From Soil to Cement: Acceptability and Lived Experiences of Low‑Carbon Cement Floors in Rural Bangladesh

From Soil to Cement: Acceptability and Lived Experiences of Low‑Carbon Cement Floors in Rural Bangladesh | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From Soil to Cement: Acceptability and Lived Experiences of Low‑Carbon Cement Floors in Rural Bangladesh Farjana Jahan, Mahbubur Rahman, Jannat-E-Tajreen Momo, Afsana Yeamin, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8714894/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract In low- and middle-income countries, household floors made of soil remain common. Concrete floors are desirable household upgrades because they offer durability, improved hygiene, and flood resilience, and their prevalence is increasing. However, cement production is a substantial contributor to global anthropogenic carbon dioxide emissions. This study assessed the acceptability and feasibility of sustainable cement-based floors with lower embodied carbon; these floors replaced 20% of cement with fly ash, a byproduct of coal combustion. To assess whether low carbon cement floors are as acceptable as traditional cement-based floors, in-depth interviews were conducted with 30 respondents from 20 households in rural Bangladesh in which soil floors were replaced with either low carbon cement or traditional cement-based floors. Findings revealed that both flooring types were highly accepted due to ease of cleaning, health benefits, and protection from environmental hazards. Traditional cement floors were preferred in terms of repair and maintenance as the users were concerned about the availability of fly ash and concrete blocks in rural settings. Financial constraints emerged as a major barrier to cement-based floor adoption for both traditional and lower embodied carbon cement-based floors, with most respondents prioritizing roof and wall improvements over flooring. Subsidized housing programs were seen as a crucial enabler for cement-based floor installation, as self-financing was largely considered unattainable. This study demonstrates that in a rural, low-income population Bangladesh, cement-based floors with lower embodied carbon were as acceptable as traditional cement-based floors, but installation of either type of floor may require government subsidies. Cement-based flooring Lower-embodied carbon floors Floor durability Household hygiene Rural Bangladesh housing Sustainable materials Figures Figure 1 Background In low- and middle-income countries, many homes are constructed with soil floors, but the proportion of homes with concrete floors has increased over time (Colston et al., 2024 ; Tusting et al., 2020 ). In rural areas, 63% of households have floors made of earth, sand, or dung (ICF, 2022 ), and soil floors and walls are more common among impoverished households in rural areas (Cluster, 2018 ; Ferdous et al., 2017 ; Gunnsteinsson et al., 2010 ; Hasan et al.; Shafie & Rahman, 2009 ). Rapid changes in social and economic conditions are driving the transformation of rural settlements. Economic growth, technological advancements, and urbanization have significantly influenced the structure of rural housing (Hossain, 2010 ; Islam et al., 2015 ). As the economy improves, more households are able to afford to replace soil floors with cement-based floors (Rashid, 2017 ); in 2022, 34% of rural homes had cement-based floors (ICF, 2022 ). The production of construction materials used in cement floors contribute significantly to environmental pollution through carbon emissions. Cement-based floors consist of a sand layer, covered by a layer of bricks and topped with a cement-based mortar and sealant. Manufacturing of Ordinary Portland cement (i.e., “traditional” cement) alone is responsible for about 5% of global anthropogenic CO 2 emissions, making the cement industry an important sector for CO 2 emission mitigation strategies (Beketie et al., 2022 ; Etim et al., 2021 ). During cement manufacturing, CO 2 is emitted when limestone is calcinated, from combustion of fuels in the kiln (Ali et al., 2011 ; Worrell et al., 2001 ). Brick production also contributes substantially to CO 2 emissions in Bangladesh; in 2020, Bangladesh emitted CO 2 from conventional brickfields over 9.8 million tons (Imran et al., 2014 ; Rahman, 2022 ). Bangladesh boasts a significant brick production industry, with over 7,000 brick kilns producing nearly 23 billion bricks annually (Rahman, 2022 ). To reduce construction-related pollution, Bangladesh is now producing environmentally friendly materials like lower-embodied carbon concrete blocks containing fly ash (Shahen, 2024 ). To reduce embodied carbon, concrete blocks are produced with a portion of the needed cement replaced with fly ash or slag. Coal-burning power plants generate fly ash as a byproduct of electricity production. Repurposing fly ash in construction not only diverts this industrial byproduct from landfills, where it could pollute soil with toxins, but also reduces the embodied carbon of cement structures. Slag is a byproduct of steel production and is often used to replace a portion of Portland cement in concrete (Shahen, 2024 ). Additionally, concrete mixes incorporating fly ash and/or slag have been shown to have higher compressive strength than traditional mixes (Bouzoubaâ et al., 2000 ; Bouzoubaâ et al., 2001 ; Tan & Pu, 1998 ). Concrete blocks constructed with fly ash/slag have been piloted at a small scale in the construction of roads in Dhaka, Bangladesh. To our knowledge, cement-based floors using fly ash or slag have not yet been adopted in household floor construction in rural Bangladesh. In this qualitative study, we explored the feasibility and acceptability among household members of floors constructed with low-carbon blocks and a low-carbon cement-based finish and compared it to that of traditional cement-based floors constructed with clay bricks and Ordinary Portland cement in a rural community in Bangladesh. Objectives Compare the acceptability and feasibility of lower-embodied carbon vs. traditional cement-based household floors among household members Assess the willingness to pay for lower-embodied carbon vs. traditional cement-based floors among household members Methods Study site and context The study was conducted in Chauhali and Belkuchi sub-districts in Sirajganj district and Nagarpur sub-district of Tangail District of Bangladesh. The study was nested in a randomized controlled trial (NCT05372068) to determine whether cement based floors reduce child STH infection and diarrhea (Rahman et al., 2025 ). The study enrolled 800 homes with soil floors in which a pregnant woman in her second or third trimester resided. The trial randomized households 1:1 to intervention (cement-based floors) or control (no intervention). In the intervention arm, cement-based floors were installed in homes with soil floors in 400 intervention households before the birth cohort was born. In a random subset of the intervention group (N = 50), to reduce embodied carbon, we used commercially produced concrete blocks (Blocktech, Rupganj, Bangladesh) with cement, sand, water and recycled slag instead of traditional clay bricks, and a neat cement finish using a mix in which 25% of Ordinary Portland cement was replaced with fly ash (Fig. 1 ). The concrete blocks were composed of approximately 15% cement, 30% slag, and 55% sand, with the sand portion consisting of Sylhet/coarse sand and White sand in a 1:1 ratio. A homogeneous mixture is formed from the dry raw materials with the addition of water, and then the mixture is transferred to a machine where, under high pressure and vibration, concrete blocks are made. Conventional fired clay bricks have the same structural functionality but require kiln firing that results in significant carbon emissions while concrete blocks were cured at ambient temperatures, which lead to a reduced carbon footprint. In current study, concrete blocks were cured by drying in the sun for 15 consecutive days. This allowed the blocks to gradually reach their optimum strength and reduced carbon emission associated with kiln firing. During floor installation, the study team explained to participants in simple terms that the fly ash floors would offer comparable strength, durability, and ease of cleaning compared to traditional brick cement-based floors, while also providing environmental benefits through reduced pollution during production. Any major cracks in cement-based floors were repaired within one year of installation. (Insert Fig. 1 ) Design of traditional and lower-embodied carbon cement-based floors To design the concrete block-cement-fly ash-based floor, we consulted with stakeholders implementing housing programs in rural Bangladesh and civil engineers from academia. Both types of floors used layers of similar height (101-110cm), varying with the existing soil foundation level. The plinth (side wall) surrounding the floor layers were constructed with layers of clay bricks or concrete blocks which had been plastered with cement-water mixture. The width of plinth was 25.4 cm, with height equal to that of the floor. The design (shown in Fig. 1 ) is summarized in Table 1 . Table 1 The layers and materials of the traditional and lower-embodied carbon cement-based floor Purpose Traditional clay-brick cement-based floor Concrete block-cement-fly ash floor Top layer This layer is the final visible layer that provides a smooth surface. Neat finish with ordinary Portland cement-water based mixture Neat finish with cement-water based mixture with 25% of cement replaced fly ash Cement mortar This mortar layer serves as an intermediary that bonds the finish to the supporting structure and supports the floor’s load. 2.5 cm layer of mixture of cement and sand (1:4 ratio) with water. For 2.5 cm thickness amount of cement and sand required were: cement: 12 kg/m2 sand: 0.348 cubic feet/m2 mixture of cement, coarse aggregates, and sand (1:2:4 ratio) with water. For 5cm thickness amount of cement, coarse aggregates and sand used were: cement: 15.4 kg/m2 aggregates: 1.53 cubic feet/m2 sand: 0.769 cubic feet/m2 Soling The brick soling acts as a rigid, load-distributing layer that enhances the overall stability of the floor system. Single layer of clay brick soling (7.6 cm). The dimension of a single traditional clay brick was 25.4 cm x 12.7 cm x 7.6 cm. Single layer of concrete block soling (10 cm). The dimension of concrete block was 38 cm x 22.6 cm x 10 cm. Sand This layer levels the surface. It also helps to manage moisture levels and provides a cushioning effect between the brick soling and the underlying foundation. Sand layer (15 cm) Sand layer (12.5 cm) The sand layer used a lower height to accommodate the greater height of concrete blocks compared to bricks. Foundation This foundation is the primary support for the entire floor assembly. This foundation is made of the existing soil floor, the soil is being compacted and made even by pressing. Compacted soil foundation (76 cm). Compacted soil foundation (76 cm). Study design and participants From September to November 2024, we conducted in-depth interviews with 20 randomly selected intervention households with lower-embodied carbon cement-based floors (n = 10) and traditional cement-based floors (n = 10). Most participants had homes with only one large room with a partition, and cement-based floors were installed on both sides of the partition as part of this study. A few households had multiple rooms, but only the rooms where the pregnant mother was sleeping and using for their children’s playtime and feeding received the cement-based floor, while the remaining rooms for other household members still had soil floors. From each of the intervention households, mothers were selected as participants and household heads were interviewed based on availability. We interviewed 20 mothers and 10 household heads in total (10 mothers and five household heads from each type of floor). Among the 30 respondents, 20 were mothers of index children in the CRADLE trial, and the remaining 10 respondents were household heads including husband or father-in-law of the enrolled mother. Out of 20 households, 11 resided on the mainland, and 9 resided on chars which are riverine islands that form in riverbeds or near riverbanks due to the build-up of sand, silt, and other sediments. These landforms are common in large river systems and often appear and disappear over time because of erosion and flooding. Data Collection We conducted in-depth interviews (IDIs) within three to ten months after floors were installed to evaluate the acceptability and feasibility of lower-embodied carbon vs. traditional cement-based floors. To assess feasibility, we evaluated whether households experienced any difficulties during the construction of the cement-based floors. Acceptability was operationalized as the respondent’s assessment of their floor’s benefits, durability, hygiene, visual appearance, safety, maintenance, usablity, and flood resilience. We defined feasibility as the respondent’s opinion on their floor’s practicality and sustainability considering installation time, construction methods, availability and affordability of raw material, maintenance requirements, and long-term repair needs. We developed the interview guideline (Supplementary material S1 & S2) based on multi-faceted research SERVQUAL tool (Parasuraman et al., 1988 ), which is used to assess consumer expectations and perceptions of a service across five dimensions. Each IDIs lasted for 40–50 minutes. Qualitative data analysis We used thematic content analysis techniques, following an inductive process to analyze the data. A team of three researchers transcribed the audio recordings into verbatim Bengali in a word processor. Then the transcripts were translated into English by two qualitative researchers (anthropologist). A third researcher checked all translations for errors. The transcripts were imported into Atlas.ti (version 5.2) for systematic coding. To begin the coding process two researchers carefully reading all transcripts, summaries, and field notes and developed a preliminary set of themes and codes. To ensure the consistency of the coding process, we chose two verbatim transcripts initially for coding by two qualitative researchers and the intercoder reliability showed substantial reliability by cohen’s kappa computation (k = 0.72). After incorporating the new codes, a third coder again independently reviewed the codes against another transcript, and no new codes were found. During the coding process, new codes and themes that emerged inductively from the data were added to the initial framework. Thus, both new codes and new overarching themes were identified beyond those generated at the start. Finally, two coders were responsible for coding the whole data set using the final codebook. Once coding was complete, all coded data extracts were collated and systematically organized into final themes, which formed the basis of our analysis and interpretation. Thematic analysis approach was utilized to identify the key themes as headings to organize and summarize thematic information from all participants (Braun & Clarke, 2006 ; Saunders et al., 2023 ) consensus. Ethical Consideration The trial protocol was approved by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Ethical Review Committee (PR-22069), and the Stanford Institutional Review Board (63990). Written informed consent was obtained from all participants before the IDIs. The consent forms were read aloud to ensure comprehension, and participants were given the opportunity to read the form themselves and ask any questions before providing their signatures. For those who were illiterate, a thumb impression was taken after they had listened to the consent details. Results 1. Sociodemographic information The participants were mostly literate, and the majority had completed education up to grade five. Mothers’ age range varied from 20 to 35 years, and household heads’ age range was from 30 to 40 years old for husbands; all fathers-in-law were older than 60 years (Table 2 ). Women were mostly housewives, and household heads were mostly construction workers. Some household heads were also barbers, van pullers, fishermen and farmers. The majority of households had six or more total members, and on average, mothers had three children. In almost all (90%) households, the youngest child’s age was below 12 months. Table 2 Sociodemographic characteristics of the respondents Characteristics N (%) / Mean (Range) Gender Male 10 (33%) Female 20 (66%) Age (years) Household head Mean: 35.6 (30–65) Mother Mean: 25.25 (20–35) Educational level No education 3 (15%) Below primary 3 (15%) Primary 19 (63.3%) Secondary and above 5 (16.6%) Occupation Housewife 18 (60%) Animal husbandry 2 (6.7%) Construction worker 3 (10%) Barber 3 (10%) Fisherman 2 (6.7%) Farmer 1 (3.3%) Van puller 1 (3.3%) Residence type Char area 9 (30%) Non-char area 21 (70%) Household demographics Average number of family members 6.25 Average number of children 2.4 Youngest child's age 12 months 1 (5%) 2. Residents’ Experiences with Previous Soil Floors Before receiving the cement-based floor, all participating households had lived with soil floors for many years. Mothers and household heads described these floors as deeply embedded in everyday life, particularly in low-income and flood-prone settings. Very few respondents acknowledged soil floors to be practically advantageous while most of the participants reported substantial challenges in terms of durability, maintenance, hygiene, and household safety. 2.1 Perceived challenges with soil floors 2.1.1 Limited durability Majority of the respondents reported that soil floors are fragile and short-lived, particularly during the monsoon season. They reported repeated damage caused by heavy rainfall and flooding, which eroded the edges of the floor and left the surface muddy and uneven. They also informed even minor flooding damaged the floor requiring frequent repairs. Some participants noted that snakes and rodents burrowed into the soil, further weakening the stability of the floor. However, a small number of respondents reported that soil floors were reasonably durable as they can continuously re-coat and repair with mud or cow-dung. 2.1.2 Burden of ongoing maintenance All the mothers mentioned, maintaining households’ floor are considered exclusively women’s responsibility. Maintaining soil floors are always physically demanding and time-consuming. The mothers mentioned that keeping the floor clean and usable required frequent sweeping, regular re-coating with soil or cow dung. To avoid damage from floodwater they also needed to build temporary barriers around the house with sand sacks or layers of mud. They had repeat this multiple times during the monsoon. Some women also expressed the difficulty of bringing soil from outside the household compound and storing cow dung for future use. They mentioned, even after these efforts, the floors accumulated dust easily, and they have never been able maintain a clean indoor household environment. One mother shared her experience: "No, there were no advantages to a soil floor. During floods, the sides of the house would get damaged. Mice and insects would make holes in the soil, making the surface rough. My house would also get flooded." Mother, Lower embodied carbon floor (32years_IDI#01) 2.1.3 Pest and Animal Infestation Another concern reported by many households was pest and animal infestation. Respondents described observing holes in the floor made by rodents, insects, and, in some cases, snakes. The floor surface became further uneven and unsafe because of these holes, particularly for young children. 2.1.4 Health vulnerability of children Both adults and children suffered from health issues due to soil floors. Many mothers reported skin conditions such as rashes, itching, and scabies from walking barefoot on the floor. One respondent shared: "During floods, we suffered from various diseases, including diarrhea and fever. Walking on the muddy floor caused skin infections, sores, and scabies on our feet and hands." -Mother, Lower embodied carbon floor (32years_IDI#01) They said when their children were living in houses with soil floors, they suffered more frequent illnesses such as colds, diarrhea, worm infections, and fever. A mother highlighted her concerns: "Since children play on the floor, we had to be extremely careful. My child hasn’t crawl yet, but he will soon. Now that we have a concrete floor, I no longer worry about him putting soil in his mouth, which could make him sick." -Mother, Lower embodied carbon floor (18years_IDI#07) 2.2 Perceived advantages of the soil floor 2.2.1 Suitability for Riverine Areas Respondents from chars acknowledged that cement-based floors were better than soil floors, but they had relied on soil floors due to the frequent need to relocate their homes because of river erosion. Constructing a cement-based floor was seen as impractical because river erosion could easily wash away the house itself irrespective of floor type if the house is close to river. A mother from char explained: "We live near the river and don’t have the money. If we build a concrete floor and it gets washed away in river due to erosion, the money would be wasted. That’s why we preferred soil floors." –Mother, Traditional floor (34 years, IDI # 05) 2.2.2 Required less cleaning and safety for children In mainland areas, some respondents noted that soil floors absorbed spilled water quickly, reducing the need for immediate cleaning since water could pool on concrete floors. A few mothers also mentioned that their children were less likely to get injured if they fell on a soil floor compared to a cement-based floor. However, they admitted that the overall disadvantages of soil floors outweighed these benefits. 3. Acceptability of Lower embodied carbon and traditional cement-based floor We found that traditional and lower-embodied carbon floors were similarly acceptable to users of both types of floors. Households reporting significant improvements in hygiene, durability, and usability compared to soil floors for both types of intervention floors. Users reported satisfaction with the smooth, easy-to-clean surfaces of both types of cement-based floors and users from mainland considered both types of floors to be resilient to floods as well. Users for char were less hopeful about their resilience as they were more concerned about river erosion and proximity of their houses to rivers. Thus, below, we reported overall results for both types of cement-based floors. 3.1 Perceived benefits and user satisfaction 3.1.1 General satisfaction Most participants expressed overall satisfaction with their newly installed cement-based floors, whether traditional or lower embodied carbon floors. Out of 20 households, 18 stated that the new floors were an improvement over their previous soil floors, which required frequent maintenance and were prone to damage during floods. Households appreciated the easy cleaning process, durability, and resistance to insect infestations. 3.1.2 Improved hygiene and health benefits The mothers reported a reduction in skin diseases, itching, sores, and scabies, which were previously common due to exposure to unhygienic soil floors. Mothers reported that their children suffered fewer episodes of diarrhea, fever, and colds after the installation of cement floors. They also mentioned they were able to keep the house cleaner and more hygienic than before. A mother from the mainland stated: “Yes, the floor is very smooth. You can do everything you like -sitting, staying, eating- everything can be done according to your preference. -Mother, Traditional floor (20years_IDI#16) 3.1.3 Durability and protection against natural hazards Households living in flood-prone areas found the raised floor height beneficial, preventing water entry during floods. Cement-based floors provided resilience against heavy rains, unlike their previous soil floors, which were easily damaged, requiring frequent re-coating. One household head reported: The height of the new floor was raised so the flood water could not enter into the house. We think this floor will last for a very long time.”- Household Head, Lower embodied carbon floor (38years_IDI#06). 3.1.4 Comfort and usability Most of the female respondents reported that they could now sit and keep children on the floor without concerns about dirt or discomfort. The smooth surface was considered more pleasant compared to the rough and uneven soil floors. 3.1.5 Cleaning and hygienic practice The mothers mentioned they more frequently clean the current floor as it is easier to clean than soil floors. One mother explained: “Cleaning a cement floor is easier because it's smooth and even. Unlike uneven soil floors, it's simple to sweep or mop, and dirt doesn’t get trapped in cracks like soil floors as no matter how we maintain soil floors are always cracked. This makes it quicker to keep clean the cement floor with less effort”. -Mother, Traditional floor (30years_IDI#06) Participants reported that they sweep the floor once or twice a day and mop with water daily. They also started keeping shoes outside of house to keep the floor clean. One minor concern that mothers mentioned was that because cement-based floors do not absorb water, they had to mop the floor whenever any liquid spilled on the floor so that the children do not fall and hurt themselves. Seven households (four lower embodied carbon floors and three traditional cement-based floors) reported buying cleaning products and using liquid or powder detergent for cleaning the floor. Other houses cleaned their floors with water only instead of using cleaning products due to financial limitations. A mother from the mainland said- “We are facing a financial crisis now. So, it is difficult to buy such cleaning products.”- Mother, Lower embodied carbon floor (32years_IDI#01) A few mothers stated that apart from financial concerns, another reason for not purchasing cleaning products is that the floor becomes too slippery after cleaning, and they can slip on the floor as they are not accustomed to such a smooth surface. A mother said: I’ll start using soap flakes now. I didn’t use it before because I was pregnant. I was afraid of slipping and getting hurt. My kids are young, so I avoided soap for safety”- Mother, Traditional floor (30years_IDI#06) 3.2 Discontent and Challenges 3.2.1 Water seepage and design issues Nine households (six traditional and three lower embodied carbon) reported dissatisfaction with cement-based floors because of the lack of sloped edges at the home exterior and the non-absorbent surface allowed water to accumulate indoors when it rained. Households emphasized the need for a sloped design to facilitate proper water drainage. A household head from the mainland said- “The construction workers didn’t listen to me. I told them to make the edges sloped, but they didn’t listen. If you don't make the floor sloped, water gets inside easily. That's what is happening now; whenever it rains, water comes inside. Even if it rains a little, water gets inside our house”. -Household head, Lower embodied carbon floor (48years_IDI#04) 3.2.2 Cracks and durability concerns Eight households (six traditional and two lower embodied carbon) reported having small to large cracks in their floors, which they attributed to inadequate use of cement during construction. Some respondents were concerned that these cracks might worsen over time, reducing the durability of the floors. One mother had put as in: The sides of the floors have cracked and even broken. Those cracks are now spreading through the middle of the house. It has also become uneven and the stairs where we step to enter the house has been broken also.”- Mother, Lower embodied carbon floor (20years_IDI#14) 3.2.3 Slippery surface A few mothers (3) raised concerns about the smoothness of the floor, which caused children to slip and fall frequently. The fear of injuries made them cautious while leaving young children unattended. 4. Feasibility of lower-embodied carbon and traditional cement-based floors 4.1 Construction process and materials 4.1.1 Awareness of construction materials Most households were aware of the materials used in their floor construction. Those who received lower embodied carbon floors recognized that an additional ingredient (fly ash) was included, though they were unfamiliar with its name or purpose. Some households actively participated in the construction process by watering the floor for a week to aid with curing to increase durability. A mother who received a lower embodied carbon floor stated: To make this concrete floor, they first level the surface. Then they placed blocks on it. Then they mixed cement and sand together. They also brought a bag of mixture which I do not know what the name is. They called it a special mixture. They mixed all this to give the coating of the concrete floor”. –Mother, Lower embodied carbon floor (32yeras_IDI#01) 4.1.2 Installation timeframe and challenges The participants reported average construction period was four to five days. However, some households reported delays and the timeframe to be extended nearly a month, causing significant disruptions for affected families. The households had to relocate temporarily to their relatives or neighbor’s houses, leading to discomfort and privacy concerns. Additionally, a small number of women moved to their parent’s household during the construction period while their husband looked after the construction. Many respondents felt that the construction timeframe was reasonable, and the few challenges during the construction period were acceptable to them. A mother who faced difficulties stated: “There was heavy rain during that construction period. Our dresses got wet. We suffered a lot staying outside the house. It was quite impossible to stay outside. So, I called the officer (study field research officer) [and told him] that we were suffering while we stayed outside during construction. We did not have place to stay for that period. I had called him multiple times about this issue. I requested him to complete the work urgently.”- Mother, Lower embodied carbon floor (32years_IDI#01) In this regard, another woman who had to stay in her cow shed during construction said: We lived in the cow shed. It was the biggest suffering. The bed and other items were outside in the yard. It rained during that time, so a few things got damaged”- Mother, Lower embodied carbon floor (37years_IDI#05) Some respondents mentioned they put their furniture in neighbor’s houses during construction time, but it was challenging as the neighbor also had shortage of space in their houses. So, in some cases they kept the furniture outside the house in the open yard without shading. A mother stated: “During the construction, we moved all our furniture outside as the work was going on inside the house. It was monsoon, and it rained heavily for several days. Most of my furniture was damaged. Our dressing table started to rot”. – Mother, Traditional floor (30years_IDI#06)” 4.2 Maintenance and repair feasibility 4.2.1 Ease of maintenance Majority of the respondents reported that cement-based floors required significantly less maintenance compared to their previous soil floors, which needed regular re-coating with mud or cow dung. Most of the respondents mentioned now they just simply swept and moped their floors daily. 4.2.2 Repair challenges Out of nine households experiencing cracks, only two managed to repair them on their own. The other seven households could not repair the floors primarily due to financial constraints. A mother stated: “This is a concrete floor. So, it will be more expensive to repair than a soil floor. My previous floor was made of soil which required only soil to repair. It did not require money. I just needed to coat with mud.”- Mother, Lower embodied carbon floor (32years_IDI#01) Additionally, lower embodied carbon floor users found it difficult to identify the materials needed for repair, making them hesitant to invest in fixes. All the household heads mentioned repairing cement-based floors require cement, brick, and sand, which must be purchased. While these materials are available in mainland markets, char area residents must transport them from the mainland, increasing costs. Lower embodied carbon floor users also expressed their concern about the purchase and availability of the additional ingredient (fly ash) that was used in their floor as they were not informed by the workers about its name or purpose. A mother illustrated this concern- “You can fix the soil floor with your own hands using soil as much as possible. If it breaks, I could repair it by myself. But now, I can't do it in case of the concrete floor”. - Mother, Traditional floor (20years_IDI#14) Most household heads stated they would need to hire workers for repairs, as they lacked the necessary skills. Only two out of twenty households reported confidence in making repairs themselves. A mother from the mainland noted- My elder son is 17. He has become very interested in construction work. While the workers were at our home, he looked at them closely and learned a lot. He even constructed a concrete surface under the tubewell himself. We might not need to hire anyone for small tasks”-. Mother, Traditional floor (30years_IDI#06) 4.3 Willingness to pay for cement-based floors 4.3.1 Financial constraints All the respondents shared that they always wanted to upgrade their floors but could not install cement-based floors because of their financial constraints. When asked which housing elements they will prioritize for housing upgrades, they stated that installing a cement-based floor is more expensive than upgrading their roof or walls. Most households preferred to upgrade the roof and walls first because they are typically made of aluminum corrugated sheets, which are less expensive. Respondents from riverine islands mentioned that because their houses are prone to river erosion, they would invest in roofing and wall upgrades because they can be disassembled and re-used if they must move because of river erosion. Although many participants said they would recommend cement-based floors to neighbours, they acknowledged that cost was a major obstacle. They explained that, if it was not external support, installing such floors would have been out of reach. Also they mentioned if they had some savings for housing improvements, they would have prioritize roofing and walls over flooring. Though the households could mention the clear benefits of cement-based flooring, they viewed soil floors as financially practical because they required no cash outlay for upkeep. Traditional methods using soil, cow dung, and mud were free of cost, whereas repairing cement floors meant buying materials and hiring labor. 4.3.2 Loan and Subsidized Housing Options Though most participants said building a cement floor with their own funds was unrealistic, few of them had considered taking a loan for this purpose. Majority of them were not interested in microfinance, but they said if government or organizational subsidies for housing upgrades are provided, they will upgrade the house. But with that support, they would be improving roofs and walls first and then floors. 4.4 SERVQUAL Framework Analysis We applied the SERVQUAL model across five dimensions: Reliability, Assurance, Tangibles, Empathy, and Responsiveness to better understand perceptions of users. We found that most dimensions aligned well with participant experiences, reinforcing the high acceptability of both types of floors. High satisfaction with construction quality and the physical improvements referred to reliability and tangibility. Empathy, however, revealed gaps—such as not meeting the demand for sloped edges to prevent water pooling—highlighting the need for greater responsiveness to user preferences during design Table 3 Acceptability and feasibility of low carbon cement floor following SERVQUAL framework analysis Dimensions Findings 1. Reliability: Construction Timeframe and Performance Most of the participants found the construction process reliable. They reported that the installation took 4–5 days, which matched their expectations. Though some households experienced delays due to labor shortages or weather disruptions, these were considered manageable. The floors were also perceived as reliable in terms of durability and flood resilience particularly in mainland area. 2. Assurance: Trust in Materials and Construction Team The participants expressed their confidence in the construction team and the materials used. Even though they were unfamiliar with fly ash, they trusted the explanation provided by the study team. They did not raise any concern if fly ash is toxic or had any health effect. 3. Tangibles: Quality of Materials and Physical Appearance They praised both types of floors for their smooth surfaces, improved hygiene, and visual appeal. They noted that the cement-based floors were easier to clean and maintain than soil floors. The neat finish and raised height were seen as tangible improvements over previous flooring. 4. Empathy: Responsiveness to User Needs and Preferences This was the only dimension where expectations and experiences diverged. Several participants requested sloped edges to prevent water accumulation, but these design preferences were not accommodated. This lack of responsiveness to user input during construction led to dissatisfaction among some households. 5. Responsiveness: Support During Disruptions Participants appreciated the support provided by field staff during construction, especially when facing challenges such as relocation or weather-related disruptions. Discussion Among rural household members who received traditional and lower-embodied carbon cement-based floors within the past year, we found high levels of acceptability and feasibility for both types of floors. There were no significant differences between the two types of cement-based floors in terms of cleaning, maintenance, texture of the floor, or usability. Perceived environmental benefits or harms of each floor type did not influence acceptability. We found differences in perceived ease of floor repairs for traditional vs. lower-embodied carbon cement-based floors as the participants were not being familiar with raw materials (fly ash and concrete block) of the latter design. Rural household members’ satisfaction with their floor was largely shaped by the durability, design, comfort, and resilience of the floor to floods and river erosion. Overall, respondents felt that soil floors did not meet most of these criteria. Our findings demonstrate the acceptability of lower-embodied carbon cement-based floors, a potential planetary health intervention (Brousselle et al., 2022 ) that may improve human health while lowering negative environmental impacts from CO 2 emissions. An ongoing randomized trial will measure health impacts of the intervention (Rahman et al., 2025 ). Recipients of lower-embodied carbon floors reported fewer cracked floors compared to those that received traditional cement-based floors, which contributed to higher satisfaction. These findings are consistent with prior studies that have shown higher compressive strength and durability of cement mixes that incorporate fly ash or slags compared to Ordinary Portland cement mixes (Bouzoubaâ et al., 2000 ; Bouzoubaâ et al., 2001 ; Kore et al., 2024; Marey et al., 2024 ; Tan & Pu, 1998 ). The most reported structural concern with cement-based floors of both types was that the floor design did not have sloped edges at the home’s exteriors to facilitate water run off during rainfall events. This highlights that a more user-centered design approach should be considered in future floor upgrade projects in rural, low-resource, flood-prone communities. Though the respondents preferred cement-based floors, they reported that they would not have been able to install them without financial support which is consistent with findings from prior studies (Hassan et al., 2000 ). Study conducted in northwestern Bangladesh found that the prevalence of homes constructed with bricks and cement was higher in communities with higher income levels (Kafy et al., 2017 ). Upon assessing the willingness to pay for cement-based floors, respondents indicated a clear preference for government housing upgradation subsidies over loans or microfinance. This findings are similar with other study results which highlighted the importance of incentives and government endorsement for constructing and scaling up sustainable housing in both urban and rural areas (Acklin et al., 2025 ; Khan & Shammi, 2022 ). Participants reported frequent structural damage due to climatic hazards like floods and river erosion; maintenance difficulties; snake and pest infestation; and health issues like skin diseases, rashes, and diarrhea among children as challenges of soil floors. Other studies also reported that damp surfaces, mold due to humidity and moisture, excessive shrinkage cracks, and structural erosion following rainfall and floods are common problems with soil floors (Cluster, 2018 ; Islam & Haque, 2009 ). Some studies have also found that soil floors act as reservoirs for parasites, viruses, and bacteria, potentially leading to diarrheal, dermatological, and respiratory illnesses (Benjamin-Chung et al., 2021 ; Boehm et al., 2016 ; Legge et al., 2023 ; Nguyen et al., 2024 ; Pickering et al., 2012 ; Tabassum et al., 2024 ). Majority of the respondents preferred cement-based floors over soil floors, while a small number who resided on chars preferred soil floors. As a reason they mentioned about frequent relocation due to river erosion; soil floors could be rebuilt more easily than cement-based floors. They also mentioned repairing soil floors was simple as it could be repaired without special materials or skilled labor. Previous studies also noted that soil and sand remain common flooring choices in Bangladesh because of the affordability, widely availability, heat resilience and easy to construct, while also producing lower CO₂ emissions compared to bricks and cement (Islam & Haque, 2009 ; Seraj & Hodgson, 2000 ). Through SERVQUAL analysis we found that four dimensions—Reliability, Assurance, Tangibles, and Responsiveness—aligned well with study participant’s experiences, reinforcing the high acceptability of both floor types (Parasuraman et al., 1988 ). However, the Empathy dimension revealed a gap: households preferred design features such as sloped edges to prevent water pooling inside the house, but these preferences were not incorporated in the first place (Shafieisabet et al., 2017 ). After this study, the design and homes were modified to include these changes, underscoring the importance of integrating user feedback early in the design process. We recommend future housing programs to prioritize community input from the outset to improve satisfaction and usability. In terms of limitation, small sample size and limited geographic scope mean the findings may not be generalizable to all rural populations, and further research in diverse settings is needed. Conclusion This study showed cement-based floors- both traditional and those incorporating lower embodied-carbon materials were generally well received by rural households in northwestern Bangladesh. The participants appreciated cement-based floors for their strength, ease of cleaning, and the added protection they offered against seasonal flooding and heavy rains. As reported by the participants floors made with fly ash performed on par with, and sometimes better than, traditional designs, noting fewer cracks as a key advantage. However, willingness to pay for these improvements was tempered by financial realities. The cost of raw materials and labor was repeatedly cited as a major barrier, making self-financed installation unachievable for most households. Respondents preferred government-supported housing programs or subsidies for housing improvement. These findings identified an opportunity for integrating lower embodied-carbon flooring into broader housing and health initiatives. These initiatives could improve living conditions while reducing environmental impact from high carbon emitting housing materials. At the same time, policies promoting lower embodied carbon materials and making them affordable will be essential for strengthening resilience and improving quality of life in rural areas. Declarations Declaration of Conflicting Interests Authors declare no competing interest related to this publication. Acknowledgments icddr,b is grateful to the Governments of Bangladesh and Government of Canada for providing core/unrestricted support. The study team is grateful to the community members who participated in the study. Ethical Consideration The trial protocol was approved by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Ethical Review Committee (PR-22069), and the Stanford Institutional Review Board (63990). Written informed consent was obtained from all participants before the IDIs. The consent forms were read aloud to ensure comprehension, and participants were given the opportunity to read the form themselves and ask any questions before providing their signatures. For those who were illiterate, a thumb impression was taken after they had listened to the consent details. Author Contributions Jade Benjamin Chung, Sarah Billington and Mahbubur Rahman contributed to the study conception and design. Material preparation, data collection and analysis were performed by Farjana Jahan, Jannat-E-Tajreen, Afsana Yeamin, Abul Kashem Shaob and Suhi Hanif. The first draft of the manuscript was written by Farjana Jahan and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript. Funding The study was funded by the King Center for Global Development at Stanford University. References Acklin, M., Graham, J. P., & Benjamin-Chung, J. (2025). Healthy homes: Stakeholder perspectives on housing interventions to reduce environmentally mediated infections. PLOS Global Public Health , 5(4), e0003805. Ali, M., Saidur, R., & Hossain, M. (2011). A review on emission analysis in cement industries. Renewable and Sustainable Energy Reviews , 15 (5), 2252–2261. Beketie, K. T., Angessa, A. T., Zeleke, T. T., & Ayal, D. Y. (2022). Impact of cement factory emission on air quality and human health around Mugher and the surrounding villages, Central Ethiopia. Air Quality Atmosphere & Health , 1–15. Benjamin-Chung, J., Crider, Y. S., Mertens, A., Ercumen, A., Pickering, A. J., Lin, A., Steinbaum, L., Swarthout, J., Rahman, M., Parvez, S. M., Haque, R., Njenga, S. M., Kihara, J., Null, C., Luby, S. P., Colford, J. M. Jr., & Arnold, B. F. (2021). Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study. 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Conference on climate change impacts and adaptation strategies for Bangladesh, Dhaka, Bangladesh. Kafy, A. A., Ferdous, L., & Wakil, M. (2017). An Analysis on Influencing Factors of Rural Housing and Settlement Pattern in Rajshahi, Bangladesh. Khan, F., & Shammi, M. (2022). Perceptions and Barriers to the Construction of Green Buildings (GB) in Bangladesh. 13 , 13–27. Kore, S., J.S, S., N, B., & Bhoyar, S. (2024). Feasibility Study of Materials on Developing Green Materials to Achieve Sustainability in Building Construction . https://doi.org/10.1007/978-3-031-50024-4_8 Legge, H., Pullan, R. L., & Sartorius, B. (2023). Improved household flooring is associated with lower odds of enteric and parasitic infections in low- and middle-income countries: A systematic review and meta-analysis. PLOS Glob Public Health , 3 (12), e0002631. https://doi.org/10.1371/journal.pgph.0002631 Marey, H., Kozma, G., & Szabó, G. (2024). Green concrete materials selection for achieving circular economy in residential buildings using system dynamics. Cleaner Materials , 11 , 100221. https://doi.org/10.1016/j.clema.2024.100221 Nguyen, A. T., Ratnasiri, K., Heitmann, G. B., Tazin, S., Anderson, C., Hanif, S., Yeamin, A., Shoab, A. K., Shanta, I. S., & Jahan, F. (2024). Pathogens and Antimicrobial Resistance Genes in Household Environments: A Study of Soil Floors and Cow Dung in Rural Bangladesh. bioRxiv , 2024.2012. 2006.627269. Parasuraman, A. P., Zeithaml, V., & Berry, L. (1988). SERVQUAL: A multiple- Item Scale for measuring consumer perceptions of service quality. Journal of retailing . Pickering, A. J., Julian, T. R., Marks, S. J., Mattioli, M. C., Boehm, A. B., Schwab, K. J., & Davis, J. (2012). Fecal Contamination and Diarrheal Pathogens on Surfaces and in Soils among Tanzanian Households with and without Improved Sanitation. Environmental Science & Technology , 46 (11), 5736–5743. https://doi.org/10.1021/es300022c Rahman, A. M. (2022). CO2 emission from brickfields in Bangladesh: Can ethical responsibility by doing reduce level of emission. Athens Journal of Social Sciences , 9 (3), 255–272. Rahman, M., Jahan, F., Hanif, S., Yeamin, A., Shoab, A. K., Andrews, J. R., Lu, Y., Billington, S., Pilotte, N., & Shanta, I. S. (2025). Effects of household concrete floors on maternal and child health: the CRADLE trial–a randomised controlled trial protocol. BMJ open , 15 (3), e090703. Rashid, D. M. U. (2017). The continuous process and purposes of the transformation of rural settlements in Bangladesh. Available at SSRN 4997907 . Saunders, C. H., Sierpe, A., von Plessen, C., Kennedy, A. M., Leviton, L. C., Bernstein, S. L., Goldwag, J., King, J. R., Marx, C. M., Pogue, J. A., Saunders, R. K., Van Citters, A., Yen, R. W., Elwyn, G., & Leyenaar, J. K. (2023). Practical thematic analysis: a guide for multidisciplinary health services research teams engaging in qualitative analysis. Bmj , 381 , e074256. https://doi.org/10.1136/bmj-2022-074256 Seraj, S. M., & Hodgson, R. L. P. (2000). Affordable village building technologies: from research and realization . Second Dhaka Housing & Hazards International Seminar Dhaka. Shafie, H., & Rahman, S. (2009). Traditional coping strategies of rural people living in flood-prone areas in North-West Bangladesh. Dhaka: Rangpur Dinajpur Rural Service (RDRS) . Shafieisabet, N., Doostisabzi, B., & Azharianfar, S. (2017). An Assessment of Villagers’ Satisfaction with the Quality of Construction-Related Services Based on the SERVQUAL Model. Current Urban Studies , 5 (1), 20–34. Shahen, M. A. (2024). Market Feasibility and Strategies for the Environment-Friendly Bricks in Bangladesh: A Learning from the Southern Part of Bangladesh. Am J Environ Econ , 3 (1), 50–58. Tabassum, T., Hossain, M. S., Ercumen, A., Benjamin-Chung, J., Abedin, M. F., Rahman, M., Jahan, F., Haque, M., & Mahmud, Z. H. (2024). Isolation and characterization of cefotaxime resistant Escherichia coli from household floors in rural Bangladesh. Heliyon , 10 (14). https://doi.org/10.1016/j.heliyon.2024.e34367 Tan, K., & Pu, X. (1998). Strengthening effects of finely ground fly ash, granulated blast furnace slag, and their combination. Cement and Concrete Research , 28 (12), 1819–1825. Tusting, L. S., Gething, P. W., Gibson, H. S., Greenwood, B., Knudsen, J., Lindsay, S. W., & Bhatt, S. (2020). Housing and child health in sub-Saharan Africa: A cross-sectional analysis. Plos Medicine , 17 (3), e1003055. https://doi.org/10.1371/journal.pmed.1003055 Worrell, E., Price, L., Martin, N., Hendriks, C., & Meida, L. O. (2001). Carbon dioxide emissions from the global cement industry. Annual review of energy and the environment , 26 (1), 303–329. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8714894","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603865805,"identity":"1e4a76c5-3269-4938-a70b-83c74ea45871","order_by":0,"name":"Farjana 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00:23:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8714894/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8714894/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104428845,"identity":"96b4dc7a-4ef2-48a0-a249-a106ca0423c5","added_by":"auto","created_at":"2026-03-11 15:14:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":155022,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCross sectional view of the (a) traditional clay brick-cement and (b) concrete block-cement-fly ash-based floors (Architectural drawing by Elizabeth Jackson)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8714894/v1/2048b2c339965093e728efb0.png"},{"id":105903800,"identity":"e2d9f5f7-6658-4823-bef3-6637a54679d4","added_by":"auto","created_at":"2026-04-01 09:53:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1501067,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8714894/v1/8a49fdea-ebaf-492b-8780-d07866e8bfb0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Soil to Cement: Acceptability and Lived Experiences of Low‑Carbon Cement Floors in Rural Bangladesh","fulltext":[{"header":"Background","content":"\u003cp\u003eIn low- and middle-income countries, many homes are constructed with soil floors, but the proportion of homes with concrete floors has increased over time (Colston et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tusting et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In rural areas, 63% of households have floors made of earth, sand, or dung (ICF, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and soil floors and walls are more common among impoverished households in rural areas (Cluster, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Ferdous et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Gunnsteinsson et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Hasan et al.; Shafie \u0026amp; Rahman, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Rapid changes in social and economic conditions are driving the transformation of rural settlements. Economic growth, technological advancements, and urbanization have significantly influenced the structure of rural housing (Hossain, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Islam et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). As the economy improves, more households are able to afford to replace soil floors with cement-based floors (Rashid, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e); in 2022, 34% of rural homes had cement-based floors (ICF, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe production of construction materials used in cement floors contribute significantly to environmental pollution through carbon emissions. Cement-based floors consist of a sand layer, covered by a layer of bricks and topped with a cement-based mortar and sealant. Manufacturing of Ordinary Portland cement (i.e., \u0026ldquo;traditional\u0026rdquo; cement) alone is responsible for about 5% of global anthropogenic CO\u003csub\u003e2\u003c/sub\u003e emissions, making the cement industry an important sector for CO\u003csub\u003e2\u003c/sub\u003e emission mitigation strategies (Beketie et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Etim et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). During cement manufacturing, CO\u003csub\u003e2\u003c/sub\u003e is emitted when limestone is calcinated, from combustion of fuels in the kiln (Ali et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Worrell et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). Brick production also contributes substantially to CO\u003csub\u003e2\u003c/sub\u003e emissions in Bangladesh; in 2020, Bangladesh emitted CO\u003csub\u003e2\u003c/sub\u003e from conventional brickfields over 9.8\u0026nbsp;million tons (Imran et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Rahman, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Bangladesh boasts a significant brick production industry, with over 7,000 brick kilns producing nearly 23\u0026nbsp;billion bricks annually (Rahman, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo reduce construction-related pollution, Bangladesh is now producing environmentally friendly materials like lower-embodied carbon concrete blocks containing fly ash (Shahen, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). To reduce embodied carbon, concrete blocks are produced with a portion of the needed cement replaced with fly ash or slag. Coal-burning power plants generate fly ash as a byproduct of electricity production. Repurposing fly ash in construction not only diverts this industrial byproduct from landfills, where it could pollute soil with toxins, but also reduces the embodied carbon of cement structures. Slag is a byproduct of steel production and is often used to replace a portion of Portland cement in concrete (Shahen, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Additionally, concrete mixes incorporating fly ash and/or slag have been shown to have higher compressive strength than traditional mixes (Bouzouba\u0026acirc; et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Bouzouba\u0026acirc; et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Tan \u0026amp; Pu, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Concrete blocks constructed with fly ash/slag have been piloted at a small scale in the construction of roads in Dhaka, Bangladesh. To our knowledge, cement-based floors using fly ash or slag have not yet been adopted in household floor construction in rural Bangladesh.\u003c/p\u003e \u003cp\u003eIn this qualitative study, we explored the feasibility and acceptability among household members of floors constructed with low-carbon blocks and a low-carbon cement-based finish and compared it to that of traditional cement-based floors constructed with clay bricks and Ordinary Portland cement in a rural community in Bangladesh.\u003c/p\u003e \u003cp\u003e \u003cb\u003eObjectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCompare the acceptability and feasibility of lower-embodied carbon vs. traditional cement-based household floors among household members\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAssess the willingness to pay for lower-embodied carbon vs. traditional cement-based floors among household members\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eStudy site and context\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study was conducted in Chauhali and Belkuchi sub-districts in Sirajganj district and Nagarpur sub-district of Tangail District of Bangladesh. The study was nested in a randomized controlled trial (NCT05372068) to determine whether cement based floors reduce child STH infection and diarrhea (Rahman et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The study enrolled 800 homes with soil floors in which a pregnant woman in her second or third trimester resided. The trial randomized households 1:1 to intervention (cement-based floors) or control (no intervention). In the intervention arm, cement-based floors were installed in homes with soil floors in 400 intervention households before the birth cohort was born. In a random subset of the intervention group (N\u0026thinsp;=\u0026thinsp;50), to reduce embodied carbon, we used commercially produced concrete blocks (Blocktech, Rupganj, Bangladesh) with cement, sand, water and recycled slag instead of traditional clay bricks, and a neat cement finish using a mix in which 25% of Ordinary Portland cement was replaced with fly ash (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The concrete blocks were composed of approximately 15% cement, 30% slag, and 55% sand, with the sand portion consisting of Sylhet/coarse sand and White sand in a 1:1 ratio. A homogeneous mixture is formed from the dry raw materials with the addition of water, and then the mixture is transferred to a machine where, under high pressure and vibration, concrete blocks are made. Conventional fired clay bricks have the same structural functionality but require kiln firing that results in significant carbon emissions while concrete blocks were cured at ambient temperatures, which lead to a reduced carbon footprint. In current study, concrete blocks were cured by drying in the sun for 15 consecutive days. This allowed the blocks to gradually reach their optimum strength and reduced carbon emission associated with kiln firing. During floor installation, the study team explained to participants in simple terms that the fly ash floors would offer comparable strength, durability, and ease of cleaning compared to traditional brick cement-based floors, while also providing environmental benefits through reduced pollution during production. Any major cracks in cement-based floors were repaired within one year of installation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e(Insert\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003eDesign of traditional and lower-embodied carbon cement-based floors\u003c/h3\u003e\n\u003cp\u003eTo design the concrete block-cement-fly ash-based floor, we consulted with stakeholders implementing housing programs in rural Bangladesh and civil engineers from academia. Both types of floors used layers of similar height (101-110cm), varying with the existing soil foundation level. The plinth (side wall) surrounding the floor layers were constructed with layers of clay bricks or concrete blocks which had been plastered with cement-water mixture. The width of plinth was 25.4 cm, with height equal to that of the floor. The design (shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) is summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe layers and materials of the traditional and lower-embodied carbon cement-based floor\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePurpose\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTraditional clay-brick cement-based floor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConcrete block-cement-fly ash floor\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTop layer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis layer is the final visible layer that provides a smooth surface.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeat finish with ordinary Portland cement-water based mixture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeat finish with cement-water based mixture with 25% of cement replaced fly ash\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCement mortar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis mortar layer serves as an intermediary that bonds the finish to the supporting structure and supports the floor\u0026rsquo;s load.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5 cm layer of mixture of cement and sand (1:4 ratio) with water.\u003c/p\u003e \u003cp\u003eFor 2.5 cm thickness amount of cement and sand required were:\u003c/p\u003e \u003cp\u003ecement: 12 kg/m2\u003c/p\u003e \u003cp\u003esand: 0.348 cubic feet/m2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003emixture of\u003c/p\u003e \u003cp\u003ecement, coarse aggregates, and sand (1:2:4 ratio) with water.\u003c/p\u003e \u003cp\u003eFor 5cm thickness amount of cement, coarse aggregates and sand used were:\u003c/p\u003e \u003cp\u003ecement: 15.4 kg/m2\u003c/p\u003e \u003cp\u003eaggregates: 1.53 cubic feet/m2\u003c/p\u003e \u003cp\u003esand: 0.769 cubic feet/m2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe brick soling acts as a rigid, load-distributing layer that enhances the overall stability of the floor system.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSingle layer of clay brick soling (7.6 cm). The dimension of a single traditional clay brick was 25.4 cm x 12.7 cm x 7.6 cm.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle layer of concrete block soling (10 cm). The dimension of concrete block was 38 cm x 22.6 cm x 10 cm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis layer levels the surface. It also helps to manage moisture levels and provides a cushioning effect between the brick soling and the underlying foundation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSand layer (15 cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSand layer (12.5\u003c/p\u003e \u003cp\u003ecm)\u003c/p\u003e \u003cp\u003eThe sand layer used a lower height to accommodate the greater height of concrete blocks compared to bricks.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoundation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis foundation is the primary support for the entire floor assembly. This foundation is made of the existing soil floor, the soil is being compacted and made even by pressing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompacted soil foundation (76 cm).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCompacted soil foundation (76 cm).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eStudy design and participants\u003c/h3\u003e\n\u003cp\u003eFrom September to November 2024, we conducted in-depth interviews with 20 randomly selected intervention households with lower-embodied carbon cement-based floors (n\u0026thinsp;=\u0026thinsp;10) and traditional cement-based floors (n\u0026thinsp;=\u0026thinsp;10). Most participants had homes with only one large room with a partition, and cement-based floors were installed on both sides of the partition as part of this study. A few households had multiple rooms, but only the rooms where the pregnant mother was sleeping and using for their children\u0026rsquo;s playtime and feeding received the cement-based floor, while the remaining rooms for other household members still had soil floors. From each of the intervention households, mothers were selected as participants and household heads were interviewed based on availability. We interviewed 20 mothers and 10 household heads in total (10 mothers and five household heads from each type of floor). Among the 30 respondents, 20 were mothers of index children in the CRADLE trial, and the remaining 10 respondents were household heads including husband or father-in-law of the enrolled mother. Out of 20 households, 11 resided on the mainland, and 9 resided on chars which are riverine islands that form in riverbeds or near riverbanks due to the build-up of sand, silt, and other sediments. These landforms are common in large river systems and often appear and disappear over time because of erosion and flooding.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eWe conducted in-depth interviews (IDIs) within three to ten months after floors were installed to evaluate the acceptability and feasibility of lower-embodied carbon vs. traditional cement-based floors. To assess feasibility, we evaluated whether households experienced any difficulties during the construction of the cement-based floors. Acceptability was operationalized as the respondent\u0026rsquo;s assessment of their floor\u0026rsquo;s benefits, durability, hygiene, visual appearance, safety, maintenance, usablity, and flood resilience. We defined feasibility as the respondent\u0026rsquo;s opinion on their floor\u0026rsquo;s practicality and sustainability considering installation time, construction methods, availability and affordability of raw material, maintenance requirements, and long-term repair needs. We developed the interview guideline (Supplementary material S1 \u0026amp; S2) based on multi-faceted research SERVQUAL tool (Parasuraman et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1988\u003c/span\u003e), which is used to assess consumer expectations and perceptions of a service across five dimensions. Each IDIs lasted for 40\u0026ndash;50 minutes.\u003c/p\u003e\n\u003ch3\u003eQualitative data analysis\u003c/h3\u003e\n\u003cp\u003eWe used thematic content analysis techniques, following an inductive process to analyze the data. A team of three researchers transcribed the audio recordings into verbatim Bengali in a word processor. Then the transcripts were translated into English by two qualitative researchers (anthropologist). A third researcher checked all translations for errors. The transcripts were imported into Atlas.ti (version 5.2) for systematic coding.\u003c/p\u003e \u003cp\u003e To begin the coding process two researchers carefully reading all transcripts, summaries, and field notes and developed a preliminary set of themes and codes. To ensure the consistency of the coding process, we chose two verbatim transcripts initially for coding by two qualitative researchers and the intercoder reliability showed substantial reliability by cohen\u0026rsquo;s kappa computation (k\u0026thinsp;=\u0026thinsp;0.72). After incorporating the new codes, a third coder again independently reviewed the codes against another transcript, and no new codes were found. During the coding process, new codes and themes that emerged inductively from the data were added to the initial framework. Thus, both new codes and new overarching themes were identified beyond those generated at the start. Finally, two coders were responsible for coding the whole data set using the final codebook. Once coding was complete, all coded data extracts were collated and systematically organized into final themes, which formed the basis of our analysis and interpretation. Thematic analysis approach was utilized to identify the key themes as headings to organize and summarize thematic information from all participants (Braun \u0026amp; Clarke, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Saunders et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) consensus.\u003c/p\u003e\n\u003ch3\u003eEthical Consideration\u003c/h3\u003e\n\u003cp\u003e The trial protocol was approved by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Ethical Review Committee (PR-22069), and the Stanford Institutional Review Board (63990). Written informed consent was obtained from all participants before the IDIs. The consent forms were read aloud to ensure comprehension, and participants were given the opportunity to read the form themselves and ask any questions before providing their signatures. For those who were illiterate, a thumb impression was taken after they had listened to the consent details.\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. Sociodemographic information\u003c/h3\u003e\n\u003cp\u003eThe participants were mostly literate, and the majority had completed education up to grade five. Mothers\u0026rsquo; age range varied from 20 to 35 years, and household heads\u0026rsquo; age range was from 30 to 40 years old for husbands; all fathers-in-law were older than 60 years (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Women were mostly housewives, and household heads were mostly construction workers. Some household heads were also barbers, van pullers, fishermen and farmers. The majority of households had six or more total members, and on average, mothers had three children. In almost all (90%) households, the youngest child\u0026rsquo;s age was below 12 months.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%) / Mean (Range)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (66%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean: 35.6 (30\u0026ndash;65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean: 25.25 (20\u0026ndash;35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (16.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (60%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnimal husbandry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruction worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFisherman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVan puller\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChar area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-char area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold demographics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage number of family members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage number of children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoungest child's age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (95%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e2. Residents’ Experiences with Previous Soil Floors\u003c/h3\u003e\n\u003cp\u003eBefore receiving the cement-based floor, all participating households had lived with soil floors for many years. Mothers and household heads described these floors as deeply embedded in everyday life, particularly in low-income and flood-prone settings. Very few respondents acknowledged soil floors to be practically advantageous while most of the participants reported substantial challenges in terms of durability, maintenance, hygiene, and household safety.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Perceived challenges with soil floors\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.1.1 Limited durability\u003c/h2\u003e \u003cp\u003eMajority of the respondents reported that soil floors are fragile and short-lived, particularly during the monsoon season. They reported repeated damage caused by heavy rainfall and flooding, which eroded the edges of the floor and left the surface muddy and uneven. They also informed even minor flooding damaged the floor requiring frequent repairs. Some participants noted that snakes and rodents burrowed into the soil, further weakening the stability of the floor. However, a small number of respondents reported that soil floors were reasonably durable as they can continuously re-coat and repair with mud or cow-dung.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2 Burden of ongoing maintenance\u003c/h2\u003e \u003cp\u003eAll the mothers mentioned, maintaining households\u0026rsquo; floor are considered exclusively women\u0026rsquo;s responsibility. Maintaining soil floors are always physically demanding and time-consuming. The mothers mentioned that keeping the floor clean and usable required frequent sweeping, regular re-coating with soil or cow dung. To avoid damage from floodwater they also needed to build temporary barriers around the house with sand sacks or layers of mud. They had repeat this multiple times during the monsoon. Some women also expressed the difficulty of bringing soil from outside the household compound and storing cow dung for future use. They mentioned, even after these efforts, the floors accumulated dust easily, and they have never been able maintain a clean indoor household environment.\u003c/p\u003e \u003cp\u003eOne mother shared her experience:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"No, there were no advantages to a soil floor. During floods, the sides of the house would get damaged. Mice and insects would make holes in the soil, making the surface rough. My house would also get flooded.\" Mother, Lower embodied carbon floor (32years_IDI#01)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.1.3 Pest and Animal Infestation\u003c/h2\u003e \u003cp\u003eAnother concern reported by many households was pest and animal infestation. Respondents described observing holes in the floor made by rodents, insects, and, in some cases, snakes. The floor surface became further uneven and unsafe because of these holes, particularly for young children.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e2.1.4 Health vulnerability of children\u003c/h2\u003e \u003cp\u003eBoth adults and children suffered from health issues due to soil floors. Many mothers reported skin conditions such as rashes, itching, and scabies from walking barefoot on the floor. One respondent shared:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"During floods, we suffered from various diseases, including diarrhea and fever. Walking on the muddy floor caused skin infections, sores, and scabies on our feet and hands.\" -Mother, Lower embodied carbon floor (32years_IDI#01)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThey said when their children were living in houses with soil floors, they suffered more frequent illnesses such as colds, diarrhea, worm infections, and fever. A mother highlighted her concerns:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Since children play on the floor, we had to be extremely careful. My child hasn\u0026rsquo;t crawl yet, but he will soon. Now that we have a concrete floor, I no longer worry about him putting soil in his mouth, which could make him sick.\" -Mother, Lower embodied carbon floor (18years_IDI#07)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Perceived advantages of the soil floor\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Suitability for Riverine Areas\u003c/h2\u003e \u003cp\u003eRespondents from chars acknowledged that cement-based floors were better than soil floors, but they had relied on soil floors due to the frequent need to relocate their homes because of river erosion. Constructing a cement-based floor was seen as impractical because river erosion could easily wash away the house itself irrespective of floor type if the house is close to river. A mother from char explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We live near the river and don\u0026rsquo;t have the money. If we build a concrete floor and it gets washed away in river due to erosion, the money would be wasted. That\u0026rsquo;s why we preferred soil floors.\" \u0026ndash;Mother, Traditional floor (34 years, IDI # 05)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Required less cleaning and safety for children\u003c/h2\u003e \u003cp\u003eIn mainland areas, some respondents noted that soil floors absorbed spilled water quickly, reducing the need for immediate cleaning since water could pool on concrete floors. A few mothers also mentioned that their children were less likely to get injured if they fell on a soil floor compared to a cement-based floor. However, they admitted that the overall disadvantages of soil floors outweighed these benefits.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003e3. Acceptability of Lower embodied carbon and traditional cement-based floor\u003c/h3\u003e\n\u003cp\u003eWe found that traditional and lower-embodied carbon floors were similarly acceptable to users of both types of floors. Households reporting significant improvements in hygiene, durability, and usability compared to soil floors for both types of intervention floors. Users reported satisfaction with the smooth, easy-to-clean surfaces of both types of cement-based floors and users from mainland considered both types of floors to be resilient to floods as well. Users for char were less hopeful about their resilience as they were more concerned about river erosion and proximity of their houses to rivers. Thus, below, we reported overall results for both types of cement-based floors.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Perceived benefits and user satisfaction\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1 General satisfaction\u003c/h2\u003e \u003cp\u003eMost participants expressed overall satisfaction with their newly installed cement-based floors, whether traditional or lower embodied carbon floors. Out of 20 households, 18 stated that the new floors were an improvement over their previous soil floors, which required frequent maintenance and were prone to damage during floods. Households appreciated the easy cleaning process, durability, and resistance to insect infestations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 Improved hygiene and health benefits\u003c/h2\u003e \u003cp\u003eThe mothers reported a reduction in skin diseases, itching, sores, and scabies, which were previously common due to exposure to unhygienic soil floors. Mothers reported that their children suffered fewer episodes of diarrhea, fever, and colds after the installation of cement floors. They also mentioned they were able to keep the house cleaner and more hygienic than before. A mother from the mainland stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, the floor is very smooth. You can do everything you like -sitting, staying, eating- everything can be done according to your preference. -Mother, Traditional floor (20years_IDI#16)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Durability and protection against natural hazards\u003c/h2\u003e \u003cp\u003eHouseholds living in flood-prone areas found the raised floor height beneficial, preventing water entry during floods. Cement-based floors provided resilience against heavy rains, unlike their previous soil floors, which were easily damaged, requiring frequent re-coating. One household head reported:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe height of the new floor was raised so the flood water could not enter into the house. We think this floor will last for a very long time.\u0026rdquo;- Household Head, Lower embodied carbon floor (38years_IDI#06).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003e3.1.4 Comfort and usability\u003c/h2\u003e \u003cp\u003eMost of the female respondents reported that they could now sit and keep children on the floor without concerns about dirt or discomfort. The smooth surface was considered more pleasant compared to the rough and uneven soil floors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e3.1.5 Cleaning and hygienic practice\u003c/h2\u003e \u003cp\u003eThe mothers mentioned they more frequently clean the current floor as it is easier to clean than soil floors. One mother explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Cleaning a cement floor is easier because it's smooth and even. Unlike uneven soil floors, it's simple to sweep or mop, and dirt doesn\u0026rsquo;t get trapped in cracks like soil floors as no matter how we maintain soil floors are always cracked. This makes it quicker to keep clean the cement floor with less effort\u0026rdquo;. -Mother, Traditional floor (30years_IDI#06)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants reported that they sweep the floor once or twice a day and mop with water daily. They also started keeping shoes outside of house to keep the floor clean. One minor concern that mothers mentioned was that because cement-based floors do not absorb water, they had to mop the floor whenever any liquid spilled on the floor so that the children do not fall and hurt themselves. Seven households (four lower embodied carbon floors and three traditional cement-based floors) reported buying cleaning products and using liquid or powder detergent for cleaning the floor. Other houses cleaned their floors with water only instead of using cleaning products due to financial limitations. A mother from the mainland said-\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We are facing a financial crisis now. So, it is difficult to buy such cleaning products.\u0026rdquo;- Mother, Lower embodied carbon floor (32years_IDI#01)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA few mothers stated that apart from financial concerns, another reason for not purchasing cleaning products is that the floor becomes too slippery after cleaning, and they can slip on the floor as they are not accustomed to such a smooth surface. A mother said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI\u0026rsquo;ll start using soap flakes now. I didn\u0026rsquo;t use it before because I was pregnant. I was afraid of slipping and getting hurt. My kids are young, so I avoided soap for safety\u0026rdquo;- Mother, Traditional floor (30years_IDI#06)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Discontent and Challenges\u003c/h2\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Water seepage and design issues\u003c/h2\u003e \u003cp\u003eNine households (six traditional and three lower embodied carbon) reported dissatisfaction with cement-based floors because of the lack of sloped edges at the home exterior and the non-absorbent surface allowed water to accumulate indoors when it rained. Households emphasized the need for a sloped design to facilitate proper water drainage. A household head from the mainland said-\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The construction workers didn\u0026rsquo;t listen to me. I told them to make the edges sloped, but they didn\u0026rsquo;t listen. If you don't make the floor sloped, water gets inside easily. That's what is happening now; whenever it rains, water comes inside. Even if it rains a little, water gets inside our house\u0026rdquo;. -Household head, Lower embodied carbon floor (48years_IDI#04)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Cracks and durability concerns\u003c/h2\u003e \u003cp\u003eEight households (six traditional and two lower embodied carbon) reported having small to large cracks in their floors, which they attributed to inadequate use of cement during construction. Some respondents were concerned that these cracks might worsen over time, reducing the durability of the floors. One mother had put as in:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe sides of the floors have cracked and even broken. Those cracks are now spreading through the middle of the house. It has also become uneven and the stairs where we step to enter the house has been broken also.\u0026rdquo;- Mother, Lower embodied carbon floor (20years_IDI#14)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section3\"\u003e \u003ch2\u003e3.2.3 Slippery surface\u003c/h2\u003e \u003cp\u003eA few mothers (3) raised concerns about the smoothness of the floor, which caused children to slip and fall frequently. The fear of injuries made them cautious while leaving young children unattended.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003e4. Feasibility of lower-embodied carbon and traditional cement-based floors\u003c/h3\u003e\n\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Construction process and materials\u003c/h2\u003e \u003cdiv id=\"Sec32\" class=\"Section3\"\u003e \u003ch2\u003e4.1.1 Awareness of construction materials\u003c/h2\u003e \u003cp\u003eMost households were aware of the materials used in their floor construction. Those who received lower embodied carbon floors recognized that an additional ingredient (fly ash) was included, though they were unfamiliar with its name or purpose. Some households actively participated in the construction process by watering the floor for a week to aid with curing to increase durability. A mother who received a lower embodied carbon floor stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTo make this concrete floor, they first level the surface. Then they placed blocks on it. Then they mixed cement and sand together. They also brought a bag of mixture which I do not know what the name is. They called it a special mixture. They mixed all this to give the coating of the concrete floor\u0026rdquo;. \u0026ndash;Mother, Lower embodied carbon floor (32yeras_IDI#01)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003e4.1.2 Installation timeframe and challenges\u003c/h2\u003e \u003cp\u003eThe participants reported average construction period was four to five days. However, some households reported delays and the timeframe to be extended nearly a month, causing significant disruptions for affected families. The households had to relocate temporarily to their relatives or neighbor\u0026rsquo;s houses, leading to discomfort and privacy concerns. Additionally, a small number of women moved to their parent\u0026rsquo;s household during the construction period while their husband looked after the construction. Many respondents felt that the construction timeframe was reasonable, and the few challenges during the construction period were acceptable to them. A mother who faced difficulties stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;There was heavy rain during that construction period. Our dresses got wet. We suffered a lot staying outside the house. It was quite impossible to stay outside. So, I called the officer (study field research officer) [and told him] that we were suffering while we stayed outside during construction. We did not have place to stay for that period. I had called him multiple times about this issue. I requested him to complete the work urgently.\u0026rdquo;- Mother, Lower embodied carbon floor (32years_IDI#01)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn this regard, another woman who had to stay in her cow shed during construction said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe lived in the cow shed. It was the biggest suffering. The bed and other items were outside in the yard. It rained during that time, so a few things got damaged\u0026rdquo;- Mother, Lower embodied carbon floor (37years_IDI#05)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome respondents mentioned they put their furniture in neighbor\u0026rsquo;s houses during construction time, but it was challenging as the neighbor also had shortage of space in their houses. So, in some cases they kept the furniture outside the house in the open yard without shading. A mother stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;During the construction, we moved all our furniture outside as the work was going on inside the house. It was monsoon, and it rained heavily for several days. Most of my furniture was damaged. Our dressing table started to rot\u0026rdquo;. \u0026ndash; Mother, Traditional floor (30years_IDI#06)\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Maintenance and repair feasibility\u003c/h2\u003e \u003cdiv id=\"Sec35\" class=\"Section3\"\u003e \u003ch2\u003e4.2.1 Ease of maintenance\u003c/h2\u003e \u003cp\u003eMajority of the respondents reported that cement-based floors required significantly less maintenance compared to their previous soil floors, which needed regular re-coating with mud or cow dung. Most of the respondents mentioned now they just simply swept and moped their floors daily.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec36\" class=\"Section3\"\u003e \u003ch2\u003e4.2.2 Repair challenges\u003c/h2\u003e \u003cp\u003eOut of nine households experiencing cracks, only two managed to repair them on their own. The other seven households could not repair the floors primarily due to financial constraints. A mother stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;This is a concrete floor. So, it will be more expensive to repair than a soil floor. My previous floor was made of soil which required only soil to repair. It did not require money. I just needed to coat with mud.\u0026rdquo;- Mother, Lower embodied carbon floor (32years_IDI#01)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAdditionally, lower embodied carbon floor users found it difficult to identify the materials needed for repair, making them hesitant to invest in fixes. All the household heads mentioned repairing cement-based floors require cement, brick, and sand, which must be purchased. While these materials are available in mainland markets, char area residents must transport them from the mainland, increasing costs. Lower embodied carbon floor users also expressed their concern about the purchase and availability of the additional ingredient (fly ash) that was used in their floor as they were not informed by the workers about its name or purpose. A mother illustrated this concern-\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;You can fix the soil floor with your own hands using soil as much as possible. If it breaks, I could repair it by myself. But now, I can't do it in case of the concrete floor\u0026rdquo;. - Mother, Traditional floor (20years_IDI#14)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eMost household heads stated they would need to hire workers for repairs, as they lacked the necessary skills. Only two out of twenty households reported confidence in making repairs themselves. A mother from the mainland noted-\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMy elder son is 17. He has become very interested in construction work. While the workers were at our home, he looked at them closely and learned a lot. He even constructed a concrete surface under the tubewell himself. We might not need to hire anyone for small tasks\u0026rdquo;-. Mother, Traditional floor (30years_IDI#06)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Willingness to pay for cement-based floors\u003c/h2\u003e \u003cdiv id=\"Sec38\" class=\"Section3\"\u003e \u003ch2\u003e4.3.1 Financial constraints\u003c/h2\u003e \u003cp\u003eAll the respondents shared that they always wanted to upgrade their floors but could not install cement-based floors because of their financial constraints. When asked which housing elements they will prioritize for housing upgrades, they stated that installing a cement-based floor is more expensive than upgrading their roof or walls. Most households preferred to upgrade the roof and walls first because they are typically made of aluminum corrugated sheets, which are less expensive. Respondents from riverine islands mentioned that because their houses are prone to river erosion, they would invest in roofing and wall upgrades because they can be disassembled and re-used if they must move because of river erosion. Although many participants said they would recommend cement-based floors to neighbours, they acknowledged that cost was a major obstacle. They explained that, if it was not external support, installing such floors would have been out of reach. Also they mentioned if they had some savings for housing improvements, they would have prioritize roofing and walls over flooring. Though the households could mention the clear benefits of cement-based flooring, they viewed soil floors as financially practical because they required no cash outlay for upkeep. Traditional methods using soil, cow dung, and mud were free of cost, whereas repairing cement floors meant buying materials and hiring labor.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec39\" class=\"Section3\"\u003e \u003ch2\u003e4.3.2 Loan and Subsidized Housing Options\u003c/h2\u003e \u003cp\u003eThough most participants said building a cement floor with their own funds was unrealistic, few of them had considered taking a loan for this purpose. Majority of them were not interested in microfinance, but they said if government or organizational subsidies for housing upgrades are provided, they will upgrade the house. But with that support, they would be improving roofs and walls first and then floors.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec40\" class=\"Section2\"\u003e \u003ch2\u003e4.4 SERVQUAL Framework Analysis\u003c/h2\u003e \u003cp\u003eWe applied the SERVQUAL model across five dimensions: Reliability, Assurance, Tangibles, Empathy, and Responsiveness to better understand perceptions of users. We found that most dimensions aligned well with participant experiences, reinforcing the high acceptability of both types of floors. High satisfaction with construction quality and the physical improvements referred to reliability and tangibility. Empathy, however, revealed gaps\u0026mdash;such as not meeting the demand for sloped edges to prevent water pooling\u0026mdash;highlighting the need for greater responsiveness to user preferences during design\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAcceptability and feasibility of low carbon cement floor following SERVQUAL framework analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFindings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Reliability: Construction Timeframe and Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost of the participants found the construction process reliable. They reported that the installation took 4\u0026ndash;5 days, which matched their expectations. Though some households experienced delays due to labor shortages or weather disruptions, these were considered manageable. The floors were also perceived as reliable in terms of durability and flood resilience particularly in mainland area.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Assurance: Trust in Materials and Construction Team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe participants expressed their confidence in the construction team and the materials used. Even though they were unfamiliar with fly ash, they trusted the explanation provided by the study team. They did not raise any concern if fly ash is toxic or had any health effect.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Tangibles: Quality of Materials and Physical Appearance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThey praised both types of floors for their smooth surfaces, improved hygiene, and visual appeal. They noted that the cement-based floors were easier to clean and maintain than soil floors. The neat finish and raised height were seen as tangible improvements over previous flooring.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Empathy: Responsiveness to User Needs and Preferences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThis was the only dimension where expectations and experiences diverged. Several participants requested sloped edges to prevent water accumulation, but these design preferences were not accommodated. This lack of responsiveness to user input during construction led to dissatisfaction among some households.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Responsiveness: Support During Disruptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants appreciated the support provided by field staff during construction, especially when facing challenges such as relocation or weather-related disruptions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAmong rural household members who received traditional and lower-embodied carbon cement-based floors within the past year, we found high levels of acceptability and feasibility for both types of floors. There were no significant differences between the two types of cement-based floors in terms of cleaning, maintenance, texture of the floor, or usability. Perceived environmental benefits or harms of each floor type did not influence acceptability. We found differences in perceived ease of floor repairs for traditional vs. lower-embodied carbon cement-based floors as the participants were not being familiar with raw materials (fly ash and concrete block) of the latter design. Rural household members\u0026rsquo; satisfaction with their floor was largely shaped by the durability, design, comfort, and resilience of the floor to floods and river erosion. Overall, respondents felt that soil floors did not meet most of these criteria. Our findings demonstrate the acceptability of lower-embodied carbon cement-based floors, a potential planetary health intervention (Brousselle et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) that may improve human health while lowering negative environmental impacts from CO\u003csub\u003e2\u003c/sub\u003e emissions. An ongoing randomized trial will measure health impacts of the intervention (Rahman et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecipients of lower-embodied carbon floors reported fewer cracked floors compared to those that received traditional cement-based floors, which contributed to higher satisfaction. These findings are consistent with prior studies that have shown higher compressive strength and durability of cement mixes that incorporate fly ash or slags compared to Ordinary Portland cement mixes (Bouzouba\u0026acirc; et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Bouzouba\u0026acirc; et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Kore et al., 2024; Marey et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tan \u0026amp; Pu, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). The most reported structural concern with cement-based floors of both types was that the floor design did not have sloped edges at the home\u0026rsquo;s exteriors to facilitate water run off during rainfall events. This highlights that a more user-centered design approach should be considered in future floor upgrade projects in rural, low-resource, flood-prone communities.\u003c/p\u003e \u003cp\u003eThough the respondents preferred cement-based floors, they reported that they would not have been able to install them without financial support which is consistent with findings from prior studies (Hassan et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Study conducted in northwestern Bangladesh found that the prevalence of homes constructed with bricks and cement was higher in communities with higher income levels (Kafy et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Upon assessing the willingness to pay for cement-based floors, respondents indicated a clear preference for government housing upgradation subsidies over loans or microfinance. This findings are similar with other study results which highlighted the importance of incentives and government endorsement for constructing and scaling up sustainable housing in both urban and rural areas (Acklin et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Khan \u0026amp; Shammi, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParticipants reported frequent structural damage due to climatic hazards like floods and river erosion; maintenance difficulties; snake and pest infestation; and health issues like skin diseases, rashes, and diarrhea among children as challenges of soil floors. Other studies also reported that damp surfaces, mold due to humidity and moisture, excessive shrinkage cracks, and structural erosion following rainfall and floods are common problems with soil floors (Cluster, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Islam \u0026amp; Haque, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Some studies have also found that soil floors act as reservoirs for parasites, viruses, and bacteria, potentially leading to diarrheal, dermatological, and respiratory illnesses (Benjamin-Chung et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Boehm et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Legge et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Nguyen et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Pickering et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Tabassum et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Majority of the respondents preferred cement-based floors over soil floors, while a small number who resided on chars preferred soil floors. As a reason they mentioned about frequent relocation due to river erosion; soil floors could be rebuilt more easily than cement-based floors. They also mentioned repairing soil floors was simple as it could be repaired without special materials or skilled labor. Previous studies also noted that soil and sand remain common flooring choices in Bangladesh because of the affordability, widely availability, heat resilience and easy to construct, while also producing lower CO₂ emissions compared to bricks and cement (Islam \u0026amp; Haque, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Seraj \u0026amp; Hodgson, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThrough SERVQUAL analysis we found that four dimensions\u0026mdash;Reliability, Assurance, Tangibles, and Responsiveness\u0026mdash;aligned well with study participant\u0026rsquo;s experiences, reinforcing the high acceptability of both floor types (Parasuraman et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1988\u003c/span\u003e). However, the Empathy dimension revealed a gap: households preferred design features such as sloped edges to prevent water pooling inside the house, but these preferences were not incorporated in the first place (Shafieisabet et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). After this study, the design and homes were modified to include these changes, underscoring the importance of integrating user feedback early in the design process. We recommend future housing programs to prioritize community input from the outset to improve satisfaction and usability.\u003c/p\u003e \u003cp\u003eIn terms of limitation, small sample size and limited geographic scope mean the findings may not be generalizable to all rural populations, and further research in diverse settings is needed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study showed cement-based floors- both traditional and those incorporating lower embodied-carbon materials were generally well received by rural households in northwestern Bangladesh. The participants appreciated cement-based floors for their strength, ease of cleaning, and the added protection they offered against seasonal flooding and heavy rains. As reported by the participants floors made with fly ash performed on par with, and sometimes better than, traditional designs, noting fewer cracks as a key advantage. However, willingness to pay for these improvements was tempered by financial realities. The cost of raw materials and labor was repeatedly cited as a major barrier, making self-financed installation unachievable for most households. Respondents preferred government-supported housing programs or subsidies for housing improvement.\u003c/p\u003e \u003cp\u003eThese findings identified an opportunity for integrating lower embodied-carbon flooring into broader housing and health initiatives. These initiatives could improve living conditions while reducing environmental impact from high carbon emitting housing materials. At the same time, policies promoting lower embodied carbon materials and making them affordable will be essential for strengthening resilience and improving quality of life in rural areas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eDeclaration of Conflicting Interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAuthors declare no competing interest related to this publication.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eicddr,b is grateful to the Governments of Bangladesh and Government of Canada for providing core/unrestricted support. The study team is grateful to the community members who participated in the study.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe trial protocol was approved by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Ethical Review Committee (PR-22069), and the Stanford Institutional Review Board (63990). Written informed consent was obtained from all participants before the IDIs. The consent forms were read aloud to ensure comprehension, and participants were given the opportunity to read the form themselves and ask any questions before providing their signatures. For those who were illiterate, a thumb impression was taken after they had listened to the consent details.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eJade Benjamin Chung, Sarah Billington and Mahbubur Rahman contributed to the study conception and design. Material preparation, data collection and analysis were performed by Farjana Jahan, Jannat-E-Tajreen, Afsana Yeamin, Abul Kashem Shaob and Suhi Hanif. The first draft of the manuscript was written by Farjana Jahan and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was funded by the King Center for Global Development at Stanford University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAcklin, M., Graham, J. P., \u0026amp; Benjamin-Chung, J. (2025). Healthy homes: Stakeholder perspectives on housing interventions to reduce environmentally mediated infections. \u003cem\u003ePLOS Global Public Health\u003c/em\u003e, 5(4), e0003805.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli, M., Saidur, R., \u0026amp; Hossain, M. (2011). 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Carbon dioxide emissions from the global cement industry. \u003cem\u003eAnnual review of energy and the environment\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(1), 303\u0026ndash;329.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cement-based flooring, Lower-embodied carbon floors, Floor durability, Household hygiene, Rural Bangladesh housing, Sustainable materials","lastPublishedDoi":"10.21203/rs.3.rs-8714894/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8714894/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn low- and middle-income countries, household floors made of soil remain common. Concrete floors are desirable household upgrades because they offer durability, improved hygiene, and flood resilience, and their prevalence is increasing. However, cement production is a substantial contributor to global anthropogenic carbon dioxide emissions. This study assessed the acceptability and feasibility of sustainable cement-based floors with lower embodied carbon; these floors replaced 20% of cement with fly ash, a byproduct of coal combustion. To assess whether low carbon cement floors are as acceptable as traditional cement-based floors, in-depth interviews were conducted with 30 respondents from 20 households in rural Bangladesh in which soil floors were replaced with either low carbon cement or traditional cement-based floors. Findings revealed that both flooring types were highly accepted due to ease of cleaning, health benefits, and protection from environmental hazards. Traditional cement floors were preferred in terms of repair and maintenance as the users were concerned about the availability of fly ash and concrete blocks in rural settings. Financial constraints emerged as a major barrier to cement-based floor adoption for both traditional and lower embodied carbon cement-based floors, with most respondents prioritizing roof and wall improvements over flooring. Subsidized housing programs were seen as a crucial enabler for cement-based floor installation, as self-financing was largely considered unattainable. This study demonstrates that in a rural, low-income population Bangladesh, cement-based floors with lower embodied carbon were as acceptable as traditional cement-based floors, but installation of either type of floor may require government subsidies.\u003c/p\u003e","manuscriptTitle":"From Soil to Cement: Acceptability and Lived Experiences of Low‑Carbon Cement Floors in Rural Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 15:14:17","doi":"10.21203/rs.3.rs-8714894/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fa8866ca-b590-4b9a-9aff-2b57c7313e9a","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T15:14:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 15:14:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8714894","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8714894","identity":"rs-8714894","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}