Evaluating the acceptability of a portable handwashing intervention (the Spatap) in three Fijian communities, a mixed-methods study

BACKGROUND: Water, sanitation, and hygiene (WASH) interventions in resource-constrained communities can improve health outcomes, but uptake and sustainability are influenced by acceptability. We evaluated the acceptability of the Spatap, a portable silicone tap attached to a bottle, as a household handwashing intervention in Fijian communities. METHODS: We distributed Spataps in three communities and conducted a survey two to seven days later, assessing sociodemographic factors, WASH access, and Spatap acceptability (n = 207). We applied a novel quantitative approach, calculating a total acceptability score from seven Likert-scale questions aligned with the component constructs of the Theoretical Framework of Acceptability (with a maximum score of 35) and asked open-ended questions about barriers and enablers to Spatap use. We analysed scores and used multiple linear models to examine predictors. Five months later, we conducted three focus group discussions (FGD) (n = 22) to supplement the survey data and performed thematic analysis using NVivo (ver 12). RESULTS: Spatap acceptability scores ranged from 18 to 35 (median 29), indicating high overall acceptability. Burden and opportunity cost scored lower than other component constructs. Sociodemographic factors were not meaningfully associated with acceptability scores. Few barriers were reported: ease of use, water saving, and convenience were key enablers. FGDs largely supported the survey findings and additionally highlighted ease of use for children and perceived illness reduction as contributors to acceptability. Time spent refilling bottles was burdensome in some larger households, the cost of larger bottles was prohibitive for some, and minor leakage issues were reported. CONCLUSIONS: The Spatap was broadly acceptable in the study communities, particularly where its portability, ease of use, and water-saving potential addressed locally important needs. These findings suggest the Spatap may have value as a household WASH intervention in resource-constrained settings, though its appropriateness relative to lower-cost alternatives should be considered. Future implementations should assess the cost-effectiveness and availability of suitable bottles, provide local language and pictorial instructions, and consider targeted engagement with children. The acceptability score method showed potential as a rapid evaluation tool but requires refinement before reapplication.