1. Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
- Author
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Nicki Tiffin, Rajani Ved, Amnesty Elizabeth LeFevre, Kerry Scott, Smisha Agarwal, Nicola Mulder, Neha Shah, Diwakar Mohan, Simone Honikman, Sara Chamberlain, Salil Arora, Jai Mendiratta, Sai Rahul, Osama Ummer, Aarushi Bhatanagar, Rakesh Chandra, Arpita Chakraborty, Neha Dumke, Priyanka Dutt, Anna Godfrey, Suresh Gopalakrishnan, Nayan Kumar, Amnesty LeFevre, Molly Miller, Radharani Mitra, Deshen Moodley, Angela Ng, Dilip Parida, Nehru Penugonda, Shiv Rajput, Aashaka Shinde, Aaditya Singh, Falyn Weiss, Sonia Whitehead, Agrima Sahore, Manjula Sharma, Shalini Yadav, Anushree Jairath, Nikita Purty, JJH Bashingwa, and Meenal Indurkar
- Subjects
0301 basic medicine ,Medicine (General) ,India ,Mothers ,Infectious and parasitic diseases ,RC109-216 ,03 medical and health sciences ,R5-920 ,0302 clinical medicine ,Pregnancy ,Humans ,030212 general & internal medicine ,health education and promotion ,Child ,mHealth ,Original Research ,030109 nutrition & dietetics ,Community engagement ,business.industry ,Health Policy ,public health ,Public Health, Environmental and Occupational Health ,Health services research ,Infant ,Extended family ,Reciprocal determinism ,Public relations ,health services research ,Telemedicine ,Audience measurement ,Family planning ,Family Planning Services ,child health ,Female ,business ,Psychology ,health systems ,Cell Phone ,Qualitative research - Abstract
IntroductionKilkari 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.MethodsWe 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.ResultsWhile 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.ConclusionTo 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.
- Published
- 2021
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