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

Abstract

BackgroundThe 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.MethodsWe 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.ResultsThe 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.ConclusionsInterpersonal 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.

Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study

“…The involvement of FCHVs in community health interventions in Nepal has effectively improved population-based coverage for various health services [17][18][19][20][21]. A post disaster health promotion intervention study involving FCHVs in an earthquake affected district in Nepal showed that their involvement helped in improving the facility delivery among the mothers from 63 to 83% [21].…”

Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial

“…The HARDIC trial was designed using a peer education approach, which has earlier proved efficient in improving dietary knowledge and behavior and promoting better maternal and neonatal care practices in rural areas of Nepal and other countries [14,39,40]. Because the use of behavior theories during the development of a health promotion program improves the likelihood of positive behavior changes [41], the HARDIC intervention was based on health behavior theories that target both individuals (i.e.…”

Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania

“…Process evaluations have been used to evaluate the implementation of other community-based interventions, including within maternal and newborn health (Dynes et al, 2011;McPherson et al, 2010;Rath et al, 2010). However, there is still a notable gap in the literature around complex behavior change interventions like EQUIP, with many interventions reporting only on impact and not on process (Butterfoss, 2006;Michie, Fixsen, Grimshaw, & Eccles, 2009;Workgroup for Intervention Development and Evaluation Research, 2009).…”