Background: Worldwide, 2.4 billion people rely on solid fuels for cooking. Approximately 3.2 million deaths from illnesses attributable to household air pollution are caused by cooking and heating on solid fuels (such as wood and charcoal). The Fuel to Pot study aimed to explore experiences and perceptions of solid fuel use for cooking in residents of informal settlements [slums] in Mukuru (Kenya) and Ndirande (Malawi) in order to understand their fuel choices.

Methods: This qualitative study used the participatory photovoice method for data collection. This entailed participants (10 in Kenya and 9 in Malawi) taking photos- using Android phones- and discussing and analysing those pictures in a group setting to identify and present the issues that matter most to them around solid fuels, smoke, health and cooking. The research was undertaken in Kenya and Malawi between July and September 2022. A focus group was also conducted with the participants at the end of the process to seek their views on taking part in a photovoice study.

Results: Although over the past decade the photovoice methodology has become increasingly used to explore health and social or cultural issues, there is very limited literature on the use of this method in African slums contexts and other resource-poor settings. Our results provide learning about the process of photovoice in this context, drawing on reflective fieldnotes and focus group discussion and practical tips on undertaking this participatory method in slums context. Overall, the participants enjoyed taking part in the photovoice and found it very informative and empowering in terms of understanding how and why members of their communities used solid fuels such as wood, charcoal, charcoal briquettes but also Kerosene, paraffin and other’ non-clean’ fuels for cooking. Methodological challenges in this context included the process around practicalities, confidentiality and anonymity in terms of taking pictures. For example, some participants reported others in the community demanding money to have their photo taken which required the team to develop a process for 3rd party consent to be administered by participants.

Conclusion: The photovoice method is increasingly used in health research and has been used recently to explore issues surrounding clean cooking. However, less is known about conducting it in informal settlements in low- and middle-income countries, which present particular challenges. This method offers an inclusive and unique chance to understand complex issues through the lens of those most affected, thus leading to better public health interventions.