), stakeholder meetings (n = 2), and community meetings (n = 2) were held with a range of participants including community members (n = 36), village-level leaders (n = 28), and local government stakeholders (n = 14) to draft and refine the theory of change framework. These meetings were informed by a previous formative research phase conducted in study communities – comprised of household observations, in-depth interviews, and focus group discussions with community members – to investigate daily routines, use of space within homes, and attitudes towards home improvement. Results The theory of change framework demonstrates how the improved household flooring intervention aims to reduce prevalence of soil-transmitted helminthiasis, enteric infections and tungiasis and improve psychological wellbeing among children and caregivers. Reductions in infections are predicated on limited contact between improved floors and animals, regular floor cleaning, and household members conducting their daily routines on the new floors. Gains in psychological wellbeing are tied to increased feelings of pride, self-efficacy, and social progress, as well as improved quality of life through reduced morbidity from enteric and parasitic infections. Conclusion This study presents a theory of change framework mapping the pathways through which an improved flooring intervention may impact health and wellbeing. The results can be of use to researchers or programmes that are in the design or evaluation phase of a household flooring project in Kenya or other settings where access to improved floors is limited.https://doi.org/10.1186/s12889-025-21469-1Housing FlooringSTHTungiasisEntericTheory of Change |
| spellingShingle | Stella Kepha Hugo Legge Katherine E. Halliday Victoria Ochwal Lynne Elson Jacinta Mwongeli William E. Oswald Beatrice Kakoi James Wambua Charles Mwandawiro Ulrike Fillinger Rachel Pullan Doris Njomo Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya BMC Public Health Housing Flooring STH Tungiasis Enteric Theory of Change |
| title | Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya |
| title_full | Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya |
| title_fullStr | Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya |
| title_full_unstemmed | Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya |
| title_short | Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya |
| title_sort | better floors better health a theory of change for an improved household flooring intervention in rural communities in kwale and bungoma counties kenya |
| topic | Housing Flooring STH Tungiasis Enteric Theory of Change |
| url | https://doi.org/10.1186/s12889-025-21469-1 |
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