P3 Ghana Cookstove Study (P3)

Prices, Peers, and Perceptions: Field Experiments on Technology Adoption in the Context of Improved Cookstoves

Background:

Despite their potential health and social benefits, adoption and use of improved cookstoves has been low throughout much of the world. Explanations for low adoption rates of these technologies include prices that are not affordable for the target populations, limited opportunities for households to learn about cookstoves through peers, and perceptions that these technologies are not appropriate for local cooking needs. The P3 project employs a novel experimental design to explore each of these factors and their interactive effects on cookstove demand, adoption, use and exposure outcomes.

Methods:

The P3 study is being conducted in the Kassena-Nankana Districts of Northern Ghana. Leveraging an earlier improved cookstove study that was conducted in this area, the central design of the P3 biomass stove experiment involves offering stoves at randomly varying prices to peers and non-peers of households that had previously received stoves for free. Using household surveys, electronic stove use monitors, and low-cost, portable monitoring equipment, we measure how prices and peers' experience affect perceptions of stove quality, the decision to purchase a stove, use of improved and traditional stoves over time, and personal exposure to air pollutants from the stoves.

Discussion:

The challenges that public health and development communities have faced in spreading adoption of potentially welfare-enhancing technologies, like improved cookstoves, have highlighted the need for interdisciplinary, multisectoral approaches. The design of the P3 project draws on economic theory, public health practice, engineering, and environmental sciences, to more fully grasp the drivers and barriers to expanding access to and uptake of cleaner stoves. Our partnership between academic institutions, in the US and Ghana, and a local environmental non-governmental organization creates unique opportunities to disseminate and scale up lessons learned.

Study Overview

• Status: Completed
• Conditions: Household Air Pollution; Behavior, Social
• Intervention / Treatment: Behavioral: P3 Bio Intervention

• Study Type: Interventional
• Enrollment (Actual): 300
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 55 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Classified as "rural"
• Uses biofuel as main cooking fuel source
• Has women in household aged 18-55 and at least one child under five

Exclusion Criteria:

• Clusters that are close to the S1 clusters, creating a set of clusters far enough from the original R group that will create the S2 cluster.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: S1 (Peer) group; S1 group households located in 25 clusters that were included in a prior cookstove study: selected households are nearest neighbors (peers) of households who received free stoves in that prior study. This group is used to represent a potentially high peer influence on the adoption of improved cookstoves. The P3 Bio Intervention is implemented in this group.	Behavioral: P3 Bio Intervention; Two types of improved biomass burning cookstoves (ACE1 and Greenway Jumbo) are offered to participants in both arms at varying prices.
Experimental: S2 (Non-Peer) Group; S2 group households are located in 25 clusters randomly selected from the area of the K-N Districts more than 1 km from the S1 clusters. This group will have minimal prior knowledge of the cookstoves through peers. The P3 Bio Intervention is implemented in this group.	Behavioral: P3 Bio Intervention; Two types of improved biomass burning cookstoves (ACE1 and Greenway Jumbo) are offered to participants in both arms at varying prices.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stove Purchases | Number of households that order stoves and complete payments	Number of households in each arm that place orders for and subsequently complete all payments on the two types of stoves.	up to 13 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cooking Behaviors | Household use of both traditional and improved cookstoves over time	Use of traditional and improved stoves over time across intervention arms.	up to 13 months
Perceptions of Stove Quality | Smoke production, efficiency, ease of use, quality of food, etc.	Likert-scale and subjective expectation questions measuring perceptions of stove quality / performance for both stove types along multiple dimensions. Example scale question: "How much smoke do you think the ACE1 stove would produce?" Response options: 1 = A lot less smoke than a 3 stone fire, 2 = A little less smoke than a 3 stone fire; 3 = About the same amount of smoke as a 3 stone fire; 4 = A little more smoke than a 3 stone fire; 5 = A lot more smoke than a 3 stone fire; 99 = Don't know / not sure.	up to 13 months
Exposure to CO and PM 2.5	Kitchen concentrations of and personal exposure to carbon monoxide (CO) and particular matter (PM2.5) among study participants	up to 13 months

Collaborators and Investigators

• Sponsor: University of Colorado, Denver
• Collaborators: National Institutes of Health (NIH); University of Colorado, Boulder; U.S. National Science Foundation; North Carolina State University; Navrongo Health Research Centre, Ghana
• Investigators: Principal Investigator: Katherine L Dickinson, PhD, Unviersity of Colorado, Aurora

Publications and helpful links

General Publications

• Dickinson KL, Dalaba M, Brown ZS, Alirigia R, Coffey ER, Mesenbring E, Achazanaga M, Agao D, Ali M, Kanyomse E, Awaregya J, Adagenera CA, Aburiya JBA, Gubilla B, Oduro AR, Hannigan MP. Prices, peers, and perceptions (P3): study protocol for improved biomass cookstove project in northern Ghana. BMC Public Health. 2018 Oct 29;18(1):1209. doi: 10.1186/s12889-018-6116-z.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2015
• Primary Completion (Actual): April 1, 2019
• Study Completion (Actual): December 31, 2021

Study Registration Dates

• First Submitted: July 3, 2018
• First Submitted That Met QC Criteria: July 31, 2018
• First Posted (Actual): August 7, 2018

Study Record Updates

• Last Update Posted (Actual): August 15, 2023
• Last Update Submitted That Met QC Criteria: August 14, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: Behavior Change; Global Health; Cookstoves; Household Air Pollution
• Other Study ID Numbers: 15-0359; SES 1528811 (Other Grant/Funding Number: NSF)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Survey Data; Personal exposure, proximity, and air quality data; and short term stove use and proximity data will have team access only to full data set with identifiers. De-identified data will be open access with registration and a statement of interest. Stove use data will be open access with registration and a statement of interest.
• IPD Sharing Time Frame: The results will be submitted for publication immediately after a sufficient level of analytical detail has been achieved through experiments and data analysis.
• IPD Sharing Access Criteria: No fee will be charged for access to the data other than applicable publication subscription fees charged by peer-reviewed journals or proceedings copy fees charged by conferences. The data will be open to wider use at the time of publication.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No