Another voice in the crowd: the challenge of changing infant and young child feeding practices through mHealth messaging in rural northern India
Summary:
Non-exclusive breastfeeding and inappropriate complementary feeding continues to drive childhood mortality and morbidity. Kilkari is the world's largest mHealth messaging program. Its weekly audio messages encourage Indian mothers to adopt recommended practices, including on infant and young child feeding (IYCF). Yet these messages enter a social context of entrenched norms, household and health system power relations, and underlying social determinants of nutrition. To understand how Kilkari engages with traditional cultures and practices around IYCF, we conducted interviews in rural central India with mothers enrolled in Kilkari (n=29) and their husbands / extended family (n=24). Respondents reported appreciating Kilkari and said that they agreed with the messages, even though some of their practices conflicted with Kilkari's recommendations. Specifically, although explicitly discouraged in Kilkari, water and herbal syrups were given to most babies in the first six months and complementary feeding was often initiated late, with insufficient quantities of thick and diverse foods. When Kilkari messages were replayed for respondents during interviews, some reported recalling only the aspects of the messages that aligned with their practice, and omitted and denied hearing conflicting content. Others incorrectly recounted the message as endorsing their practice. Competing forms of authority particularly mothers-in-law often contradicted Kilkari. Poverty and extensive demands on mothers' time further hindered uptake of recommended IYCF practices. To change IYCF behaviors, digital health programs must account for the role of social relationships, structural determinants, and the individual's cognitive processes of absorbing information and managing dissonance between knowledge and practice.
Background/Objectives:
Kilkari mHealth messaging program reaches millions of pregnant women and new mothers with short (< 2 min) weekly audio messages. Content covers a wide range of topics, including birth preparedness, childhood immunization and family planning. IYCF messages make up the largest share of content and encourage exclusive breastfeeding for six months, then appropriate complementary feeding (give thick foods with adequate dietary diversity, fed frequently in adequate quantities). To understand how families experienced Kilkari's IYCF messaging, we conducted in depth interviews in rural central India among households with high and medium Kilkari listenership. We spoke to mothers (n=29) and their husbands.
Description of Intervention and/or Methods/Design:
Respondents reported appreciating Kilkari and said that they agreed with the messages, even though some of their practices conflicted with Kilkari's recommendations. Specifically, although explicitly discouraged in Kilkari, water and herbal syrups were given to most babies in the first six months and complementary feeding was often initiated late, with insufficient quantities of thick and diverse foods. When Kilkari messages were replayed for respondents during interviews, some reported recalling only the aspects of the messages that aligned with their practice, and omitted and denied hearing conflicting content. Others incorrectly recounted the message as endorsing their practice. A minority recounted the message correctly and explained that they had not heard this content before but if they had, they would have adhered to it. Competing forms of authority particularly mothers-in-law often contradicted Kilkari. Poverty and extensive demands on young mothers' time further hindered adherence to Kilkari's recommended feeding practices.
Results/Lessons Learned:
Respondents reported appreciating Kilkari and said that they agreed with the messages, even though some of their practices conflicted with Kilkari's recommendations. Specifically, although explicitly discouraged in Kilkari, water and herbal syrups were given to most babies in the first six months and complementary feeding was often initiated late, with insufficient quantities of thick and diverse foods. When Kilkari messages were replayed for respondents during interviews, some reported recalling only the aspects of the messages that aligned with their practice, and omitted and denied hearing conflicting content. Others incorrectly recounted the message as endorsing their practice. A minority recounted the message correctly and explained that they had not heard this content before but if they had, they would have adhered to it. Competing forms of authority particularly mothers-in-law often contradicted Kilkari. Poverty and extensive demands on young mothers' time further hindered adherence to Kilkari's recommended feeding practices.
Discussion/Implications for the Field:
mHealth messaging presents an exciting opportunity to bring standardized and engaging health information to millions of mothers. However, practitioners and policymakers must ground these programs in broader behavior change communication strategies. Successful digital health programs to change IYCF behavior must account for the role of social relationships, structural determinants, and the individual's cognitive processes of absorbing information and managing dissonance between knowledge and practice. Kilkari is intended to echo IYCF recommendations that families receive from government frontline health workers investing in this partnership could enable families to discuss and process the specific recommendations that challenge traditional norms and cultures.
Abstract submitted by:
Kerry Scott
Osama Ummer
Aashaka Shinde - Johns Hopkins Bloomberg School of Public Health
Sara Chamberlain - BBC Media Action India
Amnesty LeFevre
Non-exclusive breastfeeding and inappropriate complementary feeding continues to drive childhood mortality and morbidity. Kilkari is the world's largest mHealth messaging program. Its weekly audio messages encourage Indian mothers to adopt recommended practices, including on infant and young child feeding (IYCF). Yet these messages enter a social context of entrenched norms, household and health system power relations, and underlying social determinants of nutrition. To understand how Kilkari engages with traditional cultures and practices around IYCF, we conducted interviews in rural central India with mothers enrolled in Kilkari (n=29) and their husbands / extended family (n=24). Respondents reported appreciating Kilkari and said that they agreed with the messages, even though some of their practices conflicted with Kilkari's recommendations. Specifically, although explicitly discouraged in Kilkari, water and herbal syrups were given to most babies in the first six months and complementary feeding was often initiated late, with insufficient quantities of thick and diverse foods. When Kilkari messages were replayed for respondents during interviews, some reported recalling only the aspects of the messages that aligned with their practice, and omitted and denied hearing conflicting content. Others incorrectly recounted the message as endorsing their practice. Competing forms of authority particularly mothers-in-law often contradicted Kilkari. Poverty and extensive demands on mothers' time further hindered uptake of recommended IYCF practices. To change IYCF behaviors, digital health programs must account for the role of social relationships, structural determinants, and the individual's cognitive processes of absorbing information and managing dissonance between knowledge and practice.
Background/Objectives:
Kilkari mHealth messaging program reaches millions of pregnant women and new mothers with short (< 2 min) weekly audio messages. Content covers a wide range of topics, including birth preparedness, childhood immunization and family planning. IYCF messages make up the largest share of content and encourage exclusive breastfeeding for six months, then appropriate complementary feeding (give thick foods with adequate dietary diversity, fed frequently in adequate quantities). To understand how families experienced Kilkari's IYCF messaging, we conducted in depth interviews in rural central India among households with high and medium Kilkari listenership. We spoke to mothers (n=29) and their husbands.
Description of Intervention and/or Methods/Design:
Respondents reported appreciating Kilkari and said that they agreed with the messages, even though some of their practices conflicted with Kilkari's recommendations. Specifically, although explicitly discouraged in Kilkari, water and herbal syrups were given to most babies in the first six months and complementary feeding was often initiated late, with insufficient quantities of thick and diverse foods. When Kilkari messages were replayed for respondents during interviews, some reported recalling only the aspects of the messages that aligned with their practice, and omitted and denied hearing conflicting content. Others incorrectly recounted the message as endorsing their practice. A minority recounted the message correctly and explained that they had not heard this content before but if they had, they would have adhered to it. Competing forms of authority particularly mothers-in-law often contradicted Kilkari. Poverty and extensive demands on young mothers' time further hindered adherence to Kilkari's recommended feeding practices.
Results/Lessons Learned:
Respondents reported appreciating Kilkari and said that they agreed with the messages, even though some of their practices conflicted with Kilkari's recommendations. Specifically, although explicitly discouraged in Kilkari, water and herbal syrups were given to most babies in the first six months and complementary feeding was often initiated late, with insufficient quantities of thick and diverse foods. When Kilkari messages were replayed for respondents during interviews, some reported recalling only the aspects of the messages that aligned with their practice, and omitted and denied hearing conflicting content. Others incorrectly recounted the message as endorsing their practice. A minority recounted the message correctly and explained that they had not heard this content before but if they had, they would have adhered to it. Competing forms of authority particularly mothers-in-law often contradicted Kilkari. Poverty and extensive demands on young mothers' time further hindered adherence to Kilkari's recommended feeding practices.
Discussion/Implications for the Field:
mHealth messaging presents an exciting opportunity to bring standardized and engaging health information to millions of mothers. However, practitioners and policymakers must ground these programs in broader behavior change communication strategies. Successful digital health programs to change IYCF behavior must account for the role of social relationships, structural determinants, and the individual's cognitive processes of absorbing information and managing dissonance between knowledge and practice. Kilkari is intended to echo IYCF recommendations that families receive from government frontline health workers investing in this partnership could enable families to discuss and process the specific recommendations that challenge traditional norms and cultures.
Abstract submitted by:
Kerry Scott
Osama Ummer
Aashaka Shinde - Johns Hopkins Bloomberg School of Public Health
Sara Chamberlain - BBC Media Action India
Amnesty LeFevre
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Healthcare Executive