The evaluation of a behavioural intervention to reduce the impact of indoor air pollution on child respiratory health
Date
2008-07-15T07:11:47Z
Authors
Barnes, Russel Brendon
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Abstract
ABSTRACT
Indoor air pollution has been associated with acute lower respiratory infections
amongst children less than five years old in developing countries. Very little is known
about the potential role of behavioural change in reducing child indoor air pollution
exposure. This thesis explores three questions: did people change their behaviours
following exposure to an intervention that promoted the health benefits of behavioural
change? Were changes in behaviour attributable to the intervention? What were the
motivations and barriers to behavioural change? The evaluation included a
quantitative and a qualitative study. The quantitative study utilised a quasiexperimental
before-after design amongst an intervention village (n=98 households).
Results were compared to a similar control village (n=121) that did not receive the
intervention. Baseline data were collected during winter 2003 and follow-up data
were collected during winter 2004 (12 months later). A qualitative evaluation, using
two rounds of 4 focus group interviews each, was used to answer questions that emerged from the quantitative study. Indoor air quality - PM10, CO and CO (measured
on the youngest child) - were measured over a 24 hour period in randomly selected
households before and after the intervention in the intervention (n=36) and control
(n=38) groups. After adjusting for confounding factors, there was no statistical
association between having the received the intervention and the likelihood of burning
outdoors at follow-up (OR=1.16; 95% CI 0.6-1.8). Indoor air quality data showed
significant median reductions in PM10 (94-96%), CO (85-97%) and CO (child) (83-
95%) amongst households that burned outdoors compared to those that burned
indoors. Results from the qualitative study suggest that motivations for outdoor
burning included: health considerations, reaction to participating in the study, reduced
drudgery and prestige. Barriers to outdoor burning included the need for space heating during winter, perceptions of low indoor air pollution risk and gender relations. This
study highlights the potential for exposure reduction through behavioural change and
is original for three reasons. It is the first behavioural intervention study designed to
reduce indoor air pollution in a rural African setting. Secondly, it is the first
intervention study in the indoor air pollution field to identify the factors that
influenced behavioural change. Thirdly, it is one of the first studies to align debates
about behavioural change in the field of indoor air pollution with those in the broader
environmental health promotion literature.
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Keywords
indoor air pollution, behavioural intervention, developing countries