
OBJECTIVES
Share knowledge with local research partners at the College of Medicine, University of Malawi, through training in household and ambient air pollution and behavioural change techniques alongside participatory approaches to health promotion; and identify suitable research site.
Evaluate a range of behaviour change approaches used in the sanitation sector for applicability to a Community LedSmoke-free Village setting and review potential pollution reduction interventions in relation to effectiveness and suitability.
Using a mixed methods approach, carry out a baseline survey, participatory mapping and focus groups usingphotovoice, to 1) identify the main sources of HAAP and fire in the village 2) to assess community awareness ofHAAP and barriers and enablers to change.
Work with the community to identify those actions they wish to take forward to reduce HAAP and burns, that can beinstituted at a village level, and implement the resulting action plan.
Measure outcomes in relation to HAAP, behaviours, participation and barriers and enablers to scale up among thecommunity six months after institution of the action plan and make recommendations for future local and nationalpolicy actions based on the findings.
Integrate the project findings within a final report and share recommendations for future action with stakeholders ata local, regional and national level including through the development of a smokeless village toolkit.

METHODS
MILESTONE 1
This project will take a community-led mixed-methods participatory approach to the development of an action plan in a village setting in Malawi aimed at reducing HAAP. We propose to evaluate a range of behaviour change approaches used in the sanitation sector and co-identify those most suitable for application to a community-led HAAP project. We will also evaluate a range of pollution reducing interventions for presentation to, and discussion with, the community in order to inform the development of a community led action plan. Implementation of the plan will be evaluated using both quantitative and qualitative methods and findings will be used to develop a toolkit for the implementation of a whole village approach to reducing HAAP. Findings will be shared with regional and national policy makers in order to ensure their incorporation into ongoing national and regional policy development. Milestones have been identified at significant points to demonstrate the outcomes expected at the various stages of the project.
Share knowledge with local research partners at the College of Medicine, University of Malawi, through training in household and ambient air pollution and behavioural change techniques alongside participatory approaches to health promotion; and identify suitable research site.
We will offer two short courses, participatory in approach, at the College of Medicine, University of Malawi to relevant academic staff, community health workers and research staff employed directly on the project. The first course will provide a background to the problem of HAP, basic methods used to measure HAP and the key approaches currently being instituted to address the problem. The second course will cover behaviour change techniques including information and communication approaches and also participatory methods. Each course will be approximately two days in length. When the courses have been completed, we will spend a further day applying the methods learned to the context of this project, exploring how the knowledge and skills gained will be put into practice in the field. The courses will include discussion of the ethics of the research methodology being used and provide an opportunity to agree on the ethical approaches that the study will take. This part of the programme will be led by Professor Mbengo who is an expert in the field. It will inform the application for ethical approval which will be submitted following discussions with the project team.
In addition, whilst on site in Malawi, and using the knowledge and experience of our local partners, we will together identify potential project villages, with a population of approximately 100 households that have a high level of dependence on biomass, preferably where there is already a relationship between the project team at the University of Malawi and the village members. We will meet with the traditional authorities and village chiefs of potential project villages where feasible, to assess willingness to participate, village suitability, and best contacts.

2. Evaluate a range of behaviour change approaches used in the sanitation sector for applicability to a Community Led Smoke-free Village setting and review potential pollution reduction interventions in relation to effectiveness and suitability.
In tandem, we will carry out a systematic literature review of behaviour change approaches in the sanitation sector and assess their significance and applicability in the context of implementing a smokeless village approach in the chosen setting. This will include a) identification / adaptation of suitable indicators of progress and outcome, b) factors facilitating or constraining implementation, c) role of policy environment, d) implementation quality, e) administrative context, f) community environment, g) community capacity, h) community participation patterns and j) community behaviour. The review will provide a tool for analysing which behaviour change approaches are most suitable for the purposes of this project.
In addition, we will update and summarise the evidence for the effectiveness of interventions to reduce HAAP suitable for the Malawi setting. The summary will be based on the systematic review of scale up previously carried out by the Ireland-based PI (Stanistreet) and colleagues (Rehfuess et al., 2014; Stanistreet, Puzzolo, et al., 2014) which will be extended and updated. The review provides a comprehensive overview of the barriers and facilitators of the main cleaner cooking alternatives to a traditional stove. We will update and extend this work to review cleaner alternatives to other sources of HAAP such as lighting, and non-polluting crop management alternatives and review any relevant publications pertaining to cleaner cooking, which were published after 2011. Thus we will assess evidence for the barriers and facilitators to scale up of alternative approaches to lighting, crop management etc. alongside the cleaner cooking evidence that is currently available.
In relation to the identified HAP interventions, we will then categorise interventions, using an adaptation of the Quinn et al. model (2018) under the five domains to allow the identification of actions required at different levels. For the purposes of the village action plan, we will take forward those actions relating to consumer demand and user and community needs and perceptions. Actions falling under the other categories will be taken forward to the final report to share with regional and national stakeholders as part of a longer term strategy (see objective 6). However, if it is feasible to address any of the actions in the environment, industry or energy domains within the scope of the project, these will also be taken forward as part of the village action plan. For example, if the villagers wished to purchase solar stoves and a local distributor was able to make these available locally, this would be included as part of the village action plan.
In summary, these two reviews will provide a comprehensive overview of a) the most appropriate behaviour change approaches that could be instituted as part of the project along with a framework to guide implementation in the field b) the potential interventions available to the community that could be instituted to reduce HAAP. In relation to the latter, it will also provide a guide to the advantages and disadvantages of each intervention to present to the community for consideration.
MILESTONE 2 - COMPLETION OF TWO REVIEWS AS DESCRIBED, AND COMPLETION OF ETHICS APPLICATION
