Geospatial-temporal, demographic, and programmatic adoption characteristics of a large-scale water filter and improved cookstove intervention in Western Province, Rwanda

Abstract Lowering the global disease burden of preventable disease has been addressed in part by the distribution of health products and behavior change campaigns in low-income countries. Realizing a health impact requires adoption by participants, and the topic of program uptake and sustained adoption has been studied extensively, although an ecological context is largely missing from existing work. This study characterizes self-reported and observed adoption of improved cookstoves and point-of-use water filters among nearly 80,000 households in Rwanda using demographic and programmatic variables from implementer surveys and integration of geospatial and temporal data based on differentiated recipient location. The odds of stove or filter adoption were analyzed using Generalized Estimating Equation logistic regression modeling. Administrative district, rural residency, elevation, social networks, socioeconomic category, family composition, education delivery, technological factors, and use of the accompanying technology in the combined intervention were significantly associated with the odds of adoption of either the stove or filter. Population density, precipitation, anisotropic travel time to services, and timing of the health campaign largely showed no significant relationship with adoption. This research promotes the inclusion of geospatial and temporal data in designing and evaluating other public health interventions by successfully leveraging an ecological explanation of adoption decisions.