Implementation of behavioral interventions to reduce air pollution exposures in Africa: A scoping review protocol

Air pollution is the leading environmental cause of mortality globally, with 6.7 million deaths in 2019 (1). 1.1 million (16.7%) of the total deaths took place in Africa (1). In addition to causing poor health outcomes, air pollution hinders economic productivity and development (1). Structural interventions, such as regulating industrial emissions, air quality standards, or vehicular fuel composition mandates, are critical to reducing exposure. However, in settings where political will and policies may be limited or in development, which includes settings in Africa, individual-level or community-level interventions that change behavior to reduce personal exposures, such as changing commuting or cooking habits, wearing respirators/masks, or avoiding polluted places, are an important way to protect health. There is a gap in the literature synthesizing behavioral interventions reducing exposure to air pollution in Africa, with a specific focus on evaluating and mapping the behavior change theories/frameworks and implementation science theories/models/frameworks (TMFs) applied for these interventions. No reviews to date have summarized underlying behavior change theories applied, implementation science TMFs utilized, and implementation outcomes measured for behavioral interventions aimed at reducing air pollution exposures in Africa. We aim to address this critical gap through this scoping review. Research objective: To characterize implementation of behavioral interventions focused on reducing air pollution exposure in Africa, specifically identifying the behavior change theories and implementation science theories/models/frameworks (TMFs) applied, and implementation outcomes measured. Study Outcomes Primary: • Behavior change theories/strategies applied (as well as how it was applied) • Implementation science frameworks applied (as well as how it was applied) • Implementation outcomes measured Secondary: • Outcomes assessed/study results (e.g. % intervention uptake, air pollution exposure change, health outcomes) including success/failure of the intervention studied We began developing this protocol in April 2026. By time of OSF protocol registration, we have begun the title/abstract screening phase. We aim to submit the manuscript summarizing the findings of our scoping review in early 2027.