Pengembangan Model Pemberdayaan Masyarakat Dalam Mewujudkan Status Bebas Buang Air Besar Sembarangan (BABS) Pada Masyarakat Kabupaten Tanggamus Provinsi Lampung

Vera Yulyani, Prof. dr. Fatwa Sari Tetra Dewi,M.P.H., Ph.D; Dr. Iswanto M.Kes

2026 | Disertasi | S3 Kedokteran Umum

Latar Belakang: Buang Air Besar Sembarangan (BABS) masih menjadi masalah utama di negara berkembang. Kabupaten Tanggamus memiliki angka tertinggi di Provinsi Lampung, namun belum ada intervensi yang terbukti efektif dan berkelanjutan. Penelitian ini bertujuan mengembangkan model pemberdayaan masyarakat yang efektif untuk mengubah perilaku BABS di Kabupaten Tanggamus.

Metode: Penelitian menggunakan sequential exploratory mixed-methods design melalui empat tahap: eksplorasi kualitatif dengan rapid etnografi, pengembangan instrumen perilaku berbasis RANAS (uji CVI, FVI, EFA, CFA), implementasi intervensi pemberdayaan masyarakat, dan evaluasi kuantitatif menggunakan regresi logistik hingga Difference-in-Differences (DID).

Hasil: Studi kualitatif menunjukkan perilaku BABS masih dilakukan melalui buang air di sungai, kantong plastik/WC terbang, WC cemplung, dan BAB balita di tanah, yang telah menjadi tradisi sosial yang dinormalisasi dan dipertahankan oleh keterbatasan kepemilikan jamban serta ketidakberlanjutan sanitasi komunal. Modal sosial, kepemimpinan lokal, dukungan pemerintah, dan motivasi akan privasi, kenyamanan, serta kepemilikan jamban mendukung program Stop BABS. Pengembangan instrumen menghasilkan 51 item tervalidasi, dengan kebiasaan sebagai mediator utama antara niat dan perilaku. Intervensi berupa model pemberdayaan masyarakat dikembangkan melalui kajian kebutuhan dan musyawarah desa untuk memobilisasi kepemimpinan lokal, melibatkan lurah sebagai local champion, serta memperkuat partisipasi masyarakat, gotong royong, dan pengambilan keputusan kolektif melalui arisan jamban ekotandrum dan pengelolaan sampah. Intervensi menurunkan angka BABS dari 28,7% menjadi 19,1% (p<0 p=0,0022), p=0,04),>

Kesimpulan: Kombinasi pemberdayaan masyarakat, inovasi sanitasi murah (jamban ekotandrum), penguatan ekonomi, dan dukungan lintas stakeholder berpotensi secara efektif dalam mendorong perubahan perilaku menuju Stop BABS.

Background: Open Defecation (OD) remains a major problem in developing countries. Tanggamus Regency has the highest open defecation rate in Lampung Province, yet no intervention has been proven effective and sustainable in reducing it. This study aims to develop an effective empowerment approach to reduce open defecation in Tanggamus Regency.

Methods: This study employed a sequential exploratory mixed-methods design carried out in four stages: qualitative exploration using rapid ethnography; development of a RANAS-based behavioural instrument (CVI, FVI, EFA, and CFA tests); implementation of a community empowerment intervention; and quantitative evaluation using logistic regression through Difference-in-Differences (DID) analysis.

Results: The qualitative study found that open defecation was still practiced through defecation in rivers, the use of plastic bags or “flying toilets,” pit latrines, and defecation by young children on the ground. These practices had become normalized social traditions and were maintained by limited access to household latrines and the unsustainability of communal sanitation facilities. Social capital, local leadership, government support, and motivations related to privacy, comfort, and latrine ownership supported efforts to end open defecation. The instrument development process resulted in 51 validated items, with habit identified as a key mediator between intention and behaviour. The community empowerment intervention was developed through needs assessment and village deliberation to mobilize local leadership, engage the village head as a local champion, and strengthen community participation, mutual cooperation, and collective decision-making through the arisan jamban ekotandrum and waste management activities. The intervention reduced the prevalence of open defecation from 28.7% to 19.1% (p<0 p=0.0022), p=0.04),>

Conclusion: The combination of community empowerment, affordable sanitation innovation (the ecotandrum latrine), local economic strengthening, and cross-stakeholder support holds strong potential for effectively driving behavioural change toward stopping open defecation

Kata Kunci : Community Empowerment, Defecation Behavior, Eco-Treatment Social Group, Sanitation