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

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.

Women’s Perceptions and Attitudes to Household Air Pollution Exposure and Capability to Change Cooking Behaviours in Urban Rwanda

“…In this study women report wanting to pay for LPG in small amounts, which has also been documented with in a recent successful pay-as-you-go LPG pilot study in urban Rwanda [44]. Although barriers included financial capacity and safety concerns, which are previously documented within the literature [16,22,29,43], it is likely that there are multiple interconnected barriers that need to be overcome to enable sustained adoption. In addition, female empowerment, also documented in the literature [45,46], and female cooks [47] are factors of a successful uptake of cleaner cooking, and, therefore, factors that address gender disparities and improve empowerment within the household environment should be considered in future studies [48].…”

“…Qualitative research provides a valuable tool in HAP intervention research, to understand awareness, attitudes and perceptions around biomass cooking and potential interventions, as well as enablers and barriers to change. Both traditional [16][17][18][19] and participatory [20,21] qualitative research methods have previously been used in HAP intervention research, highlighting facilitators of growing awareness of LPG [20], but barriers of cost [19][20][21], safety concerns with LPG [22], and possibly surprisingly a lack of knowledge regarding the long-term reductions in health risks associated with the cleaner fuel interventions [17,20]. A midwife-led behaviour change intervention introduced in health centres in rural Kenya indicated the important role of education in motivating women to change their cooking behaviour and share information within the community [18].…”

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

“…LPG stoves and fuel cylinders were different in each research setting, according to local supply and cooking habits, and informed by formative research on cooking practices in each community [ 14 , 18 ]. Each LPG stove had at least two burners; stoves in Guatemala, Peru, and Rwanda had three burners.…”

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

“…LPG stoves and fuel cylinders were different in each research setting, according to local supply and cooking habits and informed by formative research on cooking practices in each community (Williams et al 2020a, Hengstermann et al 2021. Each LPG stove had at least two burners; stoves in Guatemala, Peru, and Rwanda had three burners.…”