Development and evaluation of a behavioral intervention to reduce household plastic waste burning in rural Guatemala: Study protocol for Ecolectivos, a cluster-randomized community trial

ObjectiveHousehold waste burning, especially of plastics, is a major, but unaddressed environmental and health hazard in countries that lack infrastructure to properly manage waste. This study will implement village-level community working groups that aim to reduce household plastic waste burning and improve health-related quality of life in women of reproductive age in rural Guatemala. MethodsUsing a type 1 hybrid-effectiveness-implementation study design, we will randomize 16 rural villages in Jalapa, Guatemala and randomly select 400 women of reproductive age (25 in each village) who report burning plastic trash as a primary form of waste disposal to participate. In eight intervention villages, we will conduct 12-week community working groups to implement alternatives to burning plastic that are achievable over the subsequent 9 months. We will use the Behavior Change Wheel and RE-AIM, two implementation science frameworks, and a mixed-methods approach, to refine, implement, and evaluate community-initiated interventions that address plastic waste. At baseline, 4 and 12 months, we will measure personal exposures to fine particulate matter and black carbon, and urinary biomarkers of exposure (e.g., bisphenols, phthalates, polycyclic aromatic hydrocarbons, and volatile organic compounds). We will use filter-based 1,3,5-Triphenylbenzene, a known tracer of plastic incineration, to quantify emissions estimates of air pollutants due to plastic burning. Based on plastic waste reductions in intervention villages, we will assess regional impacts of pollutant emissions reduction, using a 3D chemical transport model. This study was registered at ClinicalTrials.gov (NCT05130632) on November 23, 2021. SignificanceOur findings will be incorporated into community-driven public health actions to develop programs in other local contexts. This project has direct benefit not only to those residing in Guatemala, but potentially in other areas where open waste burning contributes to air pollutants both regionally and globally. Contributions to the literatureO_LIThe Ecolectivos project will engage communities to co-create sustainable alternatives to burning household plastic waste. C_LIO_LIResearch will be refined during the formative phase, working groups will address behavior change during the main trial, and results will be disseminated using village-level fairs to introduce alternatives to burning plastic in control villages. C_LIO_LIThis work will expand the evidence on barriers and enablers to implementing alternatives to burning plastic using the capability, opportunity, and motivation domains for key behaviors (guided by the Behavior Change Wheel framework) and focusing on reach and potential for scale-up (guided by RE-AIM framework). C_LI