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Clean cooking technologies-ranging from efficient cookstoves to clean fuels-are widely deployed to reduce household air pollution and alleviate adverse health and climate consequences. Although much progress has been made on the technical aspects, sustained and proper use of clean cooking technologies by populations with the most need has been problematic. Only by understanding how clean cooking as an intervention is embedded within complex community processes can we ensure its sustained implementation. Using a community-based system dynamics approach, we engaged two rural communities in co-creating a dynamic model to explain the processes influencing the uptake and transition to sustained use of biogas (an anaerobic methane digester), a clean fuel and cooking technology. The two communities provided contrasting cases: one abandoned biogas while the other continues to use it. We present a system dynamics simulation model, associated analyses, and experiments to understand what factors drive transition and sustained use. A central insight of the model is community processes influencing the capacity to solve technical issues. Model analysis shows that families begin to abandon the technology when it takes longer to solve problems. The momentum in the community then shifts from a determination to address issues with the cooking technology toward caution in further adhering to it. We also conducted experiments using the simulation model to understand the impact of interventions aimed at renewing the use of biogas. A combination of theoretical interventions, including repair of non-functioning biogas units and provision of embedded technical support in communities, resulted in a scenario where the community can continue using the technology even after support is retracted. Our study also demonstrates the utility of a systems approach for engaging local stakeholders in delineating complex community processes to derive significant insights into the dynamic feedback mechanisms involved in the sustained use of biogas by the poor.

BackgroundMore than 3 billion of the world’s population are affected by household air pollution from relying on unprocessed solid fuels for heating and cooking. Household air pollution is harmful to human health, climate, and environment. Sustained uptake and use of cleaner cooking technologies and fuels are proposed as solutions to this problem. In this paper, we present our study protocol aimed at understanding multiple interacting feedback mechanisms involved in the dynamic behavior between social, ecological, and technological systems driving sustained use or abandonment of cleaner cooking technologies among the rural poor in India.Methods/DesignThis study uses a comparative case study design to understand the dynamics of sustained use or abandonment of cleaner cooking technologies and fuels in four rural communities of Rajasthan, India. The study adopts a community based system dynamics modeling approach. We describe our approach of using community based system dynamics with rural communities to delineate the feedback mechanisms involved in the uptake and sustainment of clean cooking technologies. We develop a reference mode with communities showing the trend over time of use or abandonment of cleaner cooking technologies and fuels in these communities. Subsequently, the study develops a system dynamics model with communities to understand the complex sub-systems driving the behavior in these communities as reflected in the reference mode. We use group model building techniques to facilitate participation of relevant stakeholders in the four communities and elicit a narrative describing the feedback mechanisms underlying sustained adoption or abandonment of cleaner cooking technologies.DiscussionIn understanding the dynamics of feedback mechanisms in the uptake and exclusive use of cleaner cooking systems, we increase the likelihood of dissemination and implementation of efficacious interventions into everyday settings to improve the health and wellbeing of women and children most affected by household air pollution. The challenge is not confined to developing robust technical solutions to reduce household air pollution and exposure to improve respiratory health, and prevent associated diseases. The bigger challenge is to disseminate and implement cleaner cooking technologies and fuels in the context of various social, behavioral, and economic constraints faced by poor households and communities.Trial registrationThe Institutional Review Board of Washington University in St. Louis has exempted community based system dynamics modeling from review.

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BackgroundImplementing efficient stoves and clean fuels in low and middle-income countries are critical for improving health of poor women and children and improve the environment. Cleaner biomass stoves, however, perform poorly against the World Health Organization’s indoor air quality guidelines. This has shifted the focus to systematic dissemination and implementation of cleaner cooking systems such as liquefied petroleum gas (LPG) among poor communities. Even when there is some uptake of LPG by poor communities, its sustained use has been low. Concurrent use of LPG with traditional biomass cookstoves compromises reductions in household air pollution and limits health and environmental dividends. Therefore understanding key drivers of adoption and sustained implementation of clean fuels among the poor is critical. There is a significant gap, however, in the research to understand determinants and sustained exclusive use of clean fuels in rural poor communities.Methods/designUsing a case control study design, this study will explore the impact of affordability, accessibility, and awareness on adoption and sustained use of LPG among rural poor communities of India. The study uses a multistage random sampling to collect primary data from 510 households. Case group or LPG adopters constitute 255 households while control group or non-LPG adopters constitute the remaining 255 households. The study will deploy sophisticated stove use monitoring sensors in each of the stoves in 100 case group households to monitor stove use and stacking behavior (using clean and traditional systems of cooking) of participants for 12 months. Moreover, this will be the first study to explore the impact of personal social networks striated by gender on LPG adoption. This study is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) implementation science evaluation framework.DiscussionLessons from this study will feed into a larger discussion on developing a pro-poor strategy to foster uptake and sustained use of cleaner cooking systems such as LPG. Understanding the determinants of adoption and sustained use of cleaner cooking systems through the RE-AIM framework will expand our insights on implementation of cleaner cooking systems among poor communities and will advance implementation science in the clean cooking sector. A thorough study of such implementation strategies is crucial to realize multiple UN Sustainable Development Goals on global health, climate change, and energy security.

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