Use of Behavior Change Techniques in Clean Cooking Interventions: A Review of the Evidence and Scorecard of Effectiveness

Figures & data

Table 1. Cleaner cooking behavior change technique groupings

Behavior change technique groupings	Description	Example for cleaner cooking sector
Reward and threat	Makes the adoption of behaviors seem attractive or makes the failure to adopt practices seem threatening. It is linked to the concept of “value exchange”, i.e., what desirable outcome would the audience receive for their compliance, or what undesirable outcome would they avoid.	Incentives for households to buy stoves
Shaping knowledge	This helps people to understand what cleaner cooking behaviors are, how to perform them, and where to acquire the technologies and materials needed.	Radio announcements on stove availability
Changing the physical environment	Involves structural changes to the surrounding environment. It also refers to resetting environmental defaults so that a new behavior is easier to sustain due to sympathetic cues and triggers.	Construction of a smoke hood, chimneys and flues
Social support	Involves providing resources and facilitating influence. “Seeding” a new behavior with an trusted person or group helps ensure the new behavior appears desirable and starts to become the norm, leading people to want to emulate and model it.	Community health workers advising on fuel choice
Goals, planning and monitoring	Working with an audience's goals involves unearthing their aspirations, ambitions and intentions, reframing the new behavior as a way of achieving these goals, and then facilitating the audience in realizing their goals through the medium of the new behavior.	Purchasing plans for new stoves
Comparisons	Provides a choice of options and the opportunity for people to compare what is available with those chosen by their peers, neighbors, friends and families.	Making a variety of stove models available
Identity and self-belief	Targets audiences according to their actual or aspirational roles. Gender and other roles determine how we perceive ourselves, how we are perceived, and how we are expected to think and act.Linked to this is the process of increasing people's sense of self-efficacy and building momentum behind a desire to change their behavior	Empowering women to decide on stove choice
Regulation	Regulatory mechanisms include bans and restrictions, or industry standards. They are a measure of enforcement as opposed to persuasion, and can amplify “softer” behavior change techniques.	Restrictions on the use of certain fuel types

Table 2. Literature sources

Academic databases

Gray literature

• EPPI-Centre database of health promotion research (Bibliomap) • Campbell Library • Cochrane Library • MEDLINE (Ovid) • Database of Promoting Health Effectiveness Reviews (DoPHER) • Public Library of Science (PLoS) • PubMed (NIH) • EconLit (EBSCO) • International Encyclopedia of the Social and Behavioral Sciences • Web of Knowledge

• International Initiative for Impact Evaluation (3ie) • Research for Development (DFID) • Ashden Awards for Sustainable Energy • EnDev • Global Alliance on Cleaner Cookstoves (GACC) • Global Village Energy Partnership (GVEP) • HEDON • Partnership for Cleaner Indoor Air • WHO effectiveness review database • Renewable Energy and Energy Efficiency Partnership • USAID • WASHPlus IAP Updates • World Bank Energy Sector Management Assistance Program (ESMAP) • Google Scholar

Fig. 1 PRISMA diagram of search process.

Table 3. Impacts and behavior change techniques identified in literature search (N =  55)

Category	Interventions n (%)
Behavior change techniques
Shaping knowledge	47 (86)
Reward and threat	35 (64)
Social support	35 (64)
Comparisons	16 (29)
Identity and self-belief	15 (28)
Regulation	15 (28)
Changing the physical environment	10 (18)
Goals, planning and monitoring	3 (6)
Impact
Economic	37 (67)
Health	32 (58)
Environmental	20 (36)

Table 4. Case study interventions

Intervention	Lead organization	Behavior change techniques used	Score of behavior change effectiveness	Scorecard of behavior change effectiveness^a	Strength of evidence assessment
Cambodia Fuelwood Saving Program	Geres	Reward and threat Shaping knowledge Social support Comparisons Regulation	77%	1. Behavior focus 1/3 2. Target population 3/3 3. Barriers and benefits 3/3 4. Methods 2/2 5. Capacity Building 2/3 6. Behavior change 1/3 7. Outcomes 3/3 8. Impact 2/2	Geres (2010): Low
China National Improved Stove Program	Ministry of Agriculture	Reward and threat Shaping knowledge Social support Goals, planning and monitoring Regulation	64%	1. Behavior focus 2/3 2. Target population 2/3 3. Barriers and benefits 2/3 4. Methods 2/2 5. Capacity Building 2/3 6. Behavior change 0/3 7. Outcomes 3/3 8. Impact 1/2	Sinton et al. (2004): High Edwards et al. (2007): High
Energising Development Kenya Country Programme	GIZ	Shaping knowledge Change the physical environment Social support Comparisons Goals, planning and monitoring Regulation	86%	1. Behavior focus 3/3 2. Target population 3/3 3. Barriers and benefits 3/3 4. Methods 2/2 5. Capacity Building 3/3 6. Behavior change 0/3 7. Outcomes 3/3 8. Impact 2/2	Reports received from EnDev did not sufficiently outline the evaluations carried out to gain the impact data to allow an assessment of the strength of evidence to be conducted.
India Room to Breathe	Shell Foundation	Shaping knowledge Social support Comparisons Goals planning and monitoring	73%	1. Behavior focus 3/3 2. Target population 3/3 3. Barriers and benefits 3/3 4. Methods 2/2 5. Capacity Building 3/3 6. Behavior change 0/3 7. Outcomes 2/3 8. Impact 0/2	Shell Foundation (2013): Moderate Berkeley Air Monitoring Group (2011): Moderate
Indonesian kerosene to LPG conversion program	Pertamina	Reward and threat Shaping knowledge Change the physical environment Social support Comparisons Regulation	86%	1. Behavior focus 2/3 2. Target population 3/3 3. Barriers and benefits 3/3 4. Methods 2/2 5. Capacity Building 3/3 6. Behavior change 2/3 7. Outcomes 2/3 8. Impact 2/2	Budya & Arofat (2011): Low Wibowo (2013): Low
South Africa Northwest Province Behavior Change Study	University of Witwatersrand	Reward and threat Shaping knowledge Social support Goals, planning and monitoring	80%	1. Behavior focus 3/3 2. Target population 3/3 3. Barriers and benefits 2/3 4. Methods 1/2 5. Capacity Building 3/3 6. Behavior change 2.67/3 7. Outcomes 3/3 8. Impact 0/2	Barnes et al. (2011): High Barnes et al. (2004): High
Strategies for Improved Cookstove Adoption in Rural Uganda	Impact Carbon	Goals planning and monitoring Shaping knowledge Social support Comparisons	82%	1. Behavior focus 3/3 2. Target population 3/3 3. Barriers and benefits 3/3 4. Methods 2/2 5. Capacity Building 2/3 6. Behavior change 3/3 7. Outcomes 2/3 8. Impact 0/2	Levine et al. (2014): High

Note. The case studies are available at http://tulodo.com/2014/09/26/report-behaviour-change-clean-cooking-interventions/.

^aEach question was worth one point for a maximum possible total of 22 points for each intervention, which was then converted to a percentage score for overall behavior change effectiveness.

Fig. 2 Cleaner cooking intervention framework.