Drivers of the Adoption and Exclusive Use of Clean Fuel for Cooking in Sub-Saharan Africa: Learnings and Policy Considerations from Cameroon

Household air pollution (HAP) caused by the combustion of solid fuels for cooking and heating is responsible for almost 5% of the global burden of disease. In response, the World Health Organisation (WHO) has recommended the urgent need to scale the adoption of clean fuels, such as liquefied petroleum gas (LPG), in low and middle-income countries (LMICs). To understand the drivers of the adoption and exclusive use of LPG for cooking, we analysed representative survey data from 3343 peri-urban and rural households in Southwest Cameroon. Surveys used standardised tools to collect information on fuel use, socio-demographic and household characteristics and use of LPG for clean cooking. Most households reported LPG to be clean (95%) and efficient (88%), but many also perceived it to be expensive (69%) and unsafe (64%). Positive perceptions about LPG's safety (OR = 2.49, 95% CI = 2.04, 3.05), cooking speed (OR = 4.31, 95% CI = 2.62, 7.10), affordability (OR = 1.7, 95% CI = 1.38, 2.09), availability (OR = 2.17, 95% CI = 1.72, 2.73), and its ability to cook most dishes (OR = 3.79, 95% CI = 2.87, 5.01), were significantly associated with exclusive LPG use. Socio-economic status (higher education) and household wealth (higher income) were also associated with a greater likelihood of LPG adoption. Effective strategies to raise awareness around safe use of LPG and interventions to address financial barriers are needed to scale wider adoption and sustained use of LPG for clean cooking, displacing reliance on polluting solid fuels

How is Respect and Social Inclusion Conceptualised by Older Adults in an Aspiring Age-Friendly City? A Photovoice Study in the North-West of England.

The World Health Organisation (WHO) Global Age-Friendly Cities (AFC) Guide classifies key characteristics of an AFC according to eight domains. Whilst much age-friendly practice and research have focused on domains of the physical environment, those related to the social environment have received less attention. Using a Photovoice methodology within a Community-Based Participatory Research approach, our study draws on photographs, interviews and focus groups among 26 older Liverpool residents (60+ years) to explore how the city promotes respect and social inclusion (a core WHO AFC domain). Being involved in this photovoice study allowed older adults across four contrasting neighbourhoods to communicate their perspectives directly to Liverpool's policymakers, service providers and third sector organisations. This paper provides novel insights into how: (i) respect and social inclusion are shaped by aspects of both physical and social environment, and (ii) the accessibility, affordability and sociability of physical spaces and wider social processes (e.g., neighbourhood fragmentation) contributed to or hindered participants' health, wellbeing, intergenerational relationships and feelings of inclusion and connection. Our findings suggest that respect and social inclusion are relevant across all eight domains of the WHO AFC Guide. It is core to an AFC and should be reflected in both city-based policies and evaluations.NIHR SPH

Academic careers: what do early career researchers think?

No abstract available

Can White allyship contribute to tackling ethnic inequalities in health? Reflections on the experiences of diverse young adults in England

Ethnic diversity and racism have not featured strongly in English research, policy or practice centred on understanding and addressing health inequalities. However, the COVID-19 pandemic and the Black Lives Matter movement have shone fresh light on deep-rooted ethnic inequalities and mobilised large segments of the population into anti-racist demonstration. These recent developments suggest that, despite strong counterforces within national government and the mainstream media, there could be a shift towards greater public awareness of racism and potentially a willingness to take individual and collective action. This paper addresses these developments, and specifically engages with the contested notion of ‘allyship’. We bring together the experiences of 25 young adults living across England and prior literature to raise questions about whether and how racialized White individuals can play a role in dismantling systemic racism and reducing ethnic inequalities in health. Our analysis reveals a variety of complexities and obstacles to effective and widespread allyship. Findings suggest the need to nurture contingent, responsive and reflexive forms of allyship that can attend to the harms inflicted upon racially minoritized people as well as push for systemic transformation. White allyship will need to take a variety of forms, but it must be underpinned by an understanding of racism as institutional and systemic and a commitment to tackling interlocking systems of oppression through solidarity. The issues addressed are relevant to those occupying public health research, policy and practice roles, as well as members of the public, in England and other multi-racial settings

Barriers and Facilitators to the Adoption and Sustained Use of Cleaner Fuels in Southwest Cameroon: Situating 'Lay' Knowledge within Evidence-Based Policy and Practice

Approximately four million people die each year in low- and middle-income countries from household air pollution (HAP) due to inefficient cooking with solid fuels. Liquid Petroleum Gas (LPG) offers a clean energy option in the transition towards renewable energy. This qualitative study explored lay knowledge of barriers and facilitators to scaling up clean fuels in Cameroon, informed by Quinn et al.'s Logic Model. The model has five domains and we focused on the user and community needs domain, reporting the findings of 28 semi-structured interviews (SSIs) and four focus group discussions (FGDs) that explored the reasons behind fuel use choices. The findings suggest that affordability, safety, convenience, and awareness of health issues are all important influences on decision making to the adoption and sustained use of LPG, with affordability being the most critical issue. We also found the ability of clean fuels to meet cooking needs to be central to decision-making, rather than an aspect of convenience, as the logic model suggests. Local communities provide important insights into the barriers and facilitators to using clean fuels. We adapt Quinn et al.'s logic model accordingly, giving more weight to lay knowledge so that it is better positioned to inform policy development

The Government-led initiative for liquified petroleum gas (LPG) scale-up in Cameroon: programme development and initial evaluation

In 2016, the government of Cameroon, a central African country heavily reliant on wood fuel for cooking, published a Masterplan for increasing primary use of LPG from 20% to 58% of households by 2035. Developed via a multi-sectoral committee with support from the Global LPG Partnership, the plan envisages a 400 million Euro investment program to 2030, focused on increasing LPG cylinder numbers, key infrastructure, and enhanced regulation. This case study describes the Masterplan process and investment proposals and draws on community studies and stakeholder interviews to identify factors likely to impact on the planned expansion of LPG use

Residents' Perceptions of a Community-Led Intervention on Health, Well-Being, and Community Inclusion Through Photovoice

Community-centered approaches can be effective ways to engage communities and improve their health and well-being. The Grange is a community-led, multifaceted, and dynamic intervention incorporating a community hub and garden, that took place in a small area of the North-West of England, characterized by high levels of deprivation and poor health. Activities have been defined, developed, and supported by residents to meet locally defined needs. This study used photovoice methods to explore residents' perceptions and experiences of this community-led intervention and any perceived impact on health, well-being, and community inclusion. Through photographs, semistructured interviews, a focus group discussion, and an exhibition, this study engaged intensively and creatively with a group of six residents. They identified positive and negative aspects related to The Grange and suggested recommendations that were directly communicated to policy makers during the photo-exhibition event. Participants reflected on various activities such as the community garden and the community shop. They also reflected on contextual factors and suggested that the culture of inclusivity and friendships associated with The Grange were more important to them than specific activities. This study demonstrated the value of using photovoice to (a) explore residents' perceptions of community led interventions; and (b) meaningfully engage residents living in areas with high levels of deprivation. Public health practitioners should consider the use of photovoice (a) in the evaluation of health interventions that take place in a complex and changing context, and (b) as a powerful tool to engage with members of the community, especially traditionally disadvantaged groups, to ensure that engagement about health, well-being, and social inclusion is meaningful

Using photovoice methods to explore older people's perceptions of respect and social inclusion in cities: Opportunities, challenges and solutions

AbstractUrbanisation and population ageing have contributed to recognise cities as important settings for healthy ageing. This paper considers opportunities, challenges and solutions of using photovoice methods for exploring how individuals perceive their cities and the contribution this makes to their health. It focuses on one aspect of older people's experiences – respect and social inclusion, in the context of a community-based participatory research. Drawing on selected findings (participants' photographs, associated quotes and researchers' field notes), we provide an assessment of the suitability of photovoice methodology for the intended purpose. Four groups of older people (n=26; aged 60 years or more) from four contrasting geographical areas in Liverpool, UK, were recruited purposively. Participants photographed perceived positive and negative aspects of respect and social inclusion in the city, reflecting on the meanings of the photographs in individual (n=23) and group interviews (n=9). Thematic and content analysis was conducted using NVivo 10 software.The work reported here provides insights into how participants engage with the photovoice process; factors preventing taking photos of interest; and how photographs complement interviews and focus groups. The findings demonstrate that photovoice both facilitated the dissemination of personalised relevant knowledge, and encouraged critical dialogue between participants, and city stakeholders. Reported difficulties included photography of negative and social concepts, and anxiety when taking photographs due to (i) expectations of what is a ‘proper’ photograph, and (ii) the need to obtain consent from subjects. With preparation, training, and discussion of participants’ ideas not expressed through photographs, photovoice was well-suited to this topic, providing insights complementing other research methods. Through analysing the application of photovoice for exploring perceptions of respect and social inclusion in cities, our paper has identified potential issues and provides important recommendations for researchers on how photovoice methodology can be strengthened in exploring conditions for better health in the urban environment