Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial

• Authors: Kendra N. Williams, Johns Hopkins School of Medicine; Lisa Thompson, Emory University; Zoe Sakas, London School of Hygiene & Tropical Medicine; Mayari Hengstermann, Universidad del Valle de Guatemala; Ashlinn Quinn, National Institutes of Health; Anaite Diaz-Artiga, Universidad del Valle de Guatemala; Gurusamy Thangavel, Sri Ramachandra Institute of Higher Education & Research; Elisa Puzzolo, University of Liverpool; Ghislaine Rosa, London School of Hygiene & Tropical Medicine; Kalpana Balakrishnan, Sri Ramachandra Institute of Higher Education & Research; Jennifer Peel, Colorado School of Public Health; William Checkley, Johns Hopkins School of Medicine; Thomas Clasen, Emory University; J. Jaime Miranda, Universidad Peruana Cayetano Heredia; Joshua P. Rosenthal, National Institutes of Health; Steven A. Harvey, Johns Hopkins University
• Journal Title: BMJ OPEN
• Volume: Volume 10, Number 9
• Publisher: BMJ PUBLISHING GROUP | 2020-01-01, Pages e037761-e037761
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/bmjopen-2020-037761
• Subjects: Health Sciences, Public Health; Health Sciences, Nutrition; Engineering, Environmental
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; public health; qualitative research; community child health; COOKSTOVE INTERVENTION; CLEAN FUELS; COOKING; ADOPTION; HEALTH; PNEUMONIA; BARRIERS; IMPACT

Abstract

Introduction Increasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda. Methods Using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial. Results We identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits. Conclusion Our formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies.