Putting heads and hands together to change knowledge and behaviours: Community Health Clubs in Port-au-Prince, Haiti

Although interventions that emphasize the role of knowledge in invoking behaviour change have recently become unpopular, the Community Health Club (CHC) model has demonstrated how group knowledge, consensus building, and peer pressure can be applied to achieve hygiene behaviour change. To date, the model has predominantly been implemented in rural settings, with limited testing in urban communities. In 2012, CHCs started in Haiti as a grassroots initiative, growing from six clubs in six Port-au-Prince communities to 66 clubs across 30 communities in 2015. This paper focuses on the 23 clubs formed between March 2012 and July 2014, when a retrospective process and outcome evaluation was conducted. Using a mixed methods study design, this evaluation used interviews with CHC facilitators and household surveys in three case neighbourhoods to assess how the CHC model was implemented and if differences exist between CHC graduates and non-members. The CHCs have successfully facilitated social bonding, while graduates demonstrated significantly higher preventative WASH knowledge and were seven times less likely to report openly defecating than non-members. However, programmatic and structural factors such as recruitment methods, non-members' distrust, urban living conditions, and market deficiencies hindered wider uptake of some behavioural changes. These findings inform how the CHC model operates in an urban context.