Adoption and sustained use of cleaner cooking fuels in rural India: a case control study protocol to understand household, network, and organizational drivers

Abstract

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.

Adapting and Operationalizing the RE-AIM Framework for Implementation Science in Environmental Health: Clean Fuel Cooking Programs in Low Resource Countries

“…Adoption, in the context of clean-fuel cooking, presents a different problem since the term "adoption" is widely used in this field to refer to individual-level initial uptake of a new cooking technology, e.g., (2,16,(33)(34)(35). This conflicts with the RE-AIM definition of adoption situated at the organizational and setting level.…”

Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

“…While a positive association between household SES and use of clean cooking fuels has held [32,33,[35][36][37][38][39], the energy ladder hypothesis has been updated to a 'multiple fuel' model [40], encompassing both primary and secondary fuel use and the role of forces outside the household in the clean energy transition [41,42]. More recently, numerous frameworks have been used to address patterns of household fuel use [43][44][45][46][47][48] and larger-scale, nation-wide interventions (subsidies, regulations) have been implemented to change household clean energy decisions [41,49]. Despite the collective effort of various stakeholders, a global lag in uptake of clean cooking fuels suggests that existing policies/interventions may be too narrowly focused to promote clean cooking fuel switching [45,50,51].…”

Dissemination Challenges of Liquefied Petroleum Gas in Rural India: Perspectives from the Field

“…These aspects of energy transition require contextualized solutions and strategies [42]. Subsidies to incentivize technology adoption do not always improve uptake or quality of services because of the emphasis on cost reduction and as such, they remain a contentious policy mechanism [5,32] that gives rise to disputes between consumers and distributors. Further, awareness campaigns on negative health impacts of fuelwood usage are beneficial but must go hand in hand with the removal of economic barriers to clean technology.…”

“…This qualitative analysis is part of a larger case-control study aimed at developing long-term, pro-poor strategies to promote adoption and sustained use of clean cooking technology in rural India [32]. The current study examines strategies employed by suppliers to increase LPG uptake and adds to discussion on enablers and obstacles to LPG dissemination from the perspective of suppliers and dissemination workforce.…”

“…Qualitative researchers have deemed 16 or fewer interviews to be adequate for theme identification in homogenous groups while 20-40 are considered more suitable for heterogenous groups [33]. The dissemination personnel interviewed for this study service the geographical area where the case-control study is currently being conducted and represented a relatively homogenous group [32]. Interviews were carried out in March 2018 in collaboration with Foundation for Ecological Security (FES), an Indian organization working on social-ecological projects across India for over two decades.…”