{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:01:39Z","timestamp":1785132099140,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Clim."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Climate change disproportionately affects communities experiencing social and environmental vulnerabilities. In South Africa, rising temperatures pose a significant risk to peri-urban communities. This pilot study explored community perceptions and attitudes toward the \u201ccool roof\u201d passive cooling technology for homes, as a climate adaptation strategy in Umlazi, South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Trained facilitators conducted focus group discussions with advisory board members from the Umlazi Health and Demographic Surveillance Site (USINGA) a peri-urban demographic surveillance node located in Umlazi, KwaZulu-Natal, South Africa, using a semi-structured guide and visual aids of cool roofs, to explore perceptions and attitudes toward cool roof interventions. Discussions were recorded, transcribed and analyzed using inductive thematic analysis following Braun and Clarke\u2019s approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The emerging themes were: limited awareness and knowledge of cool roofs as a heat adaptation strategy, perceived benefits and acceptance, concerns and reservations, affordability and equity, design preferences, as well as the importance of partnerships and community engagement. Participants recognized the potential of cool roofs in reducing indoor heat, improving comfort, reducing extreme fatigue, and benefiting vulnerable populations; they viewed the intervention as timely and necessary. However, concerns were raised that some older people might believe that white roofs attract death, and some may indulge in the conspiracy theory that the coating is associated with disease. Participants questioned the long-term effectiveness of cool roofs and their compatibility with existing informal housing structures lacking traditional roofs. They felt that the current cost of paint may make the intervention inaccessible to those most in need of it, thereby limiting equitable distribution, as most people were unemployed. Furthermore, they believed that if cool roofs lacked long-term durability and required constant maintenance, people were unlikely to accept the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While overall perceptions were positive, engaging and educating the community through transparent communication and information on cool roof interventions will address concerns and encourage the adoption of these interventions. From a policy and practice perspective, government programs on climate resilience must be culturally sensitive and responsive to local beliefs while prioritizing vulnerable populations and being inclusive during climate adaptation planning. Further research is needed to inform the development of acceptable and scalable implementation strategies in peri-urban settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fclim.2026.1873846","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:40:14Z","timestamp":1785130814000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cThe heat really troubles us\u201d: community perspectives on a cool roof intervention, Umlazi, KwaZulu-Natal, South Africa"],"prefix":"10.3389","volume":"8","author":[{"given":"Saloshni","family":"Naidoo","sequence":"first","affiliation":[{"name":"Discipline of Public Health Medicine, School of Medicine, University of KwaZulu-Natal","place":["Durban, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Nyamaruze","sequence":"additional","affiliation":[{"name":"Discipline of Public Health Medicine, School of Medicine, University of KwaZulu-Natal","place":["Durban, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Nadesan-Reddy","sequence":"additional","affiliation":[{"name":"Discipline of Public Health Medicine, School of Medicine, University of KwaZulu-Natal","place":["Durban, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nompumelelo","family":"Nzimande","sequence":"additional","affiliation":[{"name":"Discipline of Development and Population Studies, School of Social Sciences, University of KwaZulu-Natal","place":["Durban, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Madzorera","sequence":"additional","affiliation":[{"name":"Division of Community Health Sciences, School of Public Health, University of California, Berkeley","place":["Berkeley, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"He","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"B\u00e4rnighausen","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University","place":["Heidelberg, Germany"]},{"name":"Africa Health Research Institute (AHRI)","place":["KwaZulu-Natal, South Africa"]},{"name":"Harvard Center for Population and Development Studies","place":["Cambridge, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafaie","family":"Fawzi","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health","place":["Boston, MA, United States"]},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health","place":["Boston, MA, United States"]},{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref1","volume-title":"Climate Change and Extreme Heat: Strengthening Resilience and Adaptive Capacity in the Southern African Development Community (SADC). Consensus Study Pretoria","year":"2026"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e002883","DOI":"10.1136\/bmjpo-2024-002883","article-title":"Exceeding the limits of paediatric heat stress tolerance: the risk of losing a generation to climate inaction","volume":"9","author":"Azan","year":"2025","journal-title":"BMJ Paediatr Open."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2935","DOI":"10.1186\/s12889-025-23806-w","article-title":"Acceptability of cool roofs: a qualitative study in Nouna, Burkina Faso","volume":"25","author":"Barnighausen","year":"2025","journal-title":"BMC Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1080\/2159676x.2019.1704846","article-title":"To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales","volume":"13","author":"Braun","year":"2021","journal-title":"Qual. Res. Sport, Exerc. Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"343","DOI":"10.2147\/OAEM.S419028","article-title":"A systematic review on outcomes of patients with heatstroke and heat exhaustion","volume":"15","author":"Bukhari","year":"2023","journal-title":"Open Access Emerg. Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s13063-023-07804-0","article-title":"The effects of cool roofs on health, environmental, and economic outcomes in rural Africa: study protocol for a community-based cluster randomized controlled trial","volume":"25","author":"Bunker","year":"2024","journal-title":"Trials"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"m3811","DOI":"10.1136\/bmj.m3811","article-title":"Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis","volume":"371","author":"Chersich","year":"2020","journal-title":"BMJ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"101915","DOI":"10.1016\/j.smrv.2024.101915","article-title":"A systematic review of ambient heat and sleep in a warming climate","volume":"75","author":"Chevance","year":"2024","journal-title":"Sleep Med. Rev."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e002332","DOI":"10.1136\/bmjph-2024-002332","article-title":"Evaluation of community-based heat adaptation interventions: a systematic review","volume":"3","author":"Das","year":"2025","journal-title":"BMJ Public Health"},{"key":"ref11","volume-title":"Temperature change Statistics 1961\u20132024. Global, regional and Country Trends. Report No: FAOSTAT Analytical Brief 101","year":"2025"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.enbuild.2015.06.043","article-title":"Assessment of the impact of cool roofs in rural buildings in India","volume":"114","author":"Garg","year":"2016","journal-title":"Energ. Buildings"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1146\/annurev-publhealth-081624-060027","article-title":"Effectiveness of financial incentives for health behavior change: a narrative review and analysis","volume":"47","author":"Glanz","year":"2026","journal-title":"Annu. Rev. Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"122205","DOI":"10.1016\/j.jclepro.2020.122205","article-title":"Thermal and energy performance of green roof and cool roof: a comparison study in Shanghai area","volume":"267","author":"He","year":"2020","journal-title":"J. Clean. Prod."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"55","DOI":"10.5334\/bc.269","article-title":"Heat stress: adaptation measures in south African informal settlements","volume":"4","author":"Hugo","year":"2023","journal-title":"Build. Cities"},{"key":"ref16","volume-title":"Climate Change 2021: The Physical Science Basis","year":"2021"},{"key":"ref17","volume-title":"Climate Change 2022: Impacts, Adaptation and Vulnerability","year":"2022"},{"key":"ref18","volume-title":"Water Crisis: eThekwini Municipality urges Residents to Conserve water as Heatwave Continues. Cape Times","author":"Jacobs","year":"2026"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s44213-024-00038-z","article-title":"Critical insights into thermal comfort optimization and heat resilience in indoor spaces","volume":"2","author":"Jain","year":"2024","journal-title":"City Built Environ."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"101207","DOI":"10.1016\/S2542-5196(25)00007-5","article-title":"Community-based heat adaptation interventions for improving heat literacy, behaviours, and health outcomes: a systematic review","volume":"9","author":"Johar","year":"2025","journal-title":"Lancet Planet Health."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"28","DOI":"10.17159\/2413-3051\/2020\/v31i1a7689","article-title":"Passive cooling for thermal comfort in informal housing","volume":"31","author":"Kimemia","year":"2020","journal-title":"J. Energy South. Afr. Acad. Sci. South Afr."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1007\/s00484-024-02650-4","article-title":"The effects of extreme heat on human health in tropical Africa","volume":"68","author":"Kunda","year":"2024","journal-title":"Int. J. Biometeorol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e484","DOI":"10.1016\/S2542-5196(22)00117-6","article-title":"Heat exposure and cardiovascular health outcomes: a systematic review and meta-analysis","volume":"6","author":"Liu","year":"2022","journal-title":"Lancet Planet Health."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"100753","DOI":"10.1016\/j.wace.2025.100753","article-title":"Projected changes in daily temperature extremes for selected locations over South Africa","volume":"47","author":"McBride","year":"2025","journal-title":"Weather Clim. Extremes"},{"key":"ref25","volume-title":"Service Delivery at the Provincial sphere of Government: A Case Study of Operation Sukuma Sakhe (OSS) in KwaZulu-Natal","author":"Mkhize","year":"2023"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"17455057241259171","DOI":"10.1177\/17455057241259171","article-title":"Maternal exposure to heat and its association with miscarriage in rural KwaZulu-Natal, South Africa: a population-based cohort study","volume":"20","author":"Moodley","year":"2024","journal-title":"Womens Health (Lond)."},{"key":"ref27","volume-title":"KZN Heavy rain and Flooding: 56 Houses Collapse, More than 200 Residents Evacuated. The Citizen","author":"Nemakonde","year":"2025"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2501","DOI":"10.1007\/s00484-025-02971-y","article-title":"Quantifying intra-urban socio-economic and environmental vulnerability to extreme heat events in Johannesburg, South Africa","volume":"69","author":"Parker","year":"2025","journal-title":"Int. J. Biometeorol."},{"key":"ref29","year":"2022"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e019662","DOI":"10.1136\/bmjgh-2025-019662","article-title":"Incentives in immunisation campaigns in low- and middle-income countries: a scoping review mapping evidence on effectiveness and unintended consequences","volume":"10","author":"Saunders","year":"2025","journal-title":"BMJ Glob. Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"105448","DOI":"10.1016\/j.ebiom.2024.105448","article-title":"Protecting vulnerable populations in extreme heat - a growing and pervasive health challenge","volume":"109","author":"Schlader","year":"2024","journal-title":"EBioMedicine"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"15598276251346752","DOI":"10.1177\/15598276251346752","article-title":"Effects of sleep deprivation on physical and mental health outcomes: an umbrella review","author":"Shah","year":"2025","journal-title":"Am. J. Lifestyle Med."},{"key":"ref33","year":"2024"},{"key":"ref34","year":"2018"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1231827","DOI":"10.3389\/fpubh.2024.1231827","article-title":"A review of strategies and levels of community engagement in strengths-based and needs-based health communication interventions","volume":"12","author":"Stover","year":"2024","journal-title":"Front. Public Health"},{"key":"ref36","first-page":"376","volume-title":"How Climate Extremes are Endangering Millions in Africa","author":"Tamoffo","year":"2025"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1038\/s41586-019-1050-5","article-title":"Mapping changes in housing in sub-Saharan Africa from 2000 to 2015","volume":"568","author":"Tusting","year":"2019","journal-title":"Nature"},{"key":"ref38","year":""},{"key":"ref39","doi-asserted-by":"publisher","first-page":"685","DOI":"10.3390\/buildings15050685","article-title":"Experimental analysis of cool roof coatings as an urban heat mitigation strategy to enhance thermal performance","volume":"15","author":"Wai","year":"2025","journal-title":"Buildings"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e084675","DOI":"10.1136\/bmj-2025-084675","article-title":"Effects of extreme heat on physiology, morbidity, and mortality under climate change: mechanisms and clinical implications","volume":"391","author":"Xu","year":"2025","journal-title":"BMJ"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"179052","DOI":"10.1016\/j.scitotenv.2025.179052","article-title":"Heat exposure and respiratory diseases health outcomes: an umbrella review","volume":"970","author":"Zhu","year":"2025","journal-title":"Sci. Total Environ."}],"container-title":["Frontiers in Climate"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fclim.2026.1873846\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:40:19Z","timestamp":1785130819000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fclim.2026.1873846\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":41,"alternative-id":["10.3389\/fclim.2026.1873846"],"URL":"https:\/\/doi.org\/10.3389\/fclim.2026.1873846","relation":{},"ISSN":["2624-9553"],"issn-type":[{"value":"2624-9553","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"article-number":"1873846"}}