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Habtamu D, Abebe B, Seid T. Health risk perceptions of household air pollution and perceived benefits of improved stoves among pregnant women in rural Ethiopia: a mixed method study. BMJ Open 2023; 13:e072328. [PMID: 37648392 PMCID: PMC10471873 DOI: 10.1136/bmjopen-2023-072328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Since community perceptions of the risk of biomass smoke and the benefits of improved stoves play a critical role in behaviour change to the uptake and sustainable utilisation of improved stoves, we aimed to assess the level of health risk perception on kitchen smoke and benefits of using improved stoves among pregnant women. DESIGN A community-based cross-sectional mixed method study. SETTING In six kebeles of a low-income rural community of South Gondar Zone, Northwestern Ethiopia. PARTICIPANTS All 455 households with pregnant women aged 18-38 years, in their first-trimester or second-trimester gestation, exclusively use traditional biomass-fuelled or locally modified mud stoves, and the primary cook in her household were included. But completed data were obtained only from 422 households. RESULT From 422 completed data, more than half, 63% (95% CI 58% to 68%) had high-level health risk perception of household air pollution, and nearly three-fourths, 74% (95% CI 70% to 79%) of the respondents perceived that using improved stove had benefits for their families. Participants in the 32-38 years age group, rich in asset index, presence of under-five children, being a member of any women group and large family size were positively associated with high-level health risk perception. Whereas respondents in the 18-24 years age group, presence of under-five children, husbands of primary or higher education, high health risk perception and not happy with the current stove were positively associated with perceived benefits of using an improved stove. CONCLUSION The observed level of health risk perception of biomass smoke and the benefits of using improved stoves may help to adopt effective intervention measures. This study also suggests that for successful intervention, clean cooking programmes and policies must consider many local factors influencing health risk perception and benefits of using improved stoves. TRIAL REGISTRATION NUMBER ACTR202111534227089.
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Affiliation(s)
| | - Beyene Abebe
- Department of Environmental Health Science and Technology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Tiku Seid
- Department of Environmental Health Science and Technology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
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Okello G, Nantanda R, Awokola B, Thondoo M, Okure D, Tatah L, Bainomugisha E, Oni T. Air quality management strategies in Africa: A scoping review of the content, context, co-benefits and unintended consequences. ENVIRONMENT INTERNATIONAL 2023; 171:107709. [PMID: 36580733 DOI: 10.1016/j.envint.2022.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
One of the major consequences of Africa's rapid urbanisation is the worsening air pollution, especially in urban centres. However, existing societal challenges such as recovery from the COVID-19 pandemic, poverty, intensifying effects of climate change are making prioritisation of addressing air pollution harder. We undertook a scoping review of strategies developed and/or implemented in Africa to provide a repository to stakeholders as a reference that could be applied for various local contexts. The review includes strategies assessed for effectiveness in improving air quality and/or health outcomes, co-benefits of the strategies, potential collaborators, and pitfalls. An international multidisciplinary team convened to develop well-considered research themes and scope from a contextual lens relevant to the African continent. From the initial 18,684 search returns, additional 43 returns through reference chaining, contacting topic experts and policy makers, 65 studies and reports were included for final analysis. Three main strategy categories obtained from the review included technology (75%), policy (20%) and education/behavioural change (5%). Most strategies (83%) predominantly focused on household air pollution compared to outdoor air pollution (17%) yet the latter is increasing due to urbanisation. Mobility strategies were only 6% compared to household energy strategies (88%) yet motorised mobility has rapidly increased over recent decades. A cost effective way to tackle air pollution in African cities given the competing priorities could be by leveraging and adopting implemented strategies, collaborating with actors involved whilst considering local contextual factors. Lessons and best practices from early adopters/implementers can go a long way in identifying opportunities and mitigating potential barriers related to the air quality management strategies hence saving time on trying to "reinvent the wheel" and prevent pitfalls. We suggest collaboration of various stakeholders, such as policy makers, academia, businesses and communities in order to formulate strategies that are suitable and practical to various local contexts.
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Affiliation(s)
- Gabriel Okello
- Institute for Sustainability Leadership, University of Cambridge, Cambridge, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom; AirQo, Department of Computer Science, Makerere University, Kampala, Uganda.
| | | | - Babatunde Awokola
- Department of Clinical Services, Medical Research Council Gambia at London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Meelan Thondoo
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Deo Okure
- AirQo, Department of Computer Science, Makerere University, Kampala, Uganda
| | - Lambed Tatah
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Use of a Practitioner-Friendly Behavior Model to Identify Factors Associated with COVID-19 Vaccination and Other Behaviors. Vaccines (Basel) 2022; 10:vaccines10081261. [PMID: 36016149 PMCID: PMC9414643 DOI: 10.3390/vaccines10081261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
The lack of capacity for the design and implementation of behavioral interventions in low-and-middle income countries (LMICs) has been recognized by the World Health Organization (WHO) and other global health institutions. There is a need to task-shift, to translate social and behavioral science concepts into "practitioner-friendly" models-models which can be used by intervention designers, implementers, and evaluators with limited technical and financial resources. We illustrate the use of the Fogg Behavior Model (FBM), a model identified as being easy for practitioners to adopt in low-resource settings. The study uses data across four different behaviors in Nigeria, Pakistan, and India. The behaviors examined are COVID-19 vaccine uptake, condom use, iron folate use, and modern contraceptive use. The data are from surveys of healthcare workers (HCWs), married men, women of reproductive age, and adolescents, respectively. The FBM states that behavior happens when both motivation and ability are present, and a prompt occurs. In other words, persons with high motivation and high ability are the first to adopt a behavior. We created a categorical variable for motivation and ability and tested whether high motivation and high ability are associated with a greater likelihood of adopting a behavior. In Nigeria, HCWs with high motivation and high ability had 27 times higher odds of being vaccinated. In Pakistan, married men with high motivation and high ability had 35 times higher odds of condom use with their wives. In India, women with high motivation and high ability had 9 times higher odds of iron folate use. In Nigeria, adolescents and young women with high motivation and high ability had 8 times higher odds of contraceptive use. The study findings suggest that the FBM has the potential to be applied in low resource settings for the design, implementation, and evaluation of behavioral interventions. Rigorous testing of the FBM using data from experimental or quasi-experimental studies is recommended.
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Das DK, Islam MS, Dutta CB, Hassan MM, Hossen SS. Is there any demand for improved cooking stoves? Evidence from Bangladesh. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 298:113412. [PMID: 34364247 DOI: 10.1016/j.jenvman.2021.113412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Despite the multifarious benefits of improved cooking stoves (ICSs) over traditional biomass stoves, the ICSs adoption rate in rural Bangladesh remains nominal. This paper provides evidence that there is a growing demand for this environmentally friendly and less-hazardous stove. Using a discrete choice experiment (DCE) technique, we surveyed 259 sample households in the south-western region of Bangladesh. The results from the mixed logit model suggest that households are willing to pay (WTP) about $7 on average for a 'realistic' (i.e., one unit or 25 %) reduction in fuel consumption and smoke emission. Moreover, we found that a one-unit (33 %) reduction of cooking time and maintenance frequency increases households' WTP by about $3 and $5 respectively. Finally, this study underscores that extensive promotion, lower installation costs and higher social awareness about health risks and environmental degradation are likely to promote ICSs adoption.
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Affiliation(s)
- Debasish Kumar Das
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh; Arndt-Corden Department of Economics, Crawford School of Public Policy, Australian National University, Canberra, ACT, 2601, Australia; Energy Change Institute, Australian National University, Canberra, ACT, 2601, Australia.
| | - Md Sariful Islam
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Champa Bati Dutta
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh; School of Business, University of New South Wales, Australia
| | - Md Mehedi Hassan
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh
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Campbell CA, Bartington SE, Woolley KE, Pope FD, Thomas GN, Singh A, Avis WR, Tumwizere PR, Uwanyirigira C, Abimana P, Kabera T. Investigating Cooking Activity Patterns and Perceptions of Air Quality Interventions among Women in Urban Rwanda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5984. [PMID: 34199593 PMCID: PMC8199661 DOI: 10.3390/ijerph18115984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/03/2022]
Abstract
Household air pollution (HAP) from biomass cooking with traditional stoves is a major cause of morbidity and mortality in low-and-middle-income countries (LMICs) worldwide. Air quality interventions such as improved cookstoves (ICS) may mitigate HAP-related impacts; however, poor understanding of contextual socio-cultural factors such as local cooking practices have limited their widespread adoption. Policymakers and stakeholders require an understanding of local cooking practices to inform effective HAP interventions which meet end-user needs. A semi-structured questionnaire was administered to 36 women residing in biomass-cooking fuel households in Kigali, Rwanda to identify cooking activity patterns, awareness of HAP-related health risks and ICS intervention preferences. Overall, 94% of respondents exclusively used charcoal cooking fuel and 53% cooked one meal each day (range = 1-3 meals). Women were significantly more likely to cook outdoors compared to indoors (64% vs. 36%; p < 0.05). Over half of respondents (53%) were unaware of HAP-related health risks and 64% had no prior awareness of ICS. Participants expressed preferences for stove mobility (89%) and facility for multiple pans (53%) within an ICS intervention. Our findings highlight the need for HAP interventions to be flexible to suit a range of cooking patterns and preferred features for end-users in this context.
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Affiliation(s)
- Catherine A. Campbell
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
- NHS Lothian, Waverly Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK
| | - Suzanne E. Bartington
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (K.E.W.); (G.N.T.)
| | - Katherine E. Woolley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (K.E.W.); (G.N.T.)
| | - Francis D. Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (F.D.P.); (A.S.)
| | - Graham Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (K.E.W.); (G.N.T.)
| | - Ajit Singh
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (F.D.P.); (A.S.)
| | - William R. Avis
- International Development, School of Government, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - Patrick R. Tumwizere
- College of Science and Technology, University of Rwanda, Avenue de l’Armee, Kigali P.O. Box 3900, Rwanda; (P.R.T.); (C.U.); (P.A.); (T.K.)
| | - Clement Uwanyirigira
- College of Science and Technology, University of Rwanda, Avenue de l’Armee, Kigali P.O. Box 3900, Rwanda; (P.R.T.); (C.U.); (P.A.); (T.K.)
| | - Pacifique Abimana
- College of Science and Technology, University of Rwanda, Avenue de l’Armee, Kigali P.O. Box 3900, Rwanda; (P.R.T.); (C.U.); (P.A.); (T.K.)
| | - Telesphore Kabera
- College of Science and Technology, University of Rwanda, Avenue de l’Armee, Kigali P.O. Box 3900, Rwanda; (P.R.T.); (C.U.); (P.A.); (T.K.)
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Sesan T, Jewitt S, Clifford M, Ray C. Toilet training: what can the cookstove sector learn from improved sanitation promotion? INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2018; 28:667-682. [PMID: 30068235 DOI: 10.1080/09603123.2018.1503235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Within the domain of public health, commonalities exist between the sanitation and cookstove sectors. Despite these commonalities and the grounds established for cross-learning between both sectors, however, there has not been much evidence of knowledge exchange across them to date. Our paper frames this as a missed opportunity for the cookstove sector, given the capacity for user-centred innovation and multi-scale approaches demonstrated in the sanitation sector. The paper highlights points of convergence and divergence in the approaches used in both sectors, with particular focus on behaviour change approaches that go beyond the level of the individual. The analysis highlights the importance of the enabling environment, community-focused approaches and locally specific contextual factors in promoting behavioural change in the sanitation sector. Our paper makes a case for the application of such approaches to cookstove interventions, especially in light of their ability to drive sustained change by matching demand-side motivations with supply-side opportunities. Abbreviation: DALY: Disability-adjusted life year; CHC: Community Health Club; CLTS: Community-Led Total Sanitation; HAP: Household air pollution; BM-WASH: Integrated Behavioural Model for Water, Sanitation and Hygiene; ICS: Improved cookstove; LPG: Liquefied petroleum gas; NBA: Nirmal Bharat Abhiyan; NGO: Non:governmental organisation; OD: Open defecation; ODF: Open defecation free; HAST: Participatory Hygiene and Sanitation Transformation; RANAS: Risks, Attitudes, Norms, Abilities and Self-regulation RCT: Randomised controlled trial; (Sani) FOAM: Focus, Opportunity, Ability and Motivation; SBM: Swachh Bharat Mission; TSC: Total Sanitation Campaign; WASH: Water, Sanitation and Hygiene.
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Affiliation(s)
- Temilade Sesan
- a Centre for Petroleum, Energy Economics and Law , University of Ibadan , Oyo State , Nigeria
| | - Sarah Jewitt
- b School of Geography , University of Nottingham , UK
| | - Mike Clifford
- c Faculty of Engineering , University of Nottingham , UK
| | - Charlotte Ray
- c Faculty of Engineering , University of Nottingham , UK
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Drivers and Barriers to Clean Cooking: A Systematic Literature Review from a Consumer Behavior Perspective. SUSTAINABILITY 2018. [DOI: 10.3390/su10114322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A lack of access to clean energy and use of traditional cooking systems have severe negative effects on health, especially among women and children, and on the environment. Despite increasing attention toward this topic, few studies have explored the factors influencing consumers’ adoption of improved cooking stoves (ICS). This systematic literature review (n = 81) aims to identify the main drivers and barriers to clean cooking from a consumer perspective. In addition, it aims to define how consumers perceive ICS with respect to traditional stoves. Thematic analysis revealed seven factors that may act as drivers or barriers to ICS adoption: economic factors; socio-demographics; fuel availability; attitude toward technology; awareness of the risks of traditional cookstoves and the benefits of ICS; location; and social and cultural influences. Perceptions focused on four topics: convenience and uses, aesthetics, health-related impacts, and environmental impacts. This review contributes to understanding of consumer behavior with regards to ICS. The findings suggest that availability and affordability of technology are not enough to enhance ICS adoption. Rather, policy makers and managers should approach customers with a less technical and a more personalized approach that takes due consideration of a local context and its social and cultural dynamics.
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Tamire M, Addissie A, Skovbjerg S, Andersson R, Lärstad M. Socio-Cultural Reasons and Community Perceptions Regarding Indoor Cooking Using Biomass Fuel and Traditional Stoves in Rural Ethiopia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092035. [PMID: 30231480 PMCID: PMC6164706 DOI: 10.3390/ijerph15092035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/24/2022]
Abstract
Around three billion people in the world and 90% of the rural households in low-and middle-income countries are exposed to wood smoke with varying exposure levels and resulting health risks. We aimed to explore perceptions of the community towards indoor cooking and the socio-cultural barriers to bring change in Butajira, rural Ethiopia. We conducted a qualitative study involving ten separate focus group discussions with purposively selected members of the community and two key informant interviews with health extension workers. Content analysis was carried out using ATLAS.ti software. Participants reported the use of fuel wood and traditional three-stone cook stove to cook food. Economic status, lack of commitment, cultural views and concern along with safety and security issues were found to be barriers to change from traditional to cleaner methods of cooking. The community perceived wood smoke to have effects on their eyes and respiratory health, though they culturally viewed it as beneficial for postpartum mothers and newborns, avoiding bad smell and insects and in order to strengthen the fabric of their houses. Health education at community level is essential in order to bring about change in the cultural views and cooking behaviors focusing on opening windows and keeping young children away during cooking.
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Affiliation(s)
- Mulugeta Tamire
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 366 Code 1029, Ethiopia.
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, 41390 Gothenburg, Sweden.
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 366 Code 1029, Ethiopia.
| | - Susann Skovbjerg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, SE 41346 Gothenburg, Sweden.
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, SE 41346 Gothenburg, Sweden.
| | - Mona Lärstad
- Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, 41390 Gothenburg, Sweden.
- Department of Respiratory Medicine and Allergology, Institute of Medicine, Sahlgrenska University Hospital, SE 41390 Gothenburg, Sweden.
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Thompson LM, Diaz-Artiga A, Weinstein JR, Handley MA. Designing a behavioral intervention using the COM-B model and the theoretical domains framework to promote gas stove use in rural Guatemala: a formative research study. BMC Public Health 2018; 18:253. [PMID: 29444650 PMCID: PMC5813324 DOI: 10.1186/s12889-018-5138-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 02/01/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Three billion people use solid cooking fuels, and 4 million people die from household air pollution annually. Shifting households to clean fuels, like liquefied petroleum gas (LPG), may protect health only if stoves are consistently used. Few studies have used an implementation science framework to systematically assess "de-implementation" of traditional stoves, and none have done so with pregnant women who are more likely to adopt new behaviors. We evaluated an introduced LPG stove coupled with a phased behavioral intervention to encourage exclusive gas stove use among pregnant women in rural Guatemala. METHODS We enrolled 50 women at < 20 weeks gestation in this prospective cohort study. All women received a free 3-burner LPG stove and ten tank refills. We conducted formative research using COM-B Model and Theoretical Domains Framework (TDF). This included thematic analysis of focus group findings and classes delivered to 25 pregnant women (Phase 1). In Phase 2, we complemented classes with a home-based tailored behavioral intervention with a different group of 25 pregnant women. We mapped 35 TDF constructs onto survey questions. To evaluate stove use, we placed temperature sensors on wood and gas stoves and estimated fraction of stove use three times during pregnancy and twice during the first month after infant birth. RESULTS Class attendance rates were above 92%. We discussed feasible ways to reduce HAP exposure, proper stove use, maintenance and safety. We addressed food preferences, ease of cooking and time savings through cooking demonstrations. In Phase 2, the COM-B framework revealed that other household members needed to be involved if the gas stove was to be consistently used. Social identity and empowerment were key in decisions about stove repairs and LPG tank refills. The seven intervention functions included training, education, persuasion, incentivization, modelling, enablement and environmental restructuring. Wood stove use dropped upon introduction of the gas stove from 6.4 h to 1.9 h. CONCLUSIONS This is the first study using the COM-B Model to develop a behavioral intervention that promotes household-level sustained use of LPG stoves. This study lays the groundwork for a future LPG stove intervention trial coupled with a behavioral change intervention. TRIAL REGISTRATION NCT02812914, registered 3 June 2016, retrospectively registered.
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Affiliation(s)
- Lisa M. Thompson
- University of California, San Francisco, San Francisco, California USA
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Suite 226, Atlanta, GA 30322 USA
| | - Anaité Diaz-Artiga
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala, Guatemala
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