Behavioral Change – Latrine Usage (EXERCISE)


This activity explores the root causes behind why it is often difficult to create lasting behavioral change.  It focuses on efforts to encourage the adoption of latrines for sanitary reasons in developing nations.  Participants will understand some common root causes that prevent behavioral change and be able to apply this method of root cause analysis to other changes they would like to help bring about.


  • Give each group a sheet of flipchart paper and some markers.
  • Have one flipchart and stand available at the front so that you can write down “KNOW, GROW, WHOA and MO” as you describe them.
  • You might want to have a prize available for the team with the most unique ideas. (OPTIONAL)



Explaining the Exercise and the Background: 5 minutes.

Activity: 10 minutes

Debrief: 15 minutes.


Use the following script, or modify it to meet your needs:

  • “Each year, two million children die of diarrheal diseases (WHO 1998).”
  • “The main source of diarrheal infection is contact with human excrement (Caincross, 1999), so improving hygiene practices in this area will have a significant impact in increasing child survival rates.”
  • “Unfortunately, 40% of the world’s population still doesn’t have adequate sanitation.  80% of this group lives in rural areas (WHO 2000).”
  • “Promotion of improved sanitation practices has had very little impact over the past 20 years.”
  • “There are many reasons for this, but it’s important to know the right reason for each context before we try to implement a solution.”
  • “There are four types of root causes for why people don’t implement changes.  These are Know, Grow, Whoa and Mo causes.
  • KNOW – they don’t know what is expected, why it would be good for them or how to do it. For example,
  • GROW – they lack the skills necessary to do it and need to grow and develop.
  • WHOA – there is something out of their control that stops them (“whoa” means stop).
  • MO – they don’t want to. They lack the MOtivation.
  • “In your groups, I would like you to create a flipchart with four quadrants.  Label them Know (top-left), Grow (top-right), Whoa (bottom-right), Mo (bottom-left).”
  • “Brainstorm reasons that fit into each of the four types of root causes for why a community might not install sanitary latrines and use them regularly.”  (Allow ten minutes for brainstorming.  There are some examples below for each category if you need them to help the groups get started.  When they have finished their brainstorm, have each team present. (If you want to increase the energy level of the brainstorm, give a prize for the team with the most unique ideas.)  After the presentations, have them discuss the debrief questions below.)



  • They don’t know how to install latrines.
  • Concepts of dirt and clean are different in different cultures.  In some places, children’s feces are considered harmless, so there seems to be no need to dispose of them properly.
  • Latrines are sometimes viewed as dirty and even evil places.


  • They don’t have the skills to install latrines.
  • Latrines may be seen as difficult to operate and maintain (especially when it comes to emptying them).



  • They cannot afford to install latrines.
  • There may not be enough space to construct one.
  • Community leaders may be hostile to foreigners, pocket funds or sabotage efforts, because they fear loss of authority or face or see an opportunity to profit. (This is Mo for the community leaders, but it’s a Whoa for the rest of the community.



  • Religious beliefs influence adoption of new practices. For example, in India, latrines we’re installed in the northeast corner of a lot. In Hindu beliefs, this is an inauspicious place to put the latrine, so no one used them.
  • Women may feel they don’t have enough privacy in a public latrine.
  • The community may be distrustful or afraid of foreigners’ strange ideas.
  • Men may not want to use a latrine because it becomes “unclean” after a menstruating woman uses it.

(The source document for this information is “How to Promote the Use of Latrines in Developing Countries,” by Jennifer McConville in April 2003 at Michigan Technological University.


  • How important do you think it is to know the true root cause that someone (or a group) isn’t implementing a behavioral change?
  • How can you use the four types of root causes (Know, Grow, Whoa, Mo) to plan implementing changes better?
  • How will you apply what you’ve learned in your work?

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Filed under Change, exercise, Performance, Root Cause Analysis

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