Dataset Information

Process evaluation of a community-based intervention promoting multiple maternal and neonatal care practices in rural Nepal.

ABSTRACT:

Background

The challenge of delivering multiple, complex messages to promote maternal and newborn health in the terai region of Nepal was addressed through training Female Community Health Volunteers (FCHVs) to counsel pregnant women and their families using a flipchart and a pictorial booklet that was distributed to clients. The booklet consists of illustrated messages presented on postcard-sized laminated cards that are joined by a ring. Pregnant women were encouraged to discuss booklet content with their families.

Methods

We examined use of the booklet and factors affecting adoption of practices through semi-structured interviews with district and community-level government health personnel, staff from the Nepal Family Health Program, FCHVs, recently delivered women and their husbands and mothers-in-law.

Results

The booklet is shared among household members, promotes discussion, and is referred to when questions arise or during emergencies. Booklet cards on danger signs and nutritious foods are particularly well-received. Cards on family planning and certain aspects of birth preparedness generate less interest. Husbands and mothers-in-law control decision-making for maternal and newborn care-seeking and related household-level behaviors.

Conclusions

Interpersonal peer communication through trusted community-level volunteers is an acceptable primary strategy in Nepal for promotion of household-level behaviors. The content and number of messages should be simplified or streamlined before being scaled-up to minimize intervention complexity and redundant communication.

SUBMITTER: McPherson RA

PROVIDER: S-EPMC2898677 | biostudies-literature | 2010 Jun

REPOSITORIES: biostudies-literature

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Publications

Process evaluation of a community-based intervention promoting multiple maternal and neonatal care practices in rural Nepal.

McPherson Robert A RA Tamang Jyotsna J Hodgins Stephen S Pathak Laxmi R LR Silwal Ram C RC Baqui Abdullah H AH Winch Peter J PJ

BMC pregnancy and childbirth 20100607

<h4>Background</h4>The challenge of delivering multiple, complex messages to promote maternal and newborn health in the terai region of Nepal was addressed through training Female Community Health Volunteers (FCHVs) to counsel pregnant women and their families using a flipchart and a pictorial booklet that was distributed to clients. The booklet consists of illustrated messages presented on postcard-sized laminated cards that are joined by a ring. Pregnant women were encouraged to discuss bookle ...[more]

PMID: 20529251

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Project description:BACKGROUND:This study evaluates an eight-session behavior change health intervention with women's self-help groups (SHGs) aimed to promote healthy maternal and newborn practices among the more socially and economically marginalized groups. METHODS:Using a pre-post quasi-experimental design, a total of 545 SHGs were divided into two groups: a control group, which received the usual microcredit intervention; and an intervention group, which received additional participatory training around maternal, neonatal, and child health issues. Women members of SHGs who had a live birth in the 12 months preceding the survey were surveyed on demographics, practices around maternal, neonatal and child health (MNCH), and collectivization. Outcome effects were assessed using difference-in-difference (DID) methods. RESULTS:Women from the SHGs with health intervention, relative to controls over time (time 1 to time 2), were more likely to: use contraceptive methods (DID: 9 percentage points [pp], p<0.001), have institutional delivery (DID: 9pp, p<0.05), practice skin-to-skin care (DID: 17pp, p<0.05), delay bathing for 3 or more days (DID: 19pp, p<0.001), initiate timely breastfeeding (DID: 21pp, p<0.001), exclusively breastfeed the child (DID: 27pp, p<0.001), and provide age-appropriate immunization (DID: 9pp, p<0.001). Additionally, women from the SHGs with health intervention when compared to the control group over time were more likely to report: collective efficacy (DID: 17pp, p<0.001), support through accompanying SHG members for antenatal care (DID: 8pp, p<0.05), receive a visit from SHG member within 2 days post-delivery (DID: 32pp, p<0.001), and receive reproductive, maternal, neonatal and child health information from an SHG member (DID: 45pp, p<0.001). CONCLUSION:Findings demonstrate that structured participatory communication on MNCH with women's groups improve positive health practices. In addition, SHGs can reach a substantial proportion of women while providing an avenue for pregnant women and young mothers to be assisted by others in learning and practicing healthy behaviors, thus building social cohesion on health.

Project description:BackgroundA community-based intervention comprising both men and women, known as Safe Motherhood Action Groups (SMAGs), was implemented in four of Zambia's poorest and most remote districts to improve coverage of selected maternal and neonatal health interventions. This paper reports on outcomes in the coverage of maternal and neonatal care interventions, including antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) in the study areas.MethodologyThree serial cross-sectional surveys were conducted between 2012 and 2015 among 1,652 mothers of children 0-5 months of age using a 'before-and-after' evaluation design with multi-stage sampling, combining probability proportional to size and simple random sampling. Logistic regression and chi-square test for trend were used to assess effect size and changes in measures of coverage for ANC, SBA and PNC during the intervention.ResultsMothers' mean age and educational status were non-differentially comparable at all the three-time points. The odds of attending ANC at least four times (aOR 1.63; 95% CI 1.38-1.99) and SBA (aOR 1.72; 95% CI 1.38-1.99) were at least 60% higher at endline than baseline surveillance. A two-fold and four-fold increase in the odds of mothers receiving PNC from an appropriate skilled provider (aOR 2.13; 95% CI 1.62-2.79) and a SMAG (aOR 4.87; 95% CI 3.14-7.54), respectively, were observed at endline. Receiving birth preparedness messages from a SMAG during pregnancy (aOR 1.76; 95% CI, 1.20-2.19) and receiving ANC from a skilled provider (aOR 4.01; 95% CI, 2.88-5.75) were significant predictors for SBA at delivery and PNC.ConclusionsStrengthening community-based action groups in poor and remote districts through the support of mothers by SMAGs was associated with increased coverage of maternal and newborn health interventions, measured through ANC, SBA and PNC. In remote and marginalised settings, where the need is greatest, context-specific and innovative task-sharing strategies using community health volunteers can be effective in improving coverage of maternal and neonatal services and hold promise for better maternal and child survival in poorly-resourced parts of sub-Saharan Africa.

Project description:BackgroundEdutainment aims to spread educational messages in an entertaining way, and often reaches large audiences. While studies increasingly report the impacts of edutainment interventions, there is limited context-specific evidence on the underlying processes and barriers to effective delivery, especially in rural areas. This article presents results from a process evaluation of a community-based edutainment intervention designed to improve knowledge, attitudes, and practices on gender-based violence (GBV), sexual and reproductive health (SRH), and maternal and child health. The intervention focused on the television series, C'est la Vie!, screened through biweekly film clubs in rural Senegal and included post-screening discussions and thematic workshops, meant to reinforce messages, increase knowledge, and change social norms. The objectives of this study were to assess intervention adaptation, implementation fidelity, participants' responsiveness or engagement, and series appropriateness.MethodsThe intervention was implemented from December 2019 to March 2020 in 120 villages in Kaolack and Kolda regions of Senegal, and targeted adolescent girls and young women aged 14 to 34. The process evaluation was carried out in March 2020 in 14 villages using: i) individual semi-structured interviews with implementers (n = 3), village chiefs (n = 8), married women (n = 9), adolescent girls (n = 8), and men (n = 8); ii) focus groups with men (n = 7, 29 participants) and women (n = 10, 100 participants); and iii) observations of screening sessions (n = 4) and post-screening discussions (n = 2). Data were analyzed using thematic and content analysis.ResultsThe results highlight that adaptation of the intervention helped reach the target population and improved participant attendance, but might have compromised fidelity to original design, as intervention components were shortened and modified for rural delivery and some facilitators made ad hoc modifications. The screenings coverage and frequency were adequate; however, their duration was shortened due to COVID-19 restrictions in Senegal. Participant responsiveness was excellent, as was the series appropriateness for most topics, including GBV. SRH remains a sensitive topic for youth, especially when the film clubs included non-peers, such as slightly older women.ConclusionsThis study showed that using film clubs to deliver sensitive edutainment content in rural areas is feasible and has potential for scale-up.

Project description:BACKGROUND:Evidence-based medicines, technologies, and protocols exist to prevent many of the annual 300,000 maternal, 2.7 million neonatal, and 9 million child deaths, but they are not being effectively implemented and utilized in rural areas. Nepal, one of South Asia's poorest countries with over 80% of its population living in rural areas, exemplifies this challenge. Community health workers are an important cadre in low-income countries where human resources for health and health care infrastructure are limited. As local women, they are uniquely positioned to understand and successfully navigate barriers to health care access. Recent case studies of large community health worker programs have highlighted the importance of training, both initial and ongoing, and accountability through structured management, salaries, and ongoing monitoring and evaluation. A gap in the evidence regarding whether such community health worker systems can change health outcomes, as well as be sustainably adopted at scale, remains. In this study, we plan to evaluate a community health worker system delivering an evidence-based integrated reproductive, maternal, newborn, and child health intervention as it is scaled up in rural Nepal. METHODS:We will conduct a type 2 hybrid effectiveness-implementation study to test both the effect of an integrated reproductive, maternal, newborn, and child health intervention and the implementation process via a professional community health worker system. The intervention integrates five evidence-based approaches: (1) home-based antenatal care and post-natal care counseling and care coordination; (2) continuous surveillance of all reproductive age women, pregnancies, and children under age 2 years via a mobile application; (3) Community-Based Integrated Management of Newborn and Childhood Illness; (4) group antenatal and postnatal care; and 5) the Balanced Counseling Strategy to post-partum contraception. We will evaluate effectiveness using a pre-post quasi-experimental design with stepped implementation and implementation using the RE-AIM framework. DISCUSSION:This is the first hybrid effectiveness-implementation study of an integrated reproductive, maternal, newborn, and child health intervention in rural Nepal that we are aware of. As Nepal takes steps towards achieving the Sustainable Development Goals, the data from this three-year study will be useful in the detailed planning of a professionalized community health worker cadre delivering evidence-based reproductive, maternal, newborn, and child health interventions to the country's rural population. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03371186 , registered 04 December 2017, retrospectively registered.

Project description:ObjectiveContamination of weaning food leads to diarrhoea in children under 5 years. Public health interventions to improve practices in low-income and middle-income countries are rare and often not evaluated using a randomised method. We describe an intervention implementation and provide baseline data for such a trial.DesignClustered randomised controlled trial.SettingRural Gambia.Participants15 villages/clusters each with 20 randomly selected mothers with children aged 6-24 months per arm.InterventionTo develop the public health intervention, we used: (A) formative research findings to determine theoretically based critical control point corrective measures and motivational drives for behaviour change of mothers; (B) lessons from a community-based weaning food hygiene programme in Nepal and a handwashing intervention programme in India; and (C) culturally based performing arts, competitions and environmental clues. Four intensive intervention days per village involved the existing health systems and village/cultural structures that enabled per-protocol implementation and engagement of whole villager communities.ResultsBaseline village and mother's characteristics were balanced between the arms after randomisation. Most villages were farming villages accessing health centres within 10 miles, with no schools but numerous village committees and representing all Gambia's three main ethnic groups. Mothers were mainly illiterate (60%) and farmers (92%); 24% and 10% of children under 5 years were reported to have diarrhoea and respiratory symptoms, respectively, in the last 7?days (dry season). Intervention process engaged whole village members and provided lessons for future implementation; culturally adapted performing arts were an important element.ConclusionThis research has potential as a new low-cost and broadly available public health programme to reduce infection through weaning food. The theory-based intervention was widely consulted in the Gambia and with experts and was well accepted by the communities. Baseline analysis provides socioeconomic data and confirmation of Unicefs Multiple Indicator Cluster Survey (MICS) data on the prevalence of diarrhoea and respiratory symptoms in the dry season in the poorest region of Gambia.Trial registration numberPACTR201410000859336; Pre-results.

Dataset Information

Process evaluation of a community-based intervention promoting multiple maternal and neonatal care practices in rural Nepal.

Background

Methods

Results

Conclusions

Publications

Process evaluation of a community-based intervention promoting multiple maternal and neonatal care practices in rural Nepal.

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