Behavioral Reactivity Associated With Electronic Monitoring of Environmental Health Interventions—A Cluster Randomized Trial with Water Filters and Cookstoves

The study aimed to assess the effect of electronic sensors on behavior, specifically the use of household water filters and improved cookstoves. The study was designed as a cluster randomized controlled trial, with 70 households in the open group and 100 households in the blinded group. The open group was informed that their usage was being continuously monitored by the concealed sensor, while the blinded group was not informed. The households were administered identical informed consent statements, and the sensor-equipped stoves and filters were temporarily replaced by nearly identical devices that contained concealed sensors. The households were surveyed at the time of installation and removal of the sensor-equipped stoves and filters. The results showed a 63% increase in the number of uses of the water filter per week between the groups in week 1, with an average of 4.4 times in the open group and 2.83 times in the blinded group. However, this difference declined in week 4 to an insignificant 55% difference of 2.82 uses in the open group and 1.93 in the blinded group. There were no significant differences in the number of stove uses per week between the two groups. The study found that use of both filters and stoves decreased in both groups over the four-week installation period. The results suggest that behavioral monitoring should attempt to account for reactivity to awareness of electronic monitors that persists for weeks or more. The study also found that households in both groups reported preferring their sensor-equipped stove because it was approximately 10 cm taller and therefore perceived to be easier to use. The sensors used in this study were a newer iteration of the technology described in Thomas et al., 2013. The water filter sensor records water pressure relative to atmospheric within the LifeStraw Family 2.0 safe water storage container, which corresponds approximately linearly to water volume. The cookstove sensor includes a digital temperature sensor and two K-type thermocouples. The digital temperature sensor is mounted on the electronics board, and the thermocouples are attached to the cookstove's combustion chamber and exhaust pipe. The study was conducted from March to July 2015 in Western Province, Rwanda, as part of a broader health impact study of the DelAgua Health and Ministry of Health Tubeho Neza program. The program provided over 100,000 households with household water filters, improved cookstoves, and behavioral messaging and monitoring in 2014 and 2015. The study was designed to assess the reactivity associated with electronic sensor-based monitoring of household-based water filters and improved cookstoves. The study's findings have implications for the design and implementation of behavioral monitoring systems for environmental health interventions. The results suggest that awareness of electronic monitors can lead to changes in behavior, and that these changes can persist for weeks or more. The study's findings also highlight the importance of considering the potential for reactivity when designing and implementing behavioral monitoring systems.