Residents’ perspectives on a community health worker-delivered household air pollution prevention programme pilot in Eldoret, Kenya: a qualitative evaluation

TL;DR

A community health worker program in Kenya improved awareness of household air pollution and clean fuel adoption, but financial barriers remain.

Contribution

The study evaluates a novel community health worker program integrating household air pollution prevention into national training in Kenya.

Findings

Residents reported increased awareness of household air pollution and clean fuels after the program.

Participants suggested solutions like subsidies and tax removal to address financial barriers to clean fuel adoption.

The program influenced Kenya's national strategy for clean fuel access and health policy.

Abstract

Household air pollution (HAP), from the use of polluting fuels for cooking, heating, and lighting, poses significant health and environmental risks, particularly in low-resource settings. The Community Household Air Pollution Prevention Programme (CHAP-PP) integrated a ‘household air pollution, health, and prevention’ module into Kenyan national Community Health Worker training, involving household-based education, awareness-raising, and discussions around air pollution, health, and clean energy.

This evaluation examined residents’ perspectives on the programme, considering impacts on energy use and HAP exposures in the context of wider experiences and providing recommendations for improvement.

This qualitative descriptive study used semi-structured interviews and one focus group discussion with purposively selected household representatives, analysed using reflexive thematic analysis.

Residents welcomed the programme, reporting enhanced knowledge around HAP-related risks, harm mitigation practices (e.g. improved ventilation), and clean fuels. The latter enabled clean fuel adoption for some, but residual challenges remained. Using the COM-B (Capability-Opportunity-Motivation-Behaviour) model we considered how the programme influenced communities’ clean fuel uptake. Participants proposed solutions to financial barriers precluding clean fuel use including subsidies, value-added tax removal, and ‘pay-as-you-go’ schemes for liquefied petroleum gas, some of which have since been implemented.

The CHAP-PP programme was felt to be successful, increasing HAP awareness and supporting harm mitigation and transitions to cleaner cooking. Findings have informed module rollout nationally and contributed to Kenya’s HAP prevention strategy. Ongoing efforts aim to improve affordability and scale clean cooking solutions, with future evaluations planned to assess long-term impacts on energy use and health outcomes.\

Main findings: Household members reported improved awareness of household air pollution, clean fuels, and harm reduction following a novel community health worker-delivered household air pollution prevention programme in Kenya. Motivated to adopt clean fuels, participants identified residual challenges for community members and suggested potential solutions.Added knowledge: The study demonstrates how integrating household air pollution education in national community health worker programmes positively impacts household energy practices and knowledge, with evaluation findings guiding programme improvement.Global health impact for policy and action: The findings support scalable, community-based interventions as a strategy for improving community awareness of environmental determinants of health, such as air pollution and reducing the related health burdens in low-resource settings, and have already influenced Kenyan policy on clean fuel access.

Main findings: Household members reported improved awareness of household air pollution, clean fuels, and harm reduction following a novel community health worker-delivered household air pollution prevention programme in Kenya. Motivated to adopt clean fuels, participants identified residual challenges for community members and suggested potential solutions.

Added knowledge: The study demonstrates how integrating household air pollution education in national community health worker programmes positively impacts household energy practices and knowledge, with evaluation findings guiding programme improvement.

Global health impact for policy and action: The findings support scalable, community-based interventions as a strategy for improving community awareness of environmental determinants of health, such as air pollution and reducing the related health burdens in low-resource settings, and have already influenced Kenyan policy on clean fuel access.

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