JMIR Publications

ABSTRACT

Background:

Handwashing is a cost-effective health behavior to prevent infectious diseases, yet its practice is shaped by multiple contextual factors and inequalities between different social groups in Sierra Leone. To address these inequalities, there has been a trend towards participatory approaches to allow for a more equitable distribution of resources and the development of locally tailored solutions. However, social power dynamics have not been well integrated in concepts of participation despite their known impact.

Objective:

This study sought to investigate the role of power dynamics affecting participatory approaches related to handwashing in Sierra Leone.

Methods:

Following a socioecological perspective, a qualitative interview study aimed to identify relevant actors and their power relationships prior to designing a participatory handwashing project in rural Sierra Leone. A field experiment with focus groups and a research diary compared the development of power dynamics in a participatory community-driven approach versus a non-participatory top-down approach.

Results:

While distinct leadership structures were noticeable and affected intervention attendance and processes of change in (non)participatory approaches, community-led activities and handwashing increased in the participatory approach irrespective of the leadership structures. Despite their ambivalence, the strategic inclusion of different community leaders appeared essential to enhance the value of the project, mobilize creative action and empower lower-ranking individuals to practice handwashing.

Conclusions:

The results underline the advantages of participatory approaches for health promotion, despite the impact of power dynamics shown in our analysis. Clinical Trial: Not applicable