Behavioral Reactivity Associated With Electronic Monitoring of Environmental Health Interventions—A Cluster Randomized Trial with Water Filters and Cookstoves

Abstract

Subject reactivity--when research participants change their behavior in response to being observed--has been documented showing the effect of human observers. Electronics sensors are increasingly used to monitor environmental health interventions, but the effect of sensors on behavior has not been assessed. We conducted a cluster randomized controlled trial in Rwanda among 170 households (70 blinded to the presence of the sensor, 100 open) testing whether awareness of an electronic monitor would result in a difference in weekly use of household water filters and improved cookstoves over a four-week surveillance period. A 63% increase in number of uses of the water filter per week between the groups was observed in week 1, an average of 4.4 times in the open group and 2.83 times in the blind group, declining in week 4 to an insignificant 55% difference of 2.82 uses in the open, and 1.93 in the blind. There were no significant differences in the number of stove uses per week between the two groups. For both filters and stoves, use decreased in both groups over four-week installation periods. This study suggests behavioral monitoring should attempt to account for reactivity to awareness of electronic monitors that persists for weeks or more.

Usage and impacts of the Envirofit HM-5000 cookstove

“…However, longer-term SUMs data revealed an increase in cooking on traditional stoves in urban households and an associated decrease in HM-5000 usage following the end of the KPT monitoring period. households is likely to be slightly higher than what was measured during the KPT 15 . Participants in control groups were presumably less likely to overestimate their stove use as a result of the pressure felt to satisfy study evaluators.…”

“…Although the HM‐5000 remained the primary stove in the urban user group after the KPT monitoring period, this notable decline in usage is likely an example of the Hawthorne effect, which describes a reaction by individuals to change their behavior in response to their being observed. Based on the usage monitoring that followed the end of the KPT, traditional stove usage by HM‐5000‐owning households is likely to be slightly higher than what was measured during the KPT. Participants in control groups were presumably less likely to overestimate their stove use as a result of the pressure felt to satisfy study evaluators.…”

Drivers and Barriers to Clean Cooking: A Systematic Literature Review from a Consumer Behavior Perspective

“…Similarly, Jagger and Jumbe (2016) found that willingness to adopt ICS in Malawi was lower among households with a large labor force for fuel collection [70]. However, other studies find that larger families are more likely to adopt ICS [31,37,71]. In this regard, Onyeneke et al (2017) state that cooking for a large family group usually requires more time and fuelwood, so large households tend to adopt more efficient cooking technologies than small households [31].…”

Comparing regional stove‐usage patterns and using those patterns to model indoor air quality impacts

“…[7][8][9][10][11][12] For example, surveys are subject to bias due to recall error and the Hawthorne effect. 12 Direct sensor-based stove-use monitoring may provide an alternative, less biased approach. These studies employ stove-use monitors (SUMs) that measure temperature as a proxy for stove usage.…”