02950nas a2200313   4500000000100000008004100001653001500042653001800057653002200075653002000097653002200117653001200139653001100151653002600162653002100188100001400209700001900223700001500242700001700257700001300274700001800287700001600305700001400321700001600335700001300351245013100364520212800495022001302623       2018                            d10aSanitation10aMental Health10aSocial well-being10aOpen defecation10aMental well-being10aPrivacy10aSafety10aQualitative synthesis10aConceptual model1 aSclar G D1 aPenakalapati G1 aCaruso B A1 aRehfuess E A1 aGarn J V1 aAlexander K T1 aFreeman M C1 aBoisson S1 aMedlicott K1 aClasen T00aExploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis.3 a<p>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 <em>a priori</em> 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 <em>perceive</em> or <em>experience</em> 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.</p>
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