Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: the multi-country Household Air Pollution Intervention Network (HAPIN) trial.

• Type of Material: Article
• Authors: Kendra N Williams, Johns Hopkins University; Ashlinn Quinn, Berkeley Air Monitoring Group; Hayley North, National Institutes of Health, Bethesda; Jiantong Wang, Emory University; Ajay Pillarisetti, Emory University; Lisa Thompson, Emory University; Anaité Díaz-Artiga, Universidad del Valle de Guatemala; Kalpana Balakrishnan, Sri Ramachandra Institute of Higher Education and Research, Chennai; Gurusamy Thangavel, Sri Ramachandra Institute of Higher Education and Research, Chennai; Ghislaine Rosa, University of Liverpool; Florien Ndagijimana, Eagle Research Center Limited, Kigali; Lindsay J Underhill, Washington University; Miles A Kirby, Harvard University; Elisa Puzzolo, University of Liverpool; Shakir Hossen, Johns Hopkins University; Lance A Waller, Emory University; Jennifer L Peel, Colorado State University; Joshua P Rosenthal, National Institutes of Health, Bethesda; Thomas Clasen, Emory University; Steven A Harvey, Johns Hopkins University; William Checkley, Johns Hopkins University
• Language: English
• Date: 2023-06-27
• Publisher: BMJ
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: This work is licensed under a Creative Commons Attribution 4.0 International License, which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1101/2023.06.20.23291670
• Title of Journal or Parent Work: medRxiv
• Keywords: adherence; clean cooking; liquefied petroleum gas; household air pollution; intervention fidelity; health behavior chang
• Research Categories: Health Sciences, Public Health; Biology, Biostatistics; Health Sciences, Nursing; Health Sciences, Medicine and Surgery; Environmental Sciences

Abstract

BACKGROUND: Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels. METHODS: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n=1,590), with controls expected to continue cooking with biomass fuels (n=1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant's first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs). RESULTS: Fidelity and adherence to the HAPIN intervention were high. Median time required to refill LPG cylinders was 1 day (interquartile range 0-2). Although 26% (n=410) of intervention participants reported running out of LPG at some point, the number of times was low (median: 1 day [Q1, Q3: 1, 2]) and mostly limited to the first four months of the COVID-19 pandemic. Most repairs were completed on the same day as problems were reported. Traditional stove use was observed in only 3% of observation visits, and 89% of these observations were followed up with behavioral reinforcement. According to SUMs data, intervention households used their traditional stove a median of 0.4% of all monitored days, and 81% used the traditional stove <1 day per month. Traditional stove use was slightly higher post-COVID-19 (detected on a median [Q1, Q3] of 0.0% [0.0%, 3.4%] of days) than pre-COVID-19 (0.0% [0.0%, 1.6%] of days). There was no significant difference in intervention adherence pre- and post-birth. CONCLUSION: Free stoves and an unlimited supply of LPG fuel delivered to participating homes combined with timely repairs, behavioral messaging, and comprehensive stove use monitoring contributed to high intervention fidelity and near-exclusive LPG use within the HAPIN trial.