‘Pneumonia has gone’: exploring perceptions of health in a cookstove intervention trial in rural Malawi
Open Access
- 11 October 2021
- journal article
- research article
- Published by BMJ in BMJ Global Health
- Vol. 6 (10), e004596
- https://doi.org/10.1136/bmjgh-2020-004596
Abstract
Introduction Air pollution through cooking on open fires or inefficient cookstoves using biomass fuels has been linked with impaired lung health and with over 4 million premature deaths per annum. However, use of cleaner cookstoves is often sporadic and there are indications that longer-term health benefits are not prioritised by users. There is also limited information about how recipients of cookstoves perceive the health benefits of clean cooking interventions. We therefore conducted a qualitative study alongside the Cooking and Pneumonia Study (CAPS). Methods Qualitative methods and the participatory methodology Photovoice were used in an in-depth examination of health perceptions and understandings of CAPS trial participants. Fifty participants in five CAPS intervention villages collected images about cooking. These were discussed in village-level focus groups and in interviews with 12 representative participants. Village community representatives were also interviewed. Four female and eight male CAPS fieldworkers took part in gender-specific focus groups and two female and two male fieldworkers were interviewed. A thematic content approach was used for data analysis. Results We found a disconnect between locally situated perceptions of health and the biomedically focused trial model. This included the development of potentially harmful understandings such as that pneumonia was no longer a threat and potential confusion between the symptoms of pneumonia and malaria. Study participants perceived health and well-being benefits including: cookstoves saved bodily energy; quick cooking helped maintain family harmony. Conclusion A deeper understanding of narratives of health within CAPS showed how context-specific perceptions of the health benefits of cookstoves were developed. This highlighted the conflicting priorities of cookstove intervention researchers and participants, and unintended and potentially harmful health understandings. The study also emphasises the importance of including qualitative explorations in similar complex interventions where potential pathways to beneficial (and harmful) effects, cannot be completely explicated through biomedical models alone.Funding Information
- Wellcome Trust (MR/K006533/1)
- Department for International Development, UK Government (MR/K006533/1)
- Programme Grants for Applied Research (16/136/35)
- Medical Research Council (MR/K006533/1, MR/L009242/1)
This publication has 43 references indexed in Scilit:
- To Promote Adoption of Household Health Technologies, Think Beyond HealthAmerican Journal of Public Health, 2013
- What can qualitative research do for randomised controlled trials? A systematic mapping reviewBMJ Open, 2013
- Field testing and survey evaluation of household biomass cookstoves in rural sub-Saharan AfricaEnergy for Sustainable Development, 2010
- Photovoice: A Review of the Literature in Health and Public HealthHealth Education & Behavior, 2009
- Modifying Photovoice for community-based participatory Indigenous researchSocial Science & Medicine (1982), 2008
- Where techno-science meets poverty: Medical research and the economy of blood in The Gambia, West AfricaSocial Science & Medicine (1982), 2006
- Using thematic analysis in psychologyQualitative Research in Psychology, 2006
- ‘Even if they ask you to stand by a tree all day, you will have to do it (laughter)…!’: Community voices on the notion and practice of informed consent for biomedical research in developing countriesSocial Science & Medicine (1982), 2005
- Photovoice as a Participatory Health Promotion StrategyHealth Promotion International, 1998
- Empowerment through Photo Novella: Portraits of ParticipationHealth Education Quarterly, 1994