TY - JOUR
T1 - Another voice in the crowd
T2 - The challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
AU - Scott, Kerry
AU - Ummer, Osama
AU - Shinde, Aashaka
AU - Sharma, Manjula
AU - Yadav, Shalini
AU - Jairath, Anushree
AU - Purty, Nikita
AU - Shah, Neha
AU - Mohan, Diwakar
AU - Chamberlain, Sara
AU - Lefevre, Amnesty Elizabeth
N1 - Funding Information:
Competing interests All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare that the research reported was funded by the Bill and Melinda Gates Foundation. SC is employed by BBC Media Action, one of the entities supporting programme implementation for Kilkari. The authors do not have other relationships and are not engaged in activities that could appear to have influenced the submitted work.
Publisher Copyright:
©
PY - 2021/7/26
Y1 - 2021/7/26
N2 - Introduction Kilkari is one of the world's largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged. Methods We used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari's calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices. Results While women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari's recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding. Conclusion To deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.
AB - Introduction Kilkari is one of the world's largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices. This qualitative research complements the RCT to explore why these findings may have emerged. Methods We used system generated data to identify households within the RCT with very high to medium Kilkari listenership. Mothers (n=29), as well as husbands and extended family members (n=25 interviews/family group discussions) were interviewed about IYCF and family planning, including their reactions to Kilkari's calls on these topics. Analysis was informed by the theory of reciprocal determinism, which positions behaviour change within the interacting domains of individual attributes, social and environmental determinants, and existing practices. Results While women who owned and controlled their own phones were the Kilkari listeners, among women who did not own their own phones, it was often their husbands who listened. Spouses did not discuss Kilkari messages. Respondents retained and appreciated Kilkari messages that aligned with their pre-existing worldviews, social norms, and existing practices. However, they overlooked or de-emphasised content that did not. In this way, they reported agreeing with and trusting Kilkari while persisting with practices that went against Kilkari's recommendations, particularly non-exclusive breastfeeding and inappropriate complementary feeding. Conclusion To deepen impact, digital direct to beneficiary services need to be complimented by wider communication efforts (e.g., sustained face-to-face, media, community engagement) to change social norms, taking into account the role of socio-environmental, behavioural, and individual determinants.
KW - child health
KW - health education and promotion
KW - health services research
KW - health systems
KW - public health
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U2 - 10.1136/bmjgh-2021-005868
DO - 10.1136/bmjgh-2021-005868
M3 - Article
C2 - 34312156
AN - SCOPUS:85111408922
SN - 2059-7908
VL - 6
JO - BMJ Global Health
JF - BMJ Global Health
M1 - e005868
ER -