EFFECTIVENESS OF BEHAVIOUR CHANGE COMMUNICATION INTERVENTIONS IN IMPROVING THE DELIVERY OF HEALTH MESSAGES FOR ANTE-NATAL CARE IN LIMITED LITERACY SETTINGS
What do we want to know?
This evidence summary aimed to synthesize the evidence on effectiveness of different behavior change communication interventions to increase pregnant women’s coverage for antenatal (ANC) health check-ups and to increase uptake of health services offered during ANC.
Who wants to know and why?
This evidence summary is designed to provide an overview of the key evidence discussed in systematic reviews, to assist policy-makers and researchers in assessing effective behavior change communication interventions for improving pregnant women’s ANC coverage and uptake of ANC services. Receiving appropriate antenatal care is considered a foundation of maternal and child health. In many low and middle income countries and especially in the South Asia region, ANC coverage and uptake of ANC services is lower, resulting in high maternal, perinatal and neonatal mortality. Identifying and implementing effective interventions is important.
What did we find?
This evidence summary is derived from 19 systematic reviews that investigated effectiveness of BCC interventions on antenatal care coverage and uptake of services.
It appears that interventions delivered at community level and through home visits are effective in increasing pregnant women’s likelihood of getting ANC. Mobilizing the community and increasing their participation in the health program are an integral part of successful Behavior Change Communication interventions. Mobile phone technology can have a significant role in improving the health of pregnant women. Reminding women about their scheduled visit to the health facility by sending them text messages through mobile phones is effective in improving ANC service coverage.
Behavior change communication interventions have a role in improving tge uptake of different ANC services. Nutrition of women during pregnancy and intake of folic acid tablets can be improved when women are specifically educated and counselled about their diet in pregnancy and are provided with micronutrient supplements. Universal testing for Human Immunodeficiency Virus (HIV) during pregnancy can be achieved when HIV testing and counseling is initiated for health provider.
Decision aids in various forms such as interactive computer programs, printed material and counselling are effective in improving knowledge of prenatal screening for Down’s syndrome, other prenatal services and reducing decisional conflict. However, the evidence largely comes from high income countries and has limited applicability to South Asian context.
What are the conclusions?
Behavior Change Communication interventions are important to address the challenge of low ANC coverage and inadequate uptake of ANC services in many low and middle income countries. Addressing both demands as well as supply level factors are important for improving access to health services. While BCC primarily works to generate the demand (by motivating individuals and communities) parallel improvement in supply side factors is essential to achieve utilisation of services.
Overall, the evidence suggests that 1) interventions implemented at community level and with community participation are likely to be effective 2) effective BCC intervention seem to be implemented using combination of strategies such as home visit with community mobilization, nutrition counselling with food supplements and 3) mHealth (using mobile phone technology) interventions, especially when designed as narratives that personally connect with the women, are likely to be effective. However, program level data are needed.
How did we get these results?
Following a pre-defined protocol, 33 databases and several websites were systematically searched to identify English language systematic reviews that studied the effectiveness of BCC to improve women’s access to health facilities and uptake of services during pregnancy. A total of 19 systematic reviews were considered for synthesizing the evidence. Data was extracted from each systematic review in a data extraction sheet which was summarized and thematically categorized to assess effectiveness of different BCC interventions. Evidence tables were devised to provide an overview of each BCC intervention, country of included primary studies, statements about effectiveness and methodological quality and relevance.
This review should be cited as:
Nair, N S., Darak, S., Parsekar, S.S., Parchure, R., Darak, T., Nelson, H., Vijayamma, R., and Menon, S. (2017). Effectiveness of Behaviour Change Communication interventions in improving the delivery of health messages for ante-natal care in limited literacy settings: An evidence summary. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.