{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T22:33:28Z","timestamp":1783377208630,"version":"3.54.6"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Environ\ufffdHealth\ufffdInsights"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>From preventing cholera and diarrhea by reducing exposure to human waste, to reducing transmission of COVID-19 through handwashing, water, sanitation and hygiene (WASH) can save lives. Numerous global health initiatives have been created to combat the spread of infectious diseases. However, according to the Sanitation and Hygiene Fund, \u201cdecades of under investment in sanitation and hygiene have made this sector the weakest link in our efforts to achieve the [Sustainable Development Goals (SDGs)].\u201d There appear to be various reasons for the lag in global attention to, funding toward, and innovation around WASH-related diseases. Firstly, WASH is comprised of three interrelated components, water, sanitation, and hygiene, each of which has its own subset of indicators, priorities, and infrastructure, thus making streamlined communications and impact measurement within the sector incredibly complex. Secondly, WASH is a field that bridges many sectors, and there has historically been a lack of understanding of where responsibility lies to consistently fund and execute WASH interventions, programming, and policymaking. Additionally, public health research and funding tend to favor evaluations using randomized controlled trials (RCTs), which are often referred to as the \u201cgold standard.\u201d RCTs, like all single evaluative methods, have limitations which may not effectively capture the complexity of WASH interventions and their subsequent multi-sectoral outcomes. In some cases \u201cit may be infeasible (or unethical) to randomize communities to a [WASH] intervention\u201d which would prohibit the research from reaching the current \u201cgold standard\u201d threshold for academic rigor and subsequent funding. A new concept called \u201cTransformative WASH\u201d has recently emerged in the WASH sector as a result of three RCTs and calls for a \u201ccomprehensive package of WASH interventions\u201d to effectively improve health and social outcomes. We believe that the current definition of the \u201cgold standard\u201d in academic research is failing the WASH sector and does not align with \u201cTransformative WASH.\u201d Rather, the \u201cgold standard\u201d should instead be a mixed methods research toolkit that utilizes Human-Centered Design (HCD) practices, and proxy methods such as \u201cparticipatory design\u201d or \u201cBehavior Centered Design theory\u201d to better design and evaluate WASH interventions.<\/jats:p>","DOI":"10.1177\/11786302211018391","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T05:50:34Z","timestamp":1621835434000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Failure of the \u201cGold Standard\u201d: The Role of a Mixed Methods Research Toolkit and Human-Centered Design in Transformative WASH"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3960-2247","authenticated-orcid":false,"given":"Jasmine","family":"Burton","sequence":"first","affiliation":[{"name":"Wish for WASH Thinks Inc, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devika","family":"Patel","sequence":"additional","affiliation":[{"name":"Wish for WASH Thinks Inc, Atlanta, GA, USA"},{"name":"Department of Surgery,The Better Lab, University of California, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Landry","sequence":"additional","affiliation":[{"name":"Wish for WASH Thinks Inc, Atlanta, GA, USA"},{"name":"Drexel University Westphal College of Media Arts & Design, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M","family":"Anderson","sequence":"additional","affiliation":[{"name":"Wish for WASH Thinks Inc, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Rary","sequence":"additional","affiliation":[{"name":"Wish for WASH Thinks Inc, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,5,24]]},"reference":[{"key":"bibr1-11786302211018391","unstructured":"World Health Organization. Monitoring sanitation. Water sanitation hygiene. Accessed February 25, 2021. http:\/\/www.who.int\/water_sanitation_health\/monitoring\/coverage\/monitoring-sanitation\/en\/"},{"key":"bibr2-11786302211018391","unstructured":"Esteves Mills J, Cumming O. The impact of water, sanitation and hygiene on key health and social outcomes: review of evidence. 2016. Accessed February 25, 2021. https:\/\/reliefweb.int\/sites\/reliefweb.int\/files\/resources\/TheImpactofWASHonKeySocialandHealthOutcomesReviewofEvidence.pdf"},{"key":"bibr3-11786302211018391","unstructured":"United Nations. SDG 6 synthesis report 2018 on water and sanitation. UN Water. 2018. Accessed February 25, 2021. https:\/\/www.unwater.org\/publications\/executive-summary-sdg-6-synthesis-report-2018-on-water-andsanitation\/"},{"key":"bibr4-11786302211018391","unstructured":"The Sanitation & Hygiene Fund. Strengthening the weakest link: the sanitation and hygiene fund investment case. 2020. https:\/\/www.shfund.org\/"},{"key":"bibr5-11786302211018391","unstructured":"Jim\u00e9nez A, Kjell\u00e9n M, Le Deunff H. WASH and accountability: explaining the concept. Accountability for sustainability partnership: UNDP water governance facility at SIWI and UNICEF. 2015. Accessed February 25, 2021. https:\/\/www.watergovernance.org\/resources\/accountability-in-wash-explaining-the-concept\/"},{"key":"bibr6-11786302211018391","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15199"},{"key":"bibr7-11786302211018391","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001775"},{"key":"bibr8-11786302211018391","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2017.12.005"},{"key":"bibr9-11786302211018391","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1410-x"},{"key":"bibr10-11786302211018391","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0234364"},{"key":"bibr11-11786302211018391","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30396-1"},{"key":"bibr12-11786302211018391","unstructured":"WHO\/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. WASH post-2015: proposed indicators for drinking water, sanitation and hygiene. 2011. Accessed February 25, 2021. https:\/\/www.who.int\/water_sanitation_health\/monitoring\/coverage\/wash-post-2015-rev.pdf"},{"key":"bibr13-11786302211018391","unstructured":"Tennant M. Human centered design: the key to modern marketing. Medium. 2015. Accessed February 27, 2021. https:\/\/medium.com\/@matthewtennant\/human-centered-design-the-key-to-modern-marketing-2afed97d356c"},{"key":"bibr14-11786302211018391","author":"IDEO","year":"2008","journal-title":"Human Centered Design Toolkit: Hear, Create, Deliver"},{"key":"bibr15-11786302211018391","unstructured":"DEEP. DEEP design thinking. Accessed February 25, 2021. https:\/\/www.deepdesignthinking.com"},{"key":"bibr16-11786302211018391","unstructured":"Design Council. What is the framework for innovation? Design Council\u2019s evolved Double Diamond. Design council. 2015. Accessed February 25, 2021. https:\/\/www.designcouncil.org.uk\/news-opinion\/what-framework-innovation-design-councils-evolved-double-diamond"},{"key":"bibr17-11786302211018391","unstructured":"United Nations Children\u2019s Fund (UNICEF) and the World Health Organization. State of the World\u2019s sanitation: an urgent call to transform sanitation for better health, environments, economies and societies. 2020. Accessed February 25, 2021. https:\/\/www.unicef.org\/reports\/state-worlds-sanitation-2020"},{"key":"bibr18-11786302211018391","unstructured":"Acumen Academy. Human-centered design: how to embrace failing fast. 2018. Accessed February 25, 2021. https:\/\/www.acumenacademy.org\/blog\/human-centered-design-how-embrace-failing-fast"},{"key":"bibr19-11786302211018391","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2018.00248"},{"key":"bibr20-11786302211018391","unstructured":"iDE. Using human-centered design to discover solutions to poverty. iDE. 2021. 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