Barriers and Facilitators Associated with Kenyan Caregiver’s Engagement in a Child Nutritional Mobile Health Intervention

Abstract

mHealth shows high potential for nutrition interventions in low and middle-income countries. Mama Aweza, a mHealth intervention in Migori, Kenya, teaches caregivers of children aged 6-12 months to measure their child’s mid-upper arm circumference (MUAC) and asks them to respond to a weekly short message system (SMS) message with the measurements. This mixed-methods study aims to determine the perceived facilitators and barriers to engaging in Mama Aweza using data from five formative focus groups discussions (FGDs) with caregivers and assess sociodemographic factors associated with engagement (response) to weekly system messages using enrollment and midpoint response data from Mama Aweza. On average, 71% of caregivers responded to weekly SMS messages. Shared phones and mobile illiteracy were barriers to engagement [Relative Risk (RR): 0.76 and RR: 0.44, respectively]. Other concerns including message timing and language were taken into account in Mama Aweza. Facilitators to engagement included higher education, ease of use of the MUAC tape, and higher frequency of SMS use prior to study. FGDs highlighted the importance of stigma, husband and community influence on nutritional health seeking behavior and engagement in the intervention. Future mHealth interventions should consider adapting the system to increase accessibility for those with shared phones and difficulty with using SMS. Including the community and spouses in the design and dissemination of mHealth interventions will also help promote engagement.