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Water, Sanitation and Hygiene-Gender Equality Measure (WASH GEM)

The Water, Sanitation, and Hygiene–Gender Equality Measure (WaSH-GEM) scale is a multidimensional, 62-item tool to measure changing gender equality in WaSH programming and interventions. It measures across 15 themes within the following five domains: resources, agency, critical consciousness, structures, and wellbeing. This measure is currently under refinement and it is recommended to check online for updates and follow up publications.

Categories

Geographies Tested: Cambodia,Nepal

Populations Included: Female, Male

Age Range: Adults

Items:

Resources

Access to WaSH
1. In the last month, how often has your household had sufficient drinking water?
2. In the last month, how often were you able to access a toilet when you needed it?

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

3. In the last month, how often were you able to access a handwashing facility with soap and water when you needed it?
4. How often do you have sufficient access to hygienic sanitary products to manage your menstruation?
5. How often do you have access to the facilities you need to help you manage your menstruation?

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0
Non-menstruating individuals - 1

6. In the last month, how long do you (personally) spend collecting water, on average per day?

Response Options:
0 min - 1
1-30 min - 0.67
31-60 min - 0.33
More Than an hour - 0

Control over Financial and Time Resources
7. Do you have money that you can spend as you wish after your daily needs are met?*

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

8. Do you have free time that you can choose to spend as you wish?*

Response Options:
Everyday - 1
Once a week - 0.67 Once a month - 0.33
Rarely or never - less than once a month - 0

Social Capital
9. If you need non-financial support from outside your household, for example for labour, care, sharing equipment or supplies, moral support, how often are you able to access when needed?*
10. If someone from outside your extended family needs non-financial support, for example for labour, care, sharing equipment or supplies, moral support, how often are you able to provide this support?*

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

Agency

WaSH Decision Making
11. In your household, do you think people listen to your opinion when making decisions about sanitation and hygiene for the household?
12. In your household, do you think people listen to your opinion when making decisions about drinking water for the household?

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

13. If you need knowledge or advice in relation to water, sanitation and hygiene, how confident are you that you could get this knowledge or advice?

Response Options:
Very confident - 1
Somewhat confident - 0.67
Not very confident - 0.33
Not at all confident - 0

14. How easy or difficult is it for you to raise concerns about water, sanitation and hygiene in the community with local leaders, officials or other influential people?
15. In the community, do you feel people listen to you when making decisions about community-related water, sanitation or hygiene issues?

Response Options:
Very easy - 1
Easy - 0.67
Difficult - 0.33
Very difficult - 0

Household influence and respect
16. In your household, do you think people listen to your opinion when making big decisions?*
17. In your household, are you able to have the final say on big decisions?*

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

Adapted Relative Autonomy
For activities where you are the main person responsible, you do these activities…
18. because that is what your family members tell you to do
19. because you personally think it is the right thing to do, whether or not your family members agree
20. because you enjoy doing them
21. so that your family members won’t get angry with you
22. because you want your family members to like you

Response Options:
Yes
No

Collective Action
23. How often do you discuss community issues with your friends and neighbours?
24. Are you quick to work with others when you see a need in the community?

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

25. How easy or difficult is it for you to raise concerns with local leaders, officials, or other influential people?

Response Options:
Very easy - 1
Easy - 0.67
Difficult - 0.33
Very difficult - 0

26. How many community organisations or groups do you belong to or participate in at the present time?

Response Options:
More than 4 groups - 1
3-4 groups - 0.67
1-2 groups - 0.33
No groups - 0

27. How often are you involved in making important decisions in any of the groups in which you are involved?

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

Self Efficacy
28. How confident are you that you can discuss and change your household roles and responsibilities if you want to?
29. How confident are you in your ability to solve problems faced in your household?
30. How confident are you in having power to make important decisions that change the course of your life?
31. How confident are you in your ability to take on new roles beyond the household?
32. How confident are you in your ability to help solve problems faced in your village or community?

Response Options:
Very confident - 1
Somewhat confident - 0.67
Not very confident - 0.33
Not at all confident - 0

Critical Consciousness

32. Men are better leaders than women.
33. The father is the one who should have the final say in the household.
34. A husband should be more educated than his wife.
35. A woman should obey her husband in all things.
36. A man’s job is to earn money; a woman’s job is to look after home and family.
37. A woman’s role is to serve her husband.
38. Men should have greater rights to inherit money and land than women.

Response Options:
Strongly agree - 0
Agree - 0.33
Disagree - 0.67
Strongly disagree - 1

Structures

Gender norms in WaSH
39. Among people you know, how many think water collection is a woman’s responsibility?*
40. Among people you know, how many think promoting hygiene is only a woman’s responsibility?*
41. Among people you know, how many think building or maintaining a water-system is only a man’s responsibility?*
42. Among people you know, how many think building and maintaining toilets is only a man’s responsibility?*

Response Options:
All - 1
Most - 0.67
Few - 0.33
Nobody - 0

Community Gender Norms
43. Among people you know, how many think it is women that should do the care work in the household.*
44. Among people you know, how many approve of women playing community leadership roles?

Response Options:
All - 1
Most - 0.67
Few - 0.33
Nobody - 0

Mobility
In the past 12 months, has another household member prevented or stopped you from:
45. Participating in education or training
46. Participating in local events or meetings

In the past 12 months, did you have to ask permission from others in the household to:
47. Go and see you birth family members or attend a family event
48. Seek or attend education or training
49. Seek or attend work

Response Options:
Yes - 0
No - 1

Wellbeing

WASH related Wellbeing
50. To what extent does dealing with your daily defecation cause you stress?

Response Options:
No stress - 1
Not much stress - 0.67
Cause of mild stress - 0.33
Cause of severe stress - 0

51. How private are your toilet facility/defecation arrangements?

Response Options:
Very private - 1
Somewhat private - 0.67
Not very private - 0.33
Not private at all - 0

52. How often do you feel safe when accessing this toilet?

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

53. To what extent does dealing with your daily bathing needs cause you stress?

Response Options:
No stress - 1
Not much stress - 0.67
Cause of mild stress - 0.33
Cause of severe stress - 0

54. How private are your current bathing arrangements?

Response Options:
Very private - 1
Somewhat private - 0.67
Not very private - 0.33
Not private at all - 0

55. To what extent does dealing with your menstrual hygiene needs cause you stress?
56. To what extent does obtaining drinking water cause you stress?

Response Options:
No stress - 1
Not much stress - 0.67
Cause of mild stress - 0.33
Cause of severe stress - 0

57. To what extent is managing water, sanitation or hygiene a cause of conflict in your household?*

Response Options:
Very much - 1
Somewhat - 0.67
Not much - 0.33
Not at all - 0

Life satisfaction
58. In general, to what extent are you satisfied with your life?
59. In general, are you satisfied with the balance between work time and leisure time in your life?

Response Options:
Very satisfied - 1
Satisfied - 0.67
Dissatisfied - 0.33
Very dissatisfied - 0

Emotional and mental health
60. How often do you feel happy, joyful or at ease?
61. How often do you feel worried, nervous or anxious?*

Response Options:
Always - 1
Sometimes - 0.67
Rarely - 0.33
Never - 0

Physical health
62. In the last month, have you experienced an illness, health problem or injury that prevented you from doing your daily activities?

Response Options:
Yes - 0
No - 1

*Items are reverse-scored.

Scoring Procedures

Themes are scored either by a simple sum or weighted sum approach. Detailed notes on scoring procedures and weights are provided in the Supplementary 1 document available online.

Original Citation

MacArthur, J., Chase, R. P., Gonzalez, D., Kozole, T., Nicoletti, C., Toeur, V., & Willetts, J. (2024). Investigating impacts of gender-transformative interventions in water, sanitation, and hygiene: Structural validity, internal reliability and measurement invariance of the water, sanitation, and hygiene–Gender equality measure (WASH-GEM). PLOS Water, 3(10). https://doi.org/10.1371/journal.pwat.0000233


Psychometric Score

Ease of Use Score

Scoring breakdown

Formative Research

Qualitative Research

Existing Literature/Theoretical Framework

Field Expert Input

Cognitive Interviews / Pilot Testing

Reliability

Internal

Test-retest

Interrater

Validity

Content

Face

Criterion (gold-standard)

Construct

KEY

Ease of Use

Readability

Scoring Clarity

Length

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