Relationship between Sanitation Practices and Sanitation-Related Behavioral Change in the Nepalese Context: A Review

Abstract

Background: Nepal has made significant progress in improving sanitation access and reducing open-defecation. However, the mere presence of toilets does not ensure their consistent, safe, and hygienic use. Sustaining sanitation gains depends largely on behavioral changes related to toilet use, handwashing, household water treatment, waste disposal, toilet cleaning, and other hygiene practices within domestic environments. Therefore, understanding the link between sanitation practices and sustained behavioral change is crucial for maintaining and further strengthening Nepal’s sanitation achievement.

Methods: Evidence concerning sanitation practices, hygiene behaviors, household-level WASH services, and behavioral changes related to sanitation issues in Nepal were reviewed. First, peer-reviewed scientific articles published between 2021 and 2026 with available DOIs were considered for inclusion. A thematic review approach was used to systematically analyze and synthesize the relevant evidence.

Results: The reviewed evidence demonstrates a clear relationship between sanitation practices and sanitation-related behavioral changes. Adequate sanitation facilities create an enabling environment for the adoption of health-promoting behaviors; however, sustained behavioral change is essential to ensure regular toilet use, handwashing with soap, household water treatment, proper waste disposal, and hygienic practices. Sanitation-related behavioral changes are influenced by multiple factors, including education, socioeconomic conditions, water availability, social norms, motivation, institutional support, and accessibility of sanitation facilities.

Conclusion: Sustaining sanitation in Nepal requires a shift from an infrastructure-oriented approach to a more integrated environmental and behavioral intervention strategy. In addition to constructing sanitation facilities and ensuring access to sanitation services, an inclusive set of interventions is needed to promote and sustain positive sanitation and hygiene behavior over the long term.

Novelty: This review combined recent evidence from Nepal concerning the link between sanitation practice and behavioral change due to different factors.