Background
The Komboni Housewives intervention
Component | Target Audience | Setting | Implementers | Content | Delivery |
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Radio adverts & Call-in Show | Population in target areas, particularly caregivers of children under-five | Broadcast on 3 radio stations: Komboni Radio, Radio 1 and Radio 4 |
Komboni Housewives and Radio Master of Ceremonies (MCs) | Airing of three different spot adverts (EBF, HWWS, ORS + Zinc); similar content to that described in the forum & road shows skits. Call-in shows used as a discussion forum and to amplify the activities of the women’s forums (the timing of the shows coincided with the women’s forums). Discussions scripted around the target behaviours to test the callers' understanding of the intervention messages. Jingle about the target behaviours also played. | 3 times a week for 6 months, with penetration in both intervention and control areas. |
Komboni Housewives Women’s Forums | ~20 caregivers of children under-five | Forums held in the community at the home of a host (an intervention recipient) |
Komboni Housewives
| All four behaviours targeted using: 1) skits (feature the Komboni Housewives gossiping about mothers they believe are not practicing the correct behaviours, being proven wrong and welcoming the mother into their group); 2) discussion with question and answer sessions; 3) emotionally engaging demonstrations (designed to evoke feelings of disgust at mixed feeding a baby under six months and not handwashing with soap, and nurture in relation to incorrect preparation of ORS); and 4) short films featuring the Komboni Housewives (introduced partway through the intervention period). Activities were supported by banners, certificates, stickers, a branded bus and prizes (hats and T-shirts). | One or two forums a day throughout intervention period; rotating between the eight intervention areas. |
ORT Corner "Circle of mothers" sessions (with monthly prize draw) | Caregivers of children under five (preferentially those with a child presenting with diarrhoea) | At the ORT corner (where ORS solution is traditionally available) or another designated area in the government clinic in each intervention area | Two Neighbourhood Health Committee Volunteers (NHCs) linked to the clinic in each site | Circle of Mothers: content similar to forums designed to be shorter and focussed on exclusive breastfeeding and ORS and zinc. | Every Monday-Friday at clinics in all 8 sites. |
Prize draws: Winner of a hamper selected from all caregivers who attended the clinic session in the previous month. The Komboni Housewives conducted a mini forum at select prize draws. | Monthly in each site. Attended by Komboni Housewives once per site. | ||||
Road shows | All community members | Large public space in each site | MCs and Komboni Housewives (featuring a well-known local musician, Afunika)
| Large road shows, one in each intervention area. Similar content to the forums but energised by the presence of the MCs and the presence of Afunika who sang the campaign song and engaged the audience in discussion about the target behaviours. CDs featuring the campaign song as well as hat and T-shirts were given to those giving correct answers in a quiz. | One road show in each site. |
Methods
Evaluation design and framework
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Fidelity - the content and quality of the implemented intervention compared with what was intended;
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Dose delivered - the number of events that were actually conducted;
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Reach - the degree to which the target audience participated in the intervention;
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Recruitment strategies - the procedures used to attract intervention recipients;
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Participant engagement & responses - receipt and understanding of key messages, and interaction with the content;
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Acceptability - from the perspective of both the recipients and the implementers;
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Mediators - specific behavioural determinants measured along the hypothesised causal pathway;
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Context - events and influences in the intervention setting and environment that may have encouraged or impeded intervention delivery, receipt and uptake.
Data collection
Research Method or Data Source | Data Type | Respondents | Core Information Sought | Purpose of Information | Timing |
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Activity logs | Quantitative | NHC & Komboni Housewife implementers | Number of individuals from target population attending Forums and ORT Corner Sessions. Number of men, women and children attending Road Shows. Activities conducted, availability of supplies and challenges faced | Fidelity, dose delivered, reach | Throughout intervention |
CIDRZ staff | Content and quality of delivery of Radio shows | Fidelity | Throughout intervention | ||
Spot check field observations | Quantitative | CIDRZ staff | Content and quality of delivery and participant engagement, according to an observation checklist. Contextual information on delivery & receipt in clusters, including features of each site. | Fidelity, participant engagement, context | Throughout intervention |
Semi-structured interviews | Qualitative | NHC & Komboni Housewife implementers | Successes and challenges of intervention delivery from perspective of the implementers Recruitment strategies and challenges in each cluster (to enable comparison with the levels of reach achieved in that cluster) Acceptability of intervention messages and activities | Fidelity, recruitment, context, acceptability, participant engagement & responses | Midway through intervention & 4–6 weeks post intervention |
Creative Agency (DDB) and Activation Agency (EXP) | Reasons for any deviations from planned activities | Fidelity | Midway through intervention | ||
Nurse-in-Charge at intervention clinics | Information on the (clinic) environment and work load of staff Health Centre perspective on ORT Corner Sessions | Context, acceptability | 4–6 weeks post intervention | ||
Intervention recipients (pairs) | Comprehension of messages and emotional responses to the intervention. Acceptability of intervention messages and activities | Participant responses, acceptability | Throughout intervention | ||
Intervention recipients | Retention of key messages and reflections on the intervention | Participant responses | 4–6 weeks post intervention | ||
Focus group discussions | Qualitative |
Komboni Housewife implementers | Successes and challenges of intervention delivery from perspective of the implementers Recruitment strategies and challenges in each cluster (to enable comparison with the levels of reach achieved in that cluster) Data on delivery & receipt in clusters, including features of each site Acceptability of intervention messages and activities | Fidelity, recruitment, context, acceptability, participant engagement & responses | 4–6 weeks post intervention |
Intervention recipients | Retention of key messages and reflections on the intervention. Reactions to gossip in relation to the target behaviours | Participant responses, mediators | 4–6 weeks post intervention | ||
Unexposed control arm participants | Reactions to gossip in relation to the target behaviours | Mediators | 4–6 weeks post intervention | ||
Household survey | Quantitative | Sample of individuals in intervention arm and control arm | Proportion of sample reporting attendance of each intervention component/listening to the radio show at least once in each intervention and control cluster. Recall and recognition of intervention concept, messages. Quantitative capture of indicators relating to hypothesised behavioural determinants | Reach, participant responses, mediators | At baseline (mediators) & 4–6 weeks post intervention |
Document review | Quantitative | Intervention Schedule Spreadsheet | Information on deviations from planned activities | Fidelity | 4–6 weeks post intervention |
Activity logs
Field observations
Interviews
Household survey
Focus group discussions
Data handling and analysis
Quantitative data
Qualitative data
Results
Intervention implementation
Delivery of intervention components
Quote 1: “When it was just the diarrhoea cases the programme wasn’t flowing well, but when we included non-diarrhoea cases then it was perfect. The participation was poor when they were few; they would be shy or just concentrating on the child. When there were a lot, one mother would ask a question, the other would rephrase and others would attempt to answer. There was a change in all the corners, you find there was a deeper understanding and the information was spreading vastly though the community. The discussions had improved. When you have a lot of people they even strive to be the one to demonstrate [how to make ORS].” (NHC Implementer).
Delivery to clusters
Quote 2: “It was such a challenge to do the whole programme and finish it on time in [two clusters]. Basically it was the location; they have no time to waste…. even just bringing the women together was troublesome. That programme on the radio really started changing things. We [also] saw a change after the road shows took place, they really boosted everything. People would start to see us and say: ‘those are Komboni Housewives, when are you people coming to our place?’ I think it helped us a lot because people recognised us.” (Komboni Housewives Implementer)
Quote 3: “Since it was an open place people used to move around as you teach so that can make your session bad.” (NHC Implementer)
Fidelity of delivery
Quote 4: “We used to refer them to the clinician if we found that the child is falling under the category of underweight, we wanted the mother or the guardian to have knowledge on how she is going to improve the nutrition status of the child.” (NHC Implementer)
Quote 5: “You tell the mother to exclusively breastfeed and then she goes ‘what about HIV’ and things like that, and others say ‘what if the milk isn’t coming out, what do you give that child?’ They really wanted us to tell them what to feed that child and so we thought we couldn’t shut them up so we decided to go off [topic] just to keep them, because you know it is not easy to get a woman’s mind to concentrate on what you are saying.” (Komboni Housewives Implementer)
Intervention receipt
Acceptability, engagement and responses
Consequently, even though disgust was initially elicited following the Baby Tummy activity, individuals in the intervention arm at endline were not significantly more likely to agree with the statement ‘It is disgusting for me to give my baby food or drink before six months’ than control arm participants (49% vs. 43%, P = 0.49).Quote 6: “I didn’t know how to prepare porridge in the morning. But after the meeting, I started preparing the porridge.” (InterventionRecipient)
Quote 7: “Sometimes it was difficult, especially if a mother came with a baby that had diarrhoea. We would give them ORS at the corner, but even then you would see that the mother would concentrate on the child rather than listen to what we were discussing.” (NHC Implementer)
Quote 8: “Other people that stay in far off areas have requested that the programme is extended to reach them so that they also learn how to prepare ORS.” (Komboni Housewives Implementer).
Quote 9: “To be frank, we had a bit of gap [in the services we could provide prior to the intervention]: we had a shortage of staff and so we couldn’t really explain to the mothers fully how to give ORS to their children because a nurse had to do it. When the NHCs came they were specifically doing that job unlike a nurse who also had patients waiting for her.” (Head Nurse at an Intervention Clinic).
Quote 10: “There was a lot of different ways [they talked about gossip], like a woman shouldn’t leave home early in the morning to go and gossip with friends. She just leaves her house work and goes to gossip. A woman needs to work hard at home and cooks food for her children.” (Intervention Recipient).