Designing effective communication to improve uptake of Iron and Folic Acid (IFA) pills among pregnant and lactating women
Summary:
Anemia is a pervasive public health problem amongst women in India - one in two women between the ages of 15-49 years are anemic. An estimated 20% of maternal deaths are anemia-related. The disease usually starts in childhood, aggravates during adolescence, and worsens during pregnancy. Since the most effective way to reduce anemia is through consumption of IFA pills, the primary research question for this project was: how can we increase the uptake of IFA pills among pregnant and lactating anemic women from low-income backgrounds? We tested five questions in our behaviour lab through experiments: (i) will a graphic counselling card improve recall of side-effects coping mechanisms by making information salient?; (ii) will a food equivalency graphic increase valuation of IFA pills and willingness to take the pill?; (iii) will a goal tracking calendar increase adherence to IFA pills?; (iv) will testimonials by a relatable individual improve knowledge about IFA pill adherence and evaluation of the value of IFA pills?; and (v) will a reminder call, with information that makes the call interesting on a daily basis, increase IFA pill adherence? Results from the experiments showed that the goal tracking calendar, and the counselling card were effective in tackling two key barriers to uptake: forgetfulness and side-effects respectively. Further research is required to test the validity of these interventions in the field. Additionally, changing health behaviours requires long-term targeted interventions. Hence, continued research to optimize these interventions is essential for improving anemia-related outcomes.
Background/Objectives:
Anemia accounts for 20% of maternal deaths in India. The most effective way to reduce anemia is through consumption of IFA pills. We conducted a desk review and in-depth interviews to understand barriers to uptake of IFA pills. The salient barriers included: IFA pills are not a top-of-mind method of anemia prevention, forgetfulness, limited knowledge on how to mitigate side effects of the pills, and the belief that IFA pills can be substituted with iron-rich foods. We conceptualized interventions that addressed these barriers, and high impact and feasibility interventions were then tested in our behaviour lab.
Description of Intervention and/or Methods/Design:
The interventions were tested using a mobile lab across a sample of 1000 women between 18-35 years of age in rural Haryana. The mobile lab was a bus which could travel to each village to test our interventions. Recruitment was done through government appointed frontline health workers i.e. ASHAs and Anganwadi workers. Our key focus was improving the valuation of IFA pills, and compliance. The interventions were (i) a food equivalency graphic showing what quantity of iron-rich foods constitute one IFA pill; (ii) testimonials, (iii) a daily reminder call; (iv) a goal tracking device i.e. a calendar, and (v) a counselling card which explains side-effect coping mechanisms. For each intervention, participants were randomized into control and treatment groups. The treatment and control groups were well-balanced balanced across demographics. Regression analysis was done to test the hypotheses.
Results/Lessons Learned:
In the counselling card experiment, 21% of the respondents in the treatment condition were able to correctly recall coping mechanisms whereas, in the control condition, only 13% of the respondents were able to do so (p< 0.1). The food equivalency card increased the valuation of the IFA pill, though it did not change the belief that consuming the IFA pill can be substituted with eating iron-rich foods. For the goal tracking device, we use a proxy measure to test adherence i.e. giving a 'missed call' to a number. In the treatment condition, respondents called the number on 64% out of 20 days whereas, in the control condition, respondents called the number on 50% out of 20 days (p< 0.01). The testimonial and IVR experiments had no effect on improving the valuation of the pill and adherence to the IFA pill, respectively.
Discussion/Implications for the Field:
By acknowledging dynamic social interaction, my research uses complexity theory to offer a new perspective to understand the complexities of participatory social change and the role communication can play in it. The developments in media technologies also add new complexities but also lend new potential tools like social media and mobile phone networks to harness this effort.
Abstract submitted by:
Karuna Banerjee - Ashoka India
Neela Saldanha - Busara Center
Georgina Mburu - Busara Center
Sarah Swanson - Busara Center
Nishtha Tewari - Ashoka India
Irene Ngina - Busara Center
Anemia is a pervasive public health problem amongst women in India - one in two women between the ages of 15-49 years are anemic. An estimated 20% of maternal deaths are anemia-related. The disease usually starts in childhood, aggravates during adolescence, and worsens during pregnancy. Since the most effective way to reduce anemia is through consumption of IFA pills, the primary research question for this project was: how can we increase the uptake of IFA pills among pregnant and lactating anemic women from low-income backgrounds? We tested five questions in our behaviour lab through experiments: (i) will a graphic counselling card improve recall of side-effects coping mechanisms by making information salient?; (ii) will a food equivalency graphic increase valuation of IFA pills and willingness to take the pill?; (iii) will a goal tracking calendar increase adherence to IFA pills?; (iv) will testimonials by a relatable individual improve knowledge about IFA pill adherence and evaluation of the value of IFA pills?; and (v) will a reminder call, with information that makes the call interesting on a daily basis, increase IFA pill adherence? Results from the experiments showed that the goal tracking calendar, and the counselling card were effective in tackling two key barriers to uptake: forgetfulness and side-effects respectively. Further research is required to test the validity of these interventions in the field. Additionally, changing health behaviours requires long-term targeted interventions. Hence, continued research to optimize these interventions is essential for improving anemia-related outcomes.
Background/Objectives:
Anemia accounts for 20% of maternal deaths in India. The most effective way to reduce anemia is through consumption of IFA pills. We conducted a desk review and in-depth interviews to understand barriers to uptake of IFA pills. The salient barriers included: IFA pills are not a top-of-mind method of anemia prevention, forgetfulness, limited knowledge on how to mitigate side effects of the pills, and the belief that IFA pills can be substituted with iron-rich foods. We conceptualized interventions that addressed these barriers, and high impact and feasibility interventions were then tested in our behaviour lab.
Description of Intervention and/or Methods/Design:
The interventions were tested using a mobile lab across a sample of 1000 women between 18-35 years of age in rural Haryana. The mobile lab was a bus which could travel to each village to test our interventions. Recruitment was done through government appointed frontline health workers i.e. ASHAs and Anganwadi workers. Our key focus was improving the valuation of IFA pills, and compliance. The interventions were (i) a food equivalency graphic showing what quantity of iron-rich foods constitute one IFA pill; (ii) testimonials, (iii) a daily reminder call; (iv) a goal tracking device i.e. a calendar, and (v) a counselling card which explains side-effect coping mechanisms. For each intervention, participants were randomized into control and treatment groups. The treatment and control groups were well-balanced balanced across demographics. Regression analysis was done to test the hypotheses.
Results/Lessons Learned:
In the counselling card experiment, 21% of the respondents in the treatment condition were able to correctly recall coping mechanisms whereas, in the control condition, only 13% of the respondents were able to do so (p< 0.1). The food equivalency card increased the valuation of the IFA pill, though it did not change the belief that consuming the IFA pill can be substituted with eating iron-rich foods. For the goal tracking device, we use a proxy measure to test adherence i.e. giving a 'missed call' to a number. In the treatment condition, respondents called the number on 64% out of 20 days whereas, in the control condition, respondents called the number on 50% out of 20 days (p< 0.01). The testimonial and IVR experiments had no effect on improving the valuation of the pill and adherence to the IFA pill, respectively.
Discussion/Implications for the Field:
By acknowledging dynamic social interaction, my research uses complexity theory to offer a new perspective to understand the complexities of participatory social change and the role communication can play in it. The developments in media technologies also add new complexities but also lend new potential tools like social media and mobile phone networks to harness this effort.
Abstract submitted by:
Karuna Banerjee - Ashoka India
Neela Saldanha - Busara Center
Georgina Mburu - Busara Center
Sarah Swanson - Busara Center
Nishtha Tewari - Ashoka India
Irene Ngina - Busara Center
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: Theodore Goutas