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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.
- child health
- health education and promotion
- health services research
- health systems
- public health
Data availability statement
Data are available upon request. Data for this study consist of qualitative interview transcripts. Uploading all transcripts for open availability would compromise our ability to fully mask participant details. However, we are happy to share anonymised portions of these transcripts upon reasonable request.
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Data availability statement
Data are available upon request. Data for this study consist of qualitative interview transcripts. Uploading all transcripts for open availability would compromise our ability to fully mask participant details. However, we are happy to share anonymised portions of these transcripts upon reasonable request.
Supplementary materials
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Footnotes
Handling editor Soumitra S Bhuyan
Twitter @NikitaPurty
Collaborators Kilkari Impact Evaluation team (list in alphabetical order): Smisha Agarwal; Salil Arora; JJH Bashingwa; Aarushi Bhatanagar; Sara Chamberlain; Rakesh Chandra; Arpita Chakraborty; Neha Dumke; Priyanka Dutt; Anna Godfrey; Suresh Gopalakrishnan; Meenal Indurkar; Anushree Jairath; Nayan Kumar; Simone Honikman; Alain Labrique; Amnesty LeFevre; Jai Mendiratta; Molly Miller; Bibha Mishra; Radharani Mitra; Diwakar Mohan; Deshen Moodley; Nicola Mulder; Angela Ng; Dilip Parida; Nehru Penugonda; Nikita Purty; Sai Rahul, Shiv Rajput, Agrima Sahore, Neha Shah; Kerry Scott; Manjula Sharma; Aashaka Shinde; Aaditya Singh; Nicki Tiffin; Osama Ummer; Rajani Ved; Falyn Weiss; Sonia Whitehead; Shalini Yadav.
Contributors AEL, SC and KS conceptualised and designed the study, with support from OU, NS and DM. AS, MS, SY, AJ and NP collected the data and engaged in analytical debriefs under OU and KS’s guidance. OU managed the fieldwork and quality assurance. OU and AS coded the data, with KS’s support. KS led analysis and interpretation and drafted the manuscript. All authors provided critical revision to the article and approved of the version to be published.
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.
Provenance and peer review Not commissioned; externally peer reviewed.
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