Developing Visual Messages to Support Liquefied Petroleum Gas Use in Intervention Homes in the Household Air Pollution Intervention Network (HAPIN) Trial in Rural Guatemala
Authors: Hengstermann Mayarí , Díaz-Artiga Anaité , Otzóy-Sucúc Roberto , Laura Maria Ruiz-Aguilar Ana , Thompson Lisa M. , Aravindalochanan Vigneswari , Balakrishnan Kalpana , Barr Dana Boyd , Burrowes Vanessa , Campbell Devan , Campbell Julia McPeek , Canuz Eduardo , Castañaza Adly , Chang Howard , Checkley William , Chen Yunyun , Chiang Marilú , Clark Maggie L. , Clasen Thomas , Craik Rachel , Crocker Mary , Davila-Roman Victor , de las Fuentes Lisa , De Léon Oscar , Diaz-Artiga Anaité , Dusabimana Ephrem , Elon Lisa , Espinoza Juan Gabriel , Fuentes Irma Sayury Pineda , Garg Sarada , Goodman Dina , Gupton Savannah , Hardison Meghan , Hartinger Stella , Harvey Steven A. , Hengstermann Mayari , Herrera Phabiola , Hossen Shakir , Howards Penelope , Jaacks Lindsay , Jabbarzadeh Shirin , Johnson Michael A. , Jones Abigail , Kearns Katherine , Kirby Miles , Kremer Jacob , Laws Margaret , Liao Jiawen , Lovvorn Amy , Majorin Fiona , McCollum Eric , McCracken John , Meyers Rachel , Miranda J. Jaime , Mollinedo Erick , Moulton Lawrence , Mukhopadhyay Krishnendu , Naeher Luke , Nambajimana Abidan , Ndagijimana Florien , Nizam Azhar , de Dieu Ntivuguruzwa Jean , Papageorghiou Aris , Peel Jennifer , Piedrahita Ricardo , Pillarisetti Ajay , Puttaswamy Naveen , Puzzolo Elisa , Quinn Ashlinn , Rajkumar Sarah , Ramakrishnan Usha , Reardon Davis , Rosa Ghislaine , Rosenthal Joshua , Ryan P. Barry , Sakas Zoe , Sambandam Sankar , Sarnat Jeremy , Simkovich Suzanne , Sinharoy Sheela , Smith Kirk R. , Steenland Kyle , Swearing Damien , Thangavel Gurusamy , Thompson Lisa M. , Toenjes Ashley , Underhill Lindsay , Uwizeyimana Jean Damascene , Valdes Viviane , Verma Amit , Waller Lance , Warnock Megan , Williams Kendra , Ye Wenlu , Young Bonnie 
Published: March 2021

Background Household air pollution adversely affects human health and the environment, yet more than 40% of the world still depends on solid cooking fuels. The House Air Pollution Intervention Network (HAPIN) randomized controlled trial is assessing the health effects of a liquefied petroleum gas (LPG) stove and 18-month supply of free fuel in 3,200 households in rural Guatemala, India, Peru, and Rwanda. Aims We conducted formative research in Guatemala to create visual messages that support the sustained, exclusive use of LPG in HAPIN intervention households. Method We conducted ethnographic research, including direct observation ( n = 36), in-depth ( n = 18), and semistructured ( n = 6) interviews, and 24 focus group discussions ( n = 96) to understand participants’ experience with LPG. Sixty participants were selected from a pilot study of LPG stove and 2-months of free fuel to assess the acceptability and use of LPG. Emergent themes were used to create visual messages based on observations and interviews in 40 households; messages were tested and revised in focus group discussions with 20 households. Results We identified 50 codes related to household air pollution and stoves; these were reduced into 24 themes relevant to LPG stoves, prioritizing 12 for calendars. Messages addressed fear and reluctance to use LPG; preference of wood stoves for cooking traditional foods; sustainability and accessibility of fuel; association between health outcomes and household air pollution; and the need for inspirational and aspirational messages. Discussion We created a flip chart and calendar illustrating themes to promote exclusive LPG use in HAPIN intervention households.