DIY Indoor Air Cleaner Study in Rural and Urban Communities in Colorado

Our Phase II project is designed using the RE‐AIM (Reach, Effectiveness, Adoption,Implementation, and Maintenance) and PRISM (Practical, Robust, Implementation,Sustainability, and Monitoring) frameworks to evaluate each stage of the implementationprocess. RE‐AIM will assess reach and effectiveness, as well as measures ofimplementation and sustainability. PRISM will aid in design and sustainability, as weseek to better understand and incorporate community perspectives and factors related tothe external environment and implementation and sustainability infrastructure. Thisholistic view of implementation will inform sustainability and scalability to othercommunities.Hybrid Type 1 Effectiveness‐Implementation Study: Household Do it Yourself Air Cleaner(DIYac) Intervention While there is abundant evidence on the efficacy of a DIYac inreducing particulate matter (PM) in well‐controlled environments, there is a lack of dataon their effectiveness when deployed in real world settings. A Hybrid Type 1 (HT1) designis thus appropriate for our study, which tests the effectiveness of DIYac whenimplemented in rural and urban low‐resource populations (WD and SLV). Effectivenessoutcomes include behaviors (DIYac correct use), air quality (measured as PM), andphysical and mental health indicators. Following HT1 design principles, we will integratea process evaluation, guided by the RE‐AIM and PRISM frameworks, to identify barriers andfacilitators to broader, scalable implementation of the intervention as PM exposuremitigation strategy.Stepped Wedge Design We will recruit and enroll a total of 550 households (WD: n=300;SLV: n=250) using a stratified random selection from an enumerated address for bothcommunities derived from publicly available tax parcel mailing lists. Addresses will bestratified by county (SLV) and neighborhood (WD) to ensure geographic representation forthe sample in each community. After selection, households within each community will berandomly assigned to two groups which determine at what point in the study theintervention is initiated. Given the high prevalence of related health outcomes (e.g.asthma, chronic obstructive pulmonary disease (COPD)), we anticipate that a random samplefrom each stratum will include key groups (outdoor workers (20‐60%), chronic diseases(12%), aging (30%), and household with children (30%)).Natural Experiment Readiness Our project is designed to facilitate a rapid response to anevent, such as a wildfire or dust storm, by employing a flexible and adaptive frameworkthat can quickly mobilize resources and data collection efforts. Previous work byresearch team members demonstrates our adaptability to launch responsive,multidisciplinary research following events; we are well‐equipped to apply similarapproaches to assess the effectiveness of DIYac in mitigating exposure to elevated PMinside homes. By using a natural experiment design, the research can compare householdswith and without DIYac interventions and track emergent and urgent care trends, offeringcrucial insights into the potential for widespread implementation of these systems inat‐risk regions.Study Aims & Research QuestionsOur study will address the following three aims and associated research questions (RQs):Aim 1: Evaluate impacts of DIYac on exposure to indoor PM associated with ambient PM.RQ2. (Effectiveness) Does adoption and use of DIYac reduce indoor PM levels, attributedto ambient PM? Hypothesis 2a: DIYac use will lead to significant decline in indoor PMlevels. Hypothesis 2b: During an elevated PM event, households with DIYac will experiencesignificantly lower indoor PM than those without DIYac. Note: this hypothesis will onlybe answerable if an event occurs during the intervention period.Aim 2: Evaluate impacts of intervention on DIYac adoption, use, and maintenance.RQ1a. (Effectiveness) Do households that are provided a DIYac successfully adopt andconsistently use and maintain these filters as recommended? Hypothesis 2a: Households inthe intervention condition (Group 1) will have significantly higher rates of adoption ofthe DIYac use than those in Group 2 (baseline). Hypothesis 2b: After intervention phasehouseholds will report improved self‐efficacy, sense of agency, and hopefulness thanpre‐intervention.RQ1b. (Implementation) What barriers and facilitators influence DIYac adoption, use, andmaintenance across rural and urban low‐resource households? Hypothesis 1b: Barriers andfacilitators to DIYac implementation will include similar factors across sites, includingcosts (electricity and maintenance) and noise, as well as some factors that arehousehold‐specific (person with asthma) or regional (lower access to materials in urbanareas). Community engagement and program design can identify strategies to address thesebarriers.Aim 3: Evaluate impacts of DIYac on health outcomes (physical and mental health) andbiomarkers of exposures (urinary markers).RQ3. (Effectiveness) Does adoption and use of DIYac improve self‐reported and measuredphysical and mental health indicators and urinary biomarkers of exposure to PM?Hypothesis 3a: DIYac use is associated with improved metrics of physical health andmental health. Hypothesis 3b: During an elevated PM event, households with DIYac willhave improved metrics of physical and mental. Note: this hypothesis will only beanswerable if a wildfire smoke event occurs during the intervention period.