Development of report-back materials of air pollution exposure results to participants in the HAPIN trial in Guatemala and Rwanda

Background: Interpretation of individual exposure information for reporting to research participants is an important aspect of the research process that can empower participants, increase community engagement with scientific research, and better tailor future community-engaged research. In the multi-country Household Air Pollution Randomized Intervention Network (HAPIN) trial, a randomized controlled trial among 3200 pregnant women that assessed the effect of a liquefied petroleum gas (LPG) stove and fuel intervention, we engaged a subset of study participants in Guatemala and Rwanda in the development of context-appropriate materials. The purpose of this study was to: 1) report and explain air pollution exposure levels to: 2) present strategies to increase awareness of the health effects of air pollution; and 3) discuss strategies to reduce personal exposure to air pollution. Methods: Local project staff in Guatemala and Rwanda were trained to conduct qualitative research. Individual interviews and participatory observations in participant homes (n=42 in Guatemala; n=20 in Rwanda) were followed by working groups to assess interpretability of different graphical displays of exposure data. Finally, focus groups assisted in iteration of contextually relevant visual aids illustrating exposure results, health impacts, and strategies to reduce exposures. Results: After iterations, visual materials depicting community and personal exposure to fine particulate matter (PM2.5) using a simple "thermometer-style” graphic were chosen, including a marker of community-level impacts of the liquefied petroleum gas (LPG) stove intervention. Educational material about the health impacts of air pollution and contextually feasible and available methods to reduce exposure were presented. Capacity was built among field teams to conduct qualitative research. Conclusions: Development of materials to report back scientific results to study participants in accurate and understandable ways is an ethical obligation to communities participating in complex research and may yield important benefits to researchers and participating community alike. Keywords: report-back; environmental health literacy; HAPIN trial