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Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India

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, t...

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Autores principales: Scott, Kerry, Ummer, Osama, Shinde, Aashaka, Sharma, Manjula, Yadav, Shalini, Jairath, Anushree, Purty, Nikita, Shah, Neha, Mohan, Diwakar, Chamberlain, Sara, LeFevre, Amnesty Elizabeth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327813/
https://www.ncbi.nlm.nih.gov/pubmed/34312156
http://dx.doi.org/10.1136/bmjgh-2021-005868
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author Scott, Kerry
Ummer, Osama
Shinde, Aashaka
Sharma, Manjula
Yadav, Shalini
Jairath, Anushree
Purty, Nikita
Shah, Neha
Mohan, Diwakar
Chamberlain, Sara
LeFevre, Amnesty Elizabeth
author_facet Scott, Kerry
Ummer, Osama
Shinde, Aashaka
Sharma, Manjula
Yadav, Shalini
Jairath, Anushree
Purty, Nikita
Shah, Neha
Mohan, Diwakar
Chamberlain, Sara
LeFevre, Amnesty Elizabeth
author_sort Scott, Kerry
collection PubMed
description 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.
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spelling pubmed-83278132021-08-19 Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India Scott, Kerry Ummer, Osama Shinde, Aashaka Sharma, Manjula Yadav, Shalini Jairath, Anushree Purty, Nikita Shah, Neha Mohan, Diwakar Chamberlain, Sara LeFevre, Amnesty Elizabeth BMJ Glob Health Original Research 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. BMJ Publishing Group 2021-07-26 /pmc/articles/PMC8327813/ /pubmed/34312156 http://dx.doi.org/10.1136/bmjgh-2021-005868 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Scott, Kerry
Ummer, Osama
Shinde, Aashaka
Sharma, Manjula
Yadav, Shalini
Jairath, Anushree
Purty, Nikita
Shah, Neha
Mohan, Diwakar
Chamberlain, Sara
LeFevre, Amnesty Elizabeth
Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
title Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
title_full Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
title_fullStr Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
title_full_unstemmed Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
title_short Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India
title_sort another voice in the crowd: the challenge of changing family planning and child feeding practices through mhealth messaging in rural central india
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327813/
https://www.ncbi.nlm.nih.gov/pubmed/34312156
http://dx.doi.org/10.1136/bmjgh-2021-005868
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