One of the biggest takeaways from my first year as an MPH student was the importance of using evidence to inform the design and implementation of public health interventions – but what happens when there just isn’t enough evidence to make a concrete decision? This was a major practicum challenge that I didn’t anticipate. After sorting and screening and rereading titles and abstracts for hours upon hours, our article search process that started with nearly 700 publications narrowed down to only 11 – and among these, the majority only included child feces disposal practices nested as one small part of larger sanitation interventions. My research focused on the Asia-Pacific region, which has among the highest rates of open defecation globally, so I was surprised to find so few interventions targeting this behavior. Though perhaps this is due to the widespread perception that child feces aren’t as harmful as adults’.

Even large-scale sanitation interventions, like India’s Total Sanitation Campaign, have been notoriously unsuccessful at improving child health outcomes. Programs like these have focused mainly on providing hardware or subsidies for individual households to construct their own sanitation hardware (think toilets, pour-flush latrines, bathrooms) without actually working toward behavior change. Behavior-Centered Design is a new approach to solving environmental health problems and has been a major area of World Vision’s research, which is super exciting to be a part of! So maybe I didn’t find all the statistically significant effect sizes, confidence intervals or p-values that I was initially looking for to prove that yes, giving people toilets = safe child feces disposal = improved public health. But I did come across some rich qualitative data on what real communities perceive as their barriers to improved sanitation, why they engage in certain behaviors, and what they would prefer from a public health intervention. Using these determinants is the next step in designing an intervention that communities actually want.

It seems like I just blinked and the summer is gone and my practicum experience is wrapping up. Looking back to May, I now feel so much more prepared to work on real-world public health problems instead of just practicing in a classroom (but I am looking forward to being back in the classroom this fall semester to see everyone in person!). Even though I felt like my work wasn’t going as I originally planned, I learned even more than I thought I would.