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other·public health, pediatrics, obstetrics and gynecology, epidemiology, clinical trial·PMC10241028

Using behavioural design and theories of change to integrate communication solutions into health systems in India: evolution, evidence and learnings from practice

Integrated Healthcare Journal · 4 authors, 2 centres

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TL;DR

It describes the co-design of four mHealth services (*Mobile Academy*, *Mobile Kunji*, *Kilkari*, *GupShup Potli*) and their implementation.

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It describes the co-design of four mHealth services (*Mobile Academy*, *Mobile Kunji*, *Kilkari*, *GupShup Potli*) and their implementation. Key findings show *Kilkari* had a significant effect on modern contraceptive use and child immunisation at 10 weeks, with greater effects for poorer and less educated families. *Mobile Kunji* was associated with improved knowledge and practices across several behaviours, while *GupShup Potli* (weaker evidence) was linked to improved knowledge and iron-folic acid use. *Kilkari* did not impact entrenched behaviours like infant feeding. The authors conclude that digital tools supporting frontline workers improve interpersonal communication, while direct-to-consumer tools can change limited behaviours among marginalised groups, highlighting the value of layered communication.

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other

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public health

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ORIGINAL PAPER

PMC10241028

Using behavioural design and theories of change to integrate communication solutions into health systems in India: evolution, evidence and learnings from practice

Integrated Healthcare Journal

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ABSTRACT

Between 2011 and 2019, an integrated communication programme to address reproductive, maternal, neonatal and child health was implemented in the Indian state of Bihar. Along with mass media, community events and listening groups, four mobile health services were co-designed with the government of Bihar. These were Mobile Academy —a training course for frontline health workers (FLHWs) supporting them as the last mile of the health system; Mobile Kunji —a job aid to support FLHWs’ interactions with families; Kilkari —a maternal messaging service delivering information directly to families’ mobile phones, encouraging families to seek public health services through their FLHWs; and GupShup Potli —mobile audio stimulus used by FLHWs in community events. While Mobile Kunji and GupShup Potli scaled to other states (two and one, respectively), neither was adopted nationally. The Government of India adopted Kilkari and Mobile Academy and scaled to 12 additional states by 2019. In this article, we describe the programme’s overarching person-centred theory of change, reflect on how the mHealth services supported integration with the health system and discuss implications for the role of health communication solutions in supporting families to navigate healthcare systems. Evaluations of Kunji, Academy and GupShup Potli were conducted in Bihar between 2013 and 2017. Between 2018-2020, an independent evaluation was conducted involving a randomised controlled trial for Kilkari in Madhya Pradesh; qualitative research on Kilkari and Academy and secondary analyses of call record data. While the findings from these evaluations are described elsewhere, this article collates key findings for all the services and offers implications for the role digital and non-digital communication solutions can play in supporting joined-up healthcare and improving health outcomes.

CITATION EXPORT

Priyanka Dutt, Anna Godfrey, Sara Chamberlain et al.. Using behavioural design and theories of change to integrate communication solutions into health systems in India: evolution, evidence and learnings from practice. Integrated Healthcare Journal. (2022). https://doi.org/10.1136/ihj-2022-000139

AUTHORS

4 · 2 CENTRES

Priyanka Dutt, Anna Godfrey, Sara Chamberlain, Radharani Mitra

1 BBC Media Action India, New Delhi, India
2 BBC Media Action, London, UK