RESERVE CONFIDENCE AND IMMEDIATE HITCH: USE OF MOBILE PHONE MESSAGING TO IMPROVE MATERNAL AND CHILD HEALTH BEHAVIOR IN INDIA

Avishek Hazra, M. E. Khan, Subrato Mondal, Kara TureskiFebruary 10 , 2016International SBCC Summit, Addis Ababa, Ethiopia

Background• Mobile technology provides an opportunity to

use it as a tool for improving health behaviors • Globally, lots of experiments happening on

m-health• In India, 80% population (960 million) are

subscriber of mobile phone• 90% families in Uttar Pradesh, a state with

200 million population, own atleast one mobile phone

• Ownership of mobile phone among women is low, and mostly kept by men

• So, is mobile phone a viable medium to reach to women with health messages?

ObjectivesAn implementation research was conducted in Uttar Pradesh to • Examine whether provision of information on

maternal and child health to husband through mobile phone enhance their knowledge and trigger discussion on it in family; and

• Study whether such discussions result in adoption of healthy behaviors

A husband listening to intervention message in Chirgaon, Jhansi; Photo credit: Balbeer Kandari 

Study design and study area

•Quasi-experimental design was used •Eligibility criteria to include a household in the study were: index woman was

pregnant for 6 or more months;

husband of index woman owned a functional mobile phone; and

husband was living with family

= Experimental block= Control block

Uttar Pradesh

Jhansi

In 2014, after four months of intervention, 881 husbands and 956 women were interviewed

Intervention• 8 voice messages developed in Hindi language • 5 health behaviors - antenatal checkup, postnatal checkup,

early breastfeeding, clean cord care and delayed bathing• Messages were sent to husband’s mobile phone twice a

week for four months• At different time points - 9 am, 1.30 pm and 7.30 pm• Each message was of 25-30 seconds• Messages ended encouraging husbands to discuss the

messages with their wives and family members• Informed cosent was taken from each of them to send voice

message during house listing at the beginning of study

• The sample of the two groups matched well with respect to husband’s characteristics like age, religion, occupation and exposure to mass media

• The control area had higer percentage of scheduled caste or tribe husbands and those with no education or up to primary education

Socio-demographic characteristics

House listing at Chirgaon, Jhansi; Photo credit: Avishek Hazra

• Women in intervention area also matched with those from control area, except that education level was higher in intervention area

Reach of voice messages

Number of husbands

who agreed to

participate in the study

(N=640) Voice messages not

sent due to DND activation (N=148; 23%)

Voice messages

sent (N=492;

77%)

Interviewed (N=428;

87%)

Could not be interviewed(N=64; 13%)

Received voice

message(N=147;

34%)

Not received voice

message (N=281;

66%)

Discussed messages in family

(N=68)46% among received16% among interviewedDid not discuss messages in family

(N=79) 54% among

received

• Reasons for not hearing all the messages were: ‘busy at work’ (85 percent) and ‘disconnected the call after hearing once or twice’ (20

percent)• Profile of listeners and non-listener husbands

were similar and no significant differences were observed

A husband said,“…my job is painting equipment, most of the time my both hands remain either engaged or colored with paint and I cannot take out the mobile phone from my pocket. Later when I see the phone and find any missed call from a saved number, I call back.” (35 years, educated up to class 9, painter in a factory)

Reasons of not hearing messages

• 39 percent of the husbands asked their wife and 13 percent asked their mother to follow the messages they heard

“…I have a facility in my mobile to record any call. So, after the first message, when I realized the messages are for my to-be-born baby and my wife, I used to record the messages and replay those in front of my wife”. (26 years, graduate, Panchayat Mitra)“…when I got such calls with health information, I used to put my mobile phone on loud speaker so that my family members could listen to it.” (33 years, educated up to class 12, shopkeeper)• Interviews with women revealed presence of more than one

family member during discussion:“The first time when he (husband) told me about getting a check-up for Riya (respondent’s daughter), my paternal aunt, sister-in-law and elder sister were present. He also told me to breastfeed well and not to give anything else other than breast milk.” (22 years, Educated up to class 8, Housewife)

Discussion of messages in family

Husband’s knowledge on maternal and child care

Knowledge Heard message

s

Didn’t hear messages

Importance of at least one ANC checkup after 6th month of pregnancy

85.9 82.1

Need for a PNC for mother and newborn within 7 days of delivery, even if they are fine

68.0 65.3

A baby should be first breastfed within an hour

73.0** 50.9

Nothing should be applied on baby’s cord stump and keep it clean and dry

71.8** 15.7

A baby should be given first bath after 2 days of delivery

87.5** 72.4Levels of knowledge among husbands who heard the messages were significantly higher for 3 of the 5 health behaviors than those who did not hear the messages or were not exposed to the intervention

If husbands discussed the messages with family, chances of wives’ practice of at least three behaviors improve significantly, after controlling for socio-demographic factors

Practice of healthy behaviors

Received

ANC in 3rd

trimester

At least one PNC

within 7 days

Early breast-feeding

Clean

cord care

Delayed bathing

by at least 2 days

Husband discussed with wife about the behavior – NO

-- -- -- -- --

YES 1.72**

3.02** 0.87 0.80 1.93**

Conclusion• Communication intervention using mHealth

was found to be effective for behavior change• Feasibility of such intervention, however, need

to be tested with longer span of intervention • This study also addressed a neglected but

critical area -- male involvement in improving family health outcomes

• Results indicated that mobile phones can be used as a complementary medium along with other mass-media, mid-media and interpersonal communication channels to reach to women with health messages

THANK YOU

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