J Jaime Miranda, Kyle Steenland, Vanessa Burrowes, Kirk R Smith, Aris Papageorghiou, Abigail Jones, Ghislaine Rosa, Anaité Díaz-Artiga, Gurusamy Thangavel, Kalpana Balakrishnan, Joshua P Rosenthal, Thomas F Clasen, Steven A Harvey, Amit Verma, Kendra N. Williams, Lisa M. Thompson, Zoe Sakas, Mayari Hengstermann, Ashlinn Quinn, Elisa Puzzolo, Jennifer Peel, Vigneswari Aravindalochanan, Dana Boyd Barr, Alejandra Bussalleu, Devan Campbell, Eduardo Canuz, Adly Castañaza, Howard Chang, Yunyun Chen, Marilú Chiang, Maggie L Clark, Rachel Craik, Mary Crocker, Victor Davila-Roman, Lisa de las Fuentes, Oscar De León, Ephrem Dusabimana, Lisa Elon, Juan Gabriel Espinoza, Irma Sayury Pineda Fuentes, Sarada Garg, Dina Goodman, Savannah Gupton, Meghan Hardison, Stella Hartinger, Phabiola M Herrera, Shakir Hossen, Penelope Howards, Lindsay Jaacks, Shirin Jabbarzadeh, Michael A Johnson, Katherine Kearns, Miles Kirby, Jacob Kremer, Margaret A Laws, Pattie Lenzen, Jiawen Liao, Amy E Lovvorn, Fiona Majorin, Eric McCollum, John McCracken, Julia N McPeek, Rachel Meyers, Erick Mollinedo, Lawrence Moulton, Krishnendu Mukhopadhyay, Luke Naeher, Abidan Nambajimana, Durairaj Natesan, Florien Ndagijimana, Azhar Nizam, Jean de Dieu Ntivuguruzwa, Ricardo Piedrahita, Ajay Pillarisetti, Naveen Puttaswamy, Sarah Rajkumar, Usha Ramakrishnan, Rengaraj Ramasami, Davis Reardon, Barry Ryan, Sudhakar Saidam, Sankar Sambandam, Jeremy A Sarnat, Suzanne Simkovich, Sheela S Sinharoy, Damien Swearing, Ashley Toenjes, Lindsay Underhill, Jean Damascene Uwizeyimana, Viviane Valdes, Kayla Valentine, Lance Waller, Megan Warnock, Wenlu Ye, and Bonnie Young
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.Trial registration number NCT02944682, Pre-results.