Attitudes toward open defecation: the development of a measurement tool

ABSTRACT Open defecation (OD) has become a concern in many developing countries, including Nigeria, with negative consequences for both individual and public health. So far, a valid scale to measure attitudes toward OD is lacking. This gap motivated the development of Attitudes Toward Open Defecation Scale (ATODS). A sequential exploratory mixed-methods design was adopted to develop and validate ATODS, including one qualitative survey (n = 20) and two descriptive cross-sectional surveys (n = 442) and (n = 322) among residents of two local government areas in Ondo North Senatorial District, Nigeria. The results provide support for the content validity, reliability, and construct validity of ATODS. The final scale included 21 items grouped into two dimensions explaining 36% of the common variance: Cognitive-evaluative attitudes = 24.91% and behavioural-normative orientation = 11.39% of the variance explained. ATODS showed internal consistency ranging from 0.74 to 0.82 for the factors. The two-factor ATODS was also subjected to a good model fit using structural equation modelling, which revealed a good fit. The findings show that ATODS is a valid and reliable measurement tool of attitudes toward OD. The scale is useful to benchmark attitudinal change interventions and could open up research into psychosocial determinants of attitudes toward OD in different settings and populations.