Development and Validation of a Community-Led Total Sanitation (CLTS) Evaluation Instrument for Diarrhea Intervention
DOI:
https://doi.org/10.26630/rj.v19i2.5008Keywords:
Community-Led Total Sanitation (CLTS), Diarrhea, Instrument Development, ValidityAbstract
Community-Led Total Sanitation (CLTS) is a crucial methodology for preventing diarrheal diseases; however, the availability of valid and reliable assessment tools remains inadequate. The study aims to develop and evaluate the validity and reliability of an instrument for assessing CLTS initiatives.
This study employed a mixed-methods framework consisting of two distinct phases: (1) expert validation conducted by five environmental health specialists to assess content validity (Content Validity Index/CVI), and (2) reliability assessment involving 30 participants using Cronbach’s Alpha. Top of Form
The content validity (Scale-Level CVI/S-CVI) for all constructs reached the threshold of ≥0.85, although two items were considered invalid (I-CVI <0.78). The reliability coefficients derived from Cronbach’s Alpha ranged from 0.61 to 0.79, with three items identified as inconsistent. Top of Form
This instrument is suitable for implementation following the revision of items exhibiting ambiguity. The practical implications highlight the need for enhanced precision in monitoring CLTS programs.
References
Badan Kebijakan Kesehatan Nasional. (2023). Laporan Survei Kesehatan Indonesia Dalam Angka Tahun 2023. In Kemenkes RI (Ed 1). Kemnekes. https://drive.google.com/file/d/1rjNDG_f8xG6-Y9wmhJUnXhJ-vUFevVJC/view
Benham, B., & Hawley, D. (2014). The effectiveness of tools used to evaluate successful critical decision making skills for applicants to healthcare graduate educational programs: a systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 12(3), 39–50. https://doi.org/10.11124/jbisrir-2014-1392
Elwood, J., & Murphy, P. (2015). Assessment systems as cultural scripts: a sociocultural theoretical lens on assessment practice and products. Assessment in Education: Principles, Policy & Practice, 22(2), 182–192. https://doi.org/10.1080/0969594X.2015.1021568
Folk, V. G., & Smith, R. L. (2002). Models for Delivery of CBTs (1st Ed). Routledge. https://doi.org/10.4324/9781410612250-3
Grand-Guillaume-Perrenoud, J. A., Geese, F., Uhlmann, K., Blasimann, A., Wagner, F. L., Neubauer, F. B., Huwendiek, S., Hahn, S., & Schmitt, K.-U. (2023). Mixed methods instrument validation: Evaluation procedures for practitioners developed from the validation of the Swiss Instrument for Evaluating Interprofessional Collaboration. BMC Health Services Research, 23(1), 83. https://doi.org/10.1186/s12913-023-09040-3
Hair, J. F., Babin, B. J., & Anderson, R. E. (2022). Multivariate Data Analysis. Cengage Learning.
Ingram, C., Chen, Y., Buggy, C., Downey, V., Archibald, M., Rachwal, N., Roe, M., Drummond, A., & Perrotta, C. (2022). Development and validation of a multi-lingual online questionnaire for surveying the COVID-19 prevention and control measures used in global workplaces. BMC Public Health, 22(1), 74. https://doi.org/10.1186/s12889-022-12500-w
Kementerian Kesehatan RI. (2022). Strategi Nasional STBM 2022-2026.
Laurent‐Vannier, A. (2022). Shaken Baby Syndrome (SBS) or Pediatric Abusive Head Trauma from Shaking: Guidelines for Interventions During the Perinatal Period from the French National College Of Midwives. Journal of Midwifery & Women’s Health, 67(S1). https://doi.org/10.1111/jmwh.13427
Morris, K. A. (2018). Measurement equivalence: a glossary for comparative population health research. Journal of Epidemiology and Community Health, 72(7), 559–563. https://doi.org/10.1136/jech-2017-209962
Nawab, B., Nyborg, I. L. P., Esser, K. B., & Jenssen, P. D. (2006). Cultural preferences in designing ecological sanitation systems in North West Frontier Province, Pakistan. Journal of Environmental Psychology, 26(3), 236–246. https://doi.org/10.1016/j.jenvp.2006.07.005
Panulo, M., Chidziwisano, K., MacLeod, C., Kapazga, T., Dreibelbis, R., Beattie, T. K., & Morse, T. (2024). CLTS implementation in Malawi: process evaluation of a sanitation and hygiene intervention. https://doi.org/10.31219/osf.io/9bfqd
Polit, D. F., & Beck, C. T. (2010). Essentials of Nursing Research: Appraising Evidence for Nursing Practice. In Lippincott Williams & Wilkins (Tenth, Nor, Vol. 95, Issue 2). Lippincott Williams & Wilkins.
Sinharoy, S. S., Conrad, A., Patrick, M., McManus, S., & Caruso, B. A. (2022). Protocol for development and validation of instruments to measure women’s empowerment in urban sanitation across countries in South Asia and Sub-Saharan Africa: the Agency, Resources and Institutional Structures for Sanitation-related Empowerment (ARISE). BMJ Open, 12(2), e053104. https://doi.org/10.1136/bmjopen-2021-053104
Spoto, A., Nucci, M., Prunetti, E., & Vicovaro, M. (2025). Improving content validity evaluation of assessment instruments through formal content validity analysis. Psychological Methods, 30(2), 203–222. https://doi.org/10.1037/met0000545
Stuart, K., Peletz, R., Albert, J., Khush, R., & Delaire, C. (2021). Where Does CLTS Work Best? Quantifying Predictors of CLTS Performance in Four Countries. Environmental Science & Technology, 55(6), 4064–4076. https://doi.org/10.1021/acs.est.0c05733
Taber, K. S. (2018). The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Research in Science Education, 48(6), 1273–1296. https://doi.org/10.1007/s11165-016-9602-2
Tiberghien, J. E., Robbins, P. T., & Tyrrel, S. F. (2011). Reflexive assessment of practical and holistic sanitation development tools using the rural and peri-urban case of Mexico. Journal of Environmental Management, 92(3), 457–471. https://doi.org/10.1016/j.jenvman.2010.08.032
WHO. (2023). Diarrhea Disease. https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
Zakianis, Sabarinah, Djaja, I. M., & Agustina, H. (2020). Validity and Reliability of Instruments Assessing Household Satisfaction With 3R-Based Waste Management (Tempat Pengolahan Sampah) and Waste Bank Services in Depok, Indonesia. European Journal of Molecular and Clinical Medicine, 7(10), 2347–2360. https://www.ejmcm.com/archives/volume-7/issue-10/9566
Zamanzadeh, V., Ghahramanian, A., Rassouli, M., Abbaszadeh, A., Alavi-Majd, H., & Nikanfar, A.-R. (2015). Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication. Journal of Caring Sciences, 4(2), 165–178. https://doi.org/10.15171/jcs.2015.017
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