Developing Visual Messages to Support Liquefied Petroleum Gas Use in Intervention Homes in the Household Air Pollution Intervention Network (HAPIN) Trial in Rural Guatemala

• Type of Material: Article
• Authors: Mayarí Hengstermann, Universidad del Valle de Guatemala; Anaité Díaz-Artiga, Universidad del Valle de Guatemala; Roberto Otzóy-Sucúc, Universidad del Valle de Guatemala; Ana Laura Maria Ruiz-Aguilar, no affiliation; Lisa M. Thompson, Emory University
• Language: English
• Date: 2021-03-18
• Publisher: Sage Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2021
• Final Published Version (URL): https://doi.org/10.1177/1090198121996280
• Title of Journal or Parent Work: Health Education and Behavior
• Volume: 48
• Issue: 5
• Start Page: 651
• End Page: 669
• Grant/Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study is funded by the U.S. National Institutes of Health (NIH; cooperative agreement 1UM1HL134590) in collaboration with the Bill & Melinda Gates Foundation (OPP1131279). Participating NIH organizations include the National Heart, Lung and Blood Institute, National Institute of Environmental Health Sciences, National Cancer Institute, National Institute of Child Health and Human Development, Fogarty International Center, and the NIH Common Fund.
• Keywords: audiovisual aids; behavioral change communication; household air pollution; health literacy
• Research Categories: Health Sciences, Public Health; Environmental Sciences

Abstract

Background. Household air pollution adversely affects human health and the environment, yet more than 40% of the world still depends on solid cooking fuels. The House Air Pollution Intervention Network (HAPIN) randomized controlled trial is assessing the health effects of a liquefied petroleum gas (LPG) stove and 18-month supply of free fuel in 3,200 households in rural Guatemala, India, Peru, and Rwanda. Aims. We conducted formative research in Guatemala to create visual messages that support the sustained, exclusive use of LPG in HAPIN intervention households. Method. We conducted ethnographic research, including direct observation (n = 36), in-depth (n = 18), and semistructured (n = 6) interviews, and 24 focus group discussions (n = 96) to understand participants’ experience with LPG. Sixty participants were selected from a pilot study of LPG stove and 2-months of free fuel to assess the acceptability and use of LPG. Emergent themes were used to create visual messages based on observations and interviews in 40 households; messages were tested and revised in focus group discussions with 20 households. Results. We identified 50 codes related to household air pollution and stoves; these were reduced into 24 themes relevant to LPG stoves, prioritizing 12 for calendars. Messages addressed fear and reluctance to use LPG; preference of wood stoves for cooking traditional foods; sustainability and accessibility of fuel; association between health outcomes and household air pollution; and the need for inspirational and aspirational messages. Discussion. We created a flip chart and calendar illustrating themes to promote exclusive LPG use in HAPIN intervention households.