Women’s Perceptions and Attitudes to Household Air Pollution Exposure and Capability to Change Cooking Behaviours in Urban Rwanda

Household air pollution (HAP) from cooking on biomass fuel presents significant health, environmental and socioeconomic consequences worldwide. However, there is a lack of understanding of the factors influencing cooking behaviours that affect HAP exposure in Rwanda (e.g., cooking location, removing children from the cooking area). Sixteen qualitative in-depth interviews were undertaken with women living in an underprivileged neighbourhood in Kigali, Rwanda. Deductive thematic analysis was carried out using the Behaviour Change Wheel ( Capability —ability to engage with chosen activity, Opportunity —factors which are beyond the individual’s control and Motivation —brain processes which direct behaviour: COM-B) to determine the thoughts and perceptions around cooking location and removing children from the cooking area. Facilitators and barriers were subsequently identified within the COM-B framework for the following HAP mitigation interventions: outdoor cooking, removing children from the cooking area and Liquid Petroleum Gas (LPG) use. Of the 16 interviewed, 12 cooked outdoors (75%), two (12.5%) cooked indoors (in the main home) and two (12.5%) in a separate kitchen. Despite the majority cooking outdoors, this was reported not to be a favourable cooking location. Levels of awareness of HAP sources and knowledge of the health effects of air pollution were observed to be limited, reducing women’s capability to change, along with stated barriers of cost, housing constraints and safety. Factors out of the individuals’ control (opportunities) included weather, socio-economic and educational factors. Preconceived beliefs, experiencing smoke reduction and the briefly described short-term health effects, directed motivation. Furthermore, participants identified a need for community-based education as a facilitator to changing their behaviour. Despite a high level of observed motivation towards reducing HAP exposure, many women lacked the capability and opportunity to change their behaviour. There are research and policy implications concerning development of community-based interventions which involved end-users and relevant stakeholders in the development process.