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

Lisa M Thompson, Anaité Diaz-Artiga, John R Weinstein, Margaret A Handley, Lisa M Thompson, Anaité Diaz-Artiga, John R Weinstein, Margaret A Handley

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.

Keywords: Behavior change wheel; Household air pollution; Liquefied petroleum gas stove.

Conflict of interest statement

Ethics approval and consent to participate

We received ethical approval from the Committee for Human Research at the University of California, San Francisco, and from the Guatemalan Ministry of Health. Written consent was obtained after the consent was read to them in their preferred language, either Spanish or Mam.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Eleven categories and 28 themes from thematic analysis of focus group discussions and theoretical domain framework [39] constructs
Fig. 2
Fig. 2
Stove use monitoring of wood and gas stoves during pregnancy and post-partum periods, by hours in use (left panel) and fraction of gas stove use (right panel)

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