Epidemiology & Public Health

Statement of the problem: Evaluation of public health interventions focuses on assessing magnitude of outcome/s but less on the underlying mechanism that explains the “black-box” in pathway/s that connect the intervention to the outcome; which is relevant for improving intervention design and scalability.

Methodology: We performed a program theory-based impact evaluation of a community-based health literacy intervention set in a socially disadvantaged area of Ahmedabad city, India. The intervention focused on improving nutrition, and health of underthree children by empowering their mothers with knowledge and skills through context-based participatory group activities in

a few slums. We use the findings from the qualitative strand of this mixed-methods evaluation and unpack the mechanisms of action of the intervention. Data from 13 focus group discussions and 69 semi-structured interviews with participant mothers was analyzed using qualitative content analysis.

Findings: Encouragement and/or help with household work from their family motivated mothers’ engagement. Intervention design elements such as scheduling meeting in consultation with the mothers, a rarity in India, maximized participation by overcoming gender-related mobility restrictions and ensured convenience. Model-based demonstrations resulted in better understanding, retention and application of messages. Collective efforts in following intervention-recipes, and observing children liking the dishes, instilled confidence in mothers to replicate them at home. Mothers formed innovative partnerships to overcome resource constraints such as taking turns in trying recipes and sharing the food with children of a few families. Mothers also noticed program rewards such as reduced intake of outside food by children which helped save money.

Conclusion & Significance: Qualitative findings revealed a complex interplay of multiple factors related to participants and program

delivery, which facilitated mother’s engagement. These findings are used to explain the impact of this complex intervention in a

resource-poor setting. These insights may help improve intervention design and scalability in low and middle-income countries.

Recent Publications

1. Johri M, et al. (2016) Maternal health literacy is associated with early childhood nutritional status in India, The Journal of Nutrition

146(7):1402–1410.

2. Johri M, et al. (2015) Association between maternal health literacy and child vaccination in India: a cross-sectional study. J Epidemiol

Community Health 69:849–857.

3. Subramanyam MA, et al. (2011) "Is economic growth associated with reduction in child undernutrition in India?", PLoS Medicine

8(3): e1000424.

4. Subramanyam MA and Subramanian S V. (2011) "Nothing misleading about the lack of an association between economic growth

and child undernutrition in India: A reply to Deonarine", PLoS Medicine 8(3): e1000424.

5. Pahwa S, Kumar G T and Toteja G S (2010) Performance of a community-based health and nutrition-education intervention in the

management of diarrhoea in a slum of Delhi, India. International Centre for Diarrhoeal Disease Research, Bangladesh 28(6):553–559.