Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

• Type of Material: Article
• Authors: Ashlinn K Quinn, National Institutes of Health, Bethesda; Kendra N Williams, Johns Hopkins University; Lisa Thompson, Emory University; Steven A Harvey, Johns Hopkins Bloomberg Sch Publ Hlth; Ricardo Piedrahita, Berkeley Air Monitoring Group, Fort Collins; Jiantong Wang, Emory University; Casey Quinn, Colorado State University; Ajay Pillarisetti, Emory University; John P McCracken, University of Georgia; Joshua P Rosenthal, National Institutes of Health, Bethesda; Miles A Kirby, Harvard T.H. Chan School of Public Health; Anaité Diaz Artiga, Universidad del Valle de Guatemala; Gurusamy Thangavel, Sri Ramachandra Institute of Higher Education & Research; Ghislaine Rosa, London School of Hygiene & Tropical Medicine; Jaime J Miranda, Universidad Peruana Cayetano Heredia; William Checkley, Johns Hopkins University; Jennifer L Peel, Colorado State University; Thomas Clasen, Emory University
• Language: English
• Date: 2021-12-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph182312592
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
• Volume: 18
• Issue: 23
• Grant/Funding Information: The HAPIN trial is funded by the US National Institutes of Health (cooperative agreement 1UM1HL134590; MPIs: Checkley, Clasen, and Peel) in collaboration with the Bill & Melinda Gates Foundation (OPP1131279). Kendra N. Williams was additionally supported by the NIH Fogarty International Center, NINDS, NIMH, NHBLI, and NIEHS under NIH Research Training Grant D43TW009340, and by the NIH/NHLBI under Award Number T32HL007534. The findings and conclusions in this report are those of the authors, and do not necessarily represent the official position of the US National Institutes of Health or the Department of Health and Human Services. This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation (OPP1131279). Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 generic license has already been assigned to the author accepted manuscript version that might arise from this submission.
• Keywords: Environmental Sciences & Ecology; COOKING; ADOPTION; intervention; Environmental Sciences; adherence; fidelity; Science & Technology; cookstoves; Public, Environmental & Occupational Health; randomized controlled trial; HEALTH; LPG; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Engineering, Mechanical

Abstract

Background: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to a control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through to the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). Results: 1585 women received the intervention at a median (interquartile range) of 8.0 (5.0–15.0) days post-randomization and had a gestational age of 17.9 (15.4–20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of the intervention households. Of the intervention households, 31.4% removed their traditional stoves upon receipt of the intervention; among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). Conclusions: The fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.