Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India. (26th July 2021)

• Record Type: Journal Article
• Authors: Scott, Kerry; Ummer, Osama; Shinde, Aashaka; Sharma, Manjula; Yadav, Shalini; Jairath, Anushree; Purty, Nikita; Shah, Neha; Mohan, Diwakar; Chamberlain, Sara; LeFevre, Amnesty Elizabeth
• Other Names: author non-byline.; Agarwal Smisha author non-byline.; Arora Salil author non-byline.; Bashingwa JJH author non-byline.; Bhatanagar Aarushi author non-byline.; Chamberlain Sara author non-byline.; Chandra Rakesh author non-byline.; Chakraborty Arpita author non-byline.; Dumke Neha author non-byline.; Dutt Priyanka author non-byline.; Godfrey Anna author non-byline.; Gopalakrishnan Suresh author non-byline.; Indurkar Meenal author non-byline.; Jairath Anushree author non-byline.; Kumar Nayan author non-byline.; Honikman Simone author non-byline.; Labrique Alain author non-byline.; LeFevre Amnesty author non-byline.; Mendiratta Jai author non-byline.; Miller Molly author non-byline.; Mitra Radharani author non-byline.; Mohan Diwakar author non-byline.; Moodley Deshen author non-byline.; Mulder Nicola author non-byline.; Ng Angela author non-byline.; Parida Dilip author non-byline.; Penugonda Nehru author non-byline.; Purty Nikita author non-byline.; Rahul Sai author non-byline.; Rajput Shiv author non-byline.; Sahore Agrima author non-byline.; Shah Neha author non-byline.; Scott Kerry author non-byline.; Sharma Manjula author non-byline.; Shinde Aashaka author non-byline.; Singh Aaditya author non-byline.; Tiffin Nicki author non-byline.; Ummer Osama author non-byline.; Ved Rajani author non-byline.; Weiss Falyn author non-byline.; Whitehead Sonia author non-byline.; Yadav Shalini author non-byline.;
• Is Part Of: BMJ global health. Volume 6(2021)Supplement 5
• Publication Date: 2021-07-26
• Subjects: child health -- health education and promotion -- health services research -- health systems -- public health; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2021-005868
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : 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.