Perceptions regarding making household air pollution a routine topic for health education during antenatal care: A qualitative study in Eastern Uganda

In Uganda, pregnant women do not routinely receive health education during antenatal care regarding exposure to household air pollution (HAP). The study was conducted to explore perceptions regarding what would be needed to incorporate HAP as a routine topic for health education during antenatal care. The study was based on the capability, motivation, opportunity-behavior (COM-B) model. Qualitative interviews were conducted among healthcare workers and pregnant women attending antenatal care at Mbale Regional Referral Hospital in Uganda. Thematic analysis was used to identify key themes. Capability to provide health education on HAP emanated from health system factors (e.g., lack of capacity, workload, time constraints) and behavioral factors (e.g., HAP not seen as a major risk factor for adverse pregnancy outcomes). Capability to adopt cleaner fuels following health education was thought to be affected by willingness to adopt short-term interventions ahead of cleaner fuels alternatives, cost/affordability constraints, unwillingness to change, and socio-cultural concerns. Socio-economic constraints, weather and safety concerns were thought to affect women's capability to open doors/windows and cook outdoors following health education. Participants were motivated to provide/receive antenatal health education because of their need to reduce adverse birth outcomes caused by HAP, acceptability of HAP as a topic for education, and the perception of healthcare workers as role models. Training midwives about HAP, using innovative teaching aids, including prompts on HAP in the antenatal card to remind healthcare workers to talk about HAP, giving incentives to healthcare workers and involving them when designing health education about HAP were suggested to enable integration of HAP as routine topic. Our study highlights an opportunity to empower and create demand among pregnant people to adopt behaviors that could reduce exposure to HAP during ANC. Integration of HAP into antenatal care could help transition households from precontemplation and contemplation stage in the uptake of cleaner fuels.