EXAMINING BARRIERS AND FACILITATORS TO COMMUNITY PARTICIPATION IN WATERBORNE DISEASE PREVENTION IN RIVERS STATE: A QUALITATIVE STUDY

Abstract

Introduction: Water is essential for life, yet in many riverine communities of Rivers State, Nigeria, it also serves as a conduit for diseases such as cholera, typhoid, and diarrheal infections. Persistent outbreaks highlight gaps in community participation, undermining the effectiveness of preventive interventions. Understanding socio-cultural, economic, and institutional barriers, alongside facilitators, is crucial for designing sustainable waterborne disease prevention strategies. Methodology: A mixed-methods quasi-experimental pretest–post-test design was employed across 15 purposively selected riverine communities over 15 months. Quantitative surveys (n = 600 households) assessed knowledge, attitudes, and participation, while in-depth interviews explored barriers and facilitators qualitatively. Multistage cluster sampling, validated instruments (α = 0.81–0.87), and triangulated data collection ensured reliability. Ethical approval, informed consent, and confidentiality were rigorously maintained. Results: Economic constraints, including opportunity and transport costs, limited participation, while flexible scheduling and in-kind contributions facilitated engagement. Knowledge and attitudes improved significantly post-intervention, particularly among higher-educated and income groups. Community responsibility and trust in local health workers increased by over 25%, and active women and youth participation correlated with improved preventive behaviors. Discussion: Sustainable participation requires interventions that align with local socio-economic and cultural contexts. Trust, social capital, experiential learning, and economic incentives were pivotal, while traditional beliefs persisted, demonstrating the need for culturally congruent approaches. Recommendations: Integrating participatory learning and action (PLA) tools into routine health outreach can strengthen experiential engagement, ownership, and long-term WASH outcomes. Conclusion: Community-driven, context-sensitive interventions significantly enhance waterborne disease prevention, highlighting the centrality of trust, inclusion, and culturally congruent strategies for sustainable public health impact.