Mobile Technology Integrated into a Large-Scale Nutrition Program Enables Age-Appropriate Home Visits and Counseling for Mothers of Infants in India

Abstract

Objectives An mHealth job aid and real time monitoring tool currently targets over 1 million community health workers in India (Anganwadi workers – AWWs). Previous studies have shown that mHealth interventions can be effective at a small scale. In this study, we evaluate whether this at-scale mHealth intervention improved the quantity and quality of AWW home visits and counseling. We also examined whether these improvements led to better infant and young child feeding (IYCF) practices among beneficiaries. Methods The mHealth intervention (Common Application Software – CAS) is currently being used by 581,282 AWWs across India. We conducted a village-matched, quasi-experimental design to examine program effectiveness across 428 villages in Madhya Pradesh (MP) and Bihar (BH). Repeated cross-sectional surveys were completed 17–24 months apart with AWWs (n = 1344) and mothers of children < 12 m (n = 6635). We compared post-intervention outcomes between matched groups, controlling for average baseline outcome levels and other covariates to correct for imbalances and improve precision. Program effects were assessed separately within each state. Results In both states, mothers in the intervention group were more likely to receive adequate number of home visits (MP: control = 42%; ß = 9.1%; P < 0.05; BH: control = 24%; ß = 7.7%; P < 0.05). A larger proportion of mothers in the intervention group could recall at least half the life-stage appropriate counseling messages (MP: control = 28.1%; ß = 11.8%. BH: control = 9.5%; ß = 7.7%). However, no improvements in IYCF practices were associated with the intervention. Conclusions mHealth interventions like CAS can support gains in immediate term service delivery outcomes by enabling more age-appropriate home-visits and counseling. However, impacts on nutrition and health behaviors will require a longer-term evaluation and parallel efforts to improve a range of other outcomes, including structural poverty, gender norms, and larger socio-economic and political factors. Funding Sources The Bill and Melinda Gates Foundation.

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review

“…Additionally, our review did not find any studies which incorporated the use of mobile health (mHealth) as part of an intervention package for improving IYCF. 105 Future experimental studies that consider the use of mHealth techniques are required, especially that previously published studies have shown the positive impacts of interventions (in the form of voice messages, SMS and phone calls) on IYCF practices. [106][107][108] Finally, interventional studies that consider the role of fathers/partners as well as grandmothers in improving IYCF behaviours may be warranted in Ethiopia.…”

Interventions to Improve Infant and Young Child Feeding Practices in Ethiopia: A Systematic Review  

“…Additionally, our review did not nd any studies which incorporated the use of mobile health (mHealth) as part of an intervention package for improving IYCF [72]. Future experimental studies that consider the use of mHealth techniques are required, especially that previously published studies have shown the positive impacts of interventions (in form of voice messages, SMS, and phone calls) on IYCF practices [73][74][75].…”

Methods and Lessons From Costing a Large mHealth Intervention at Scale in India

“…ICDS-CAS was thus envisaged to reduce this burden. Recent evaluations have also shown that mHealth interventions such as ICDS-CAS can support gains in immediate term service delivery outcomes by enabling more age-appropriate home-visits and counseling but require longer term evaluations to improve other outcomes ( 20 ).…”