Development and validation of instrument to measure citywide inclusive sanitation (CWIS Scale) for Low-and Middle-Income Countries (LMICs)

Abstract

Universal access to safe and adequate sanitation is a critical public health and environmental issue, particularly in low-income urban areas. The Citywide Inclusive Sanitation (CWIS) approach seeks to address the challenge of meeting the universal access to sanitation for all, including the most vulnerable groups. The six key criteria in CWIS are: (1) equity; (2) safety; (3) sustainability; (4) responsibility; (5) accountability; and (6) Resource Planning and Management. This study aimed to develop and validate survey instruments for CWIS measurement in urban areas of Low- and Middle-Income Countries (LMICs). First, we specified the domains based on the six CWIS criteria by, adding the vulnerability criterion to the equation. We developed candidate items for each domain by reviewing the relevant literature. Face validity was determined through cognitive interviews, and content validity was determined through the evaluation of two experts. We added, removed, merged, and rephrased items based on the results of cognitive interviews and feedback from subject matter experts. We piloted the instrument and conducted statistical analysis to ensure the validity and reliability of the ‘scales and indices. The CWIS survey modules address a recognized need for greater emphasis on inclusive sanitation. We provide researchers and policymakers with tools to measure CWIS sub-constructs in a valid and reliable manner to generate data for improved targeting, design, implementation, and evaluation of strategies to improve sanitation access for vulnerable and marginalized urban citizens.