title: Enablers and barriers to large-scale uptake of improved solid fuel stoves: a systematic review.
abstract: BACKGROUND
  Globally, 2.8 billion people rely on household solid fuels. Reducing the resulting adverse health, environmental, and development consequences will involve transitioning through a mix of clean fuels and improved solid fuel stoves (IS) of demonstrable effectiveness. To date, achieving uptake of IS has presented significant challenges.
  
  
  OBJECTIVE
  We performed a systematic review of factors that enable or limit large-scale uptake of IS in low- and middle-income countries.
  
  
  METHODS
  We conducted systematic searches through multidisciplinary databases, specialist websites, and consulting experts. The review drew on qualitative, quantitative, and case studies and used standardized methods for screening, data extraction, critical appraisal, and synthesis. We summarized our findings as "factors" relating to one of seven domains-fuel and technology characteristics; household and setting characteristics; knowledge and perceptions; finance, tax, and subsidy aspects; market development; regulation, legislation, and standards; programmatic and policy mechanisms-and also recorded issues that impacted equity.
  
  
  RESULTS
  We identified 31 factors influencing uptake from 57 studies conducted in Asia, Africa, and Latin America. All domains matter. Although factors such as offering technologies that meet household needs and save fuel, user training and support, effective financing, and facilitative government action appear to be critical, none guarantee success: All factors can be influential, depending on context. The nature of available evidence did not permit further prioritization.
  
  
  CONCLUSIONS
  Achieving adoption and sustained use of IS at a large scale requires that all factors, spanning household/community and program/societal levels, be assessed and supported by policy. We propose a planning tool that would aid this process and suggest further research to incorporate an evaluation of effectiveness.
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Eva A
authors.initials: EA
authors.lastname: Rehfuess
authors.forename: Elisa
authors.initials: E
authors.lastname: Puzzolo
authors.forename: Debbi
authors.initials: D
authors.lastname: Stanistreet
authors.forename: Daniel
authors.initials: D
authors.lastname: Pope
authors.forename: Nigel G
authors.initials: NG
authors.lastname: Bruce
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000706:statistics & numerical data*; D056804:Biofuels / Q000706:statistics & numerical data; D003296:Cooking / Q000191:economics* / Q000295:instrumentation* / Q000379:methods*; D003906:Developing Countries; D005191:Family Characteristics; D005524:Food Technology / Q000379:methods* / Q000639:trends; D033161:Government Regulation; D006801:Humans
chemical_list: D056804:Biofuels