ABSTRACT
Water, sanitation and hygiene (WaSH) are intertwined with physical health, the natural environment and psychological wellbeing. Mixed-methods research is intended to capture complexity, such as the interactions of WaSH and the health-environment-wellbeing nexus. This chapter describes a participatory, qualitatively driven mixed-methods study of WaSH and wellbeing in rural Eswatini, southern Africa. Ten community co-researchers and I conducted participatory mapping and photography, to identify, describe and visualise toilets and water sources in their village. We developed unique survey questions to enquire about WaSH using local terms and implemented the questions as part of a demographic and health census survey. The co-researchers then conducted focus group discussions with community members about health-related benefits and problems they experienced. WaSH-related data from this qualitatively driven mixed-methods study were combined for analysis with the intention of producing insights that could not be gleaned from either the qualitative or quantitative data alone (i.e. meta-inferences). After presenting the results showing how WaSH influenced and was influenced by the health-environment-wellbeing nexus, I discuss how the combined analysis of qualitative and quantitative data produced meta-inferences regarding (1) the relative influence of structural factors (e.g. poverty) and individual agency on WaSH-related practices and (2) the exceptional importance of WaSH in contexts highly affected by HIV. Conducting mixed-methods research within a participatory paradigm enhanced cultural relevance and scientific rigour. The study demonstrates the value of qualitatively driven approaches to mixing methods and embedding mixed-methods designs within participatory methodologies.
