Integration of the Environmental Health Index and Behavior Change in Promoting Sustainable Sanitation Practices in Island Regions

Introduction: Environment and behavior are major determinants of public health. According to H.L. Blum’s concept, these two factors contribute more than 75% to overall health status. Rote Ndao Regency, as an island region with a dry climate, continues to face environmental sanitation challenges that have the potential to increase the burden of environmentally related diseases. Objective: This study aims to analyze the impact of the Environmental Health Index (EHI) on the incidence of environmentally related diseases in Matasio and Keoen Villages, Rote Ndao Regency. Methods: This study employed a cross-sectional design with statistical analyses using the Independent t-test and Paired Sample t-test to examine differences among variables influencing environmental health conditions in the two villages. The variables assessed included access to clean water, latrine ownership, wastewater management systems (SPAL), food management practices, solid waste management, vector presence, and indoor air sanitation. Results: The analysis indicated that access to clean water (p < 0.001), latrine ownership (p < 0.001), and wastewater management systems (SPAL) (p = 0.004) had a statistically significant effect on environmental health conditions. Matasio Village showed higher scores than Keoen Village across all three variables. In contrast, food management (p = 0.288), solid waste management (p = 0.129), vector presence (p = 0.914), and indoor air sanitation (p = 0.079) were not significantly associated with environmental health conditions. Conclusion: The Environmental Health Index did not show a significant association with environmentally related diseases in Matasio and Keoen Villages, except for access to clean water. Despite variations in sanitation and water facilities, low community awareness and inconsistent sanitation practices remained key contributors to disease risk. Sustainable sanitation improvement requires not only adequate infrastructure but also systematic, theory-based health promotion strategies to foster sustainable sanitation behaviors. Keywords: environmental health index; health promotion strategies; sustainable sanitation behavior.