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Arch Public Health. 2017 Dec 14;75:70. doi: 10.1186/s13690-017-0244-2. eCollection 2017.

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

Author information

Boston College School of Social Work, Boston College, 125 McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA.
Department of Neurology, Harvard Medical School/Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA.
Network Science Institute, Northeastern University, 177 Huntington Street, Boston, MA 02115 USA.
Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130 USA.
Boston College School of Social Work, McGuinn Hall 132, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA.



Implementing 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.


Using 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.


Lessons 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.


Adoption; Cleaner cooking systems; Gender-based networks; Implementation science; Implementation strategies; LPG; Re-aim; Stove Use Monitoring Systems; Sustained use

Conflict of interest statement

The Institutional Review Board (IRB) at Washington University in St. Louis (WUSTL) has approved this study and all study procedures (IRB # 201608013). Ethical and cultural approvals were sought and obtained from the IRB at Washington University in St. Louis. Recruitment and data collection for this study began in September of 2016.Using the WUSTL IRB committee’s approved consent forms, the consent for publication was sought and obtained from the study participants. To help protect the confidentiality of study particpants, their identitiy will not be revealed for any publication resulting from this study. If we share the study dataset with others, we will do so in such a way that the study particpants cannot be directly identified.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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