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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Study protocol

The Philani MOVIE study: a cluster-randomized controlled trial of a mobile video entertainment-education intervention to promote exclusive breastfeeding in South Africa

Authors: Maya Adam, Mark Tomlinson, Ingrid Le Roux, Amnesty E LeFevre, Shannon A McMahon, Jamie Johnston, Angela Kirton, Nokwanele Mbewu, Stacy-Leigh Strydom, Charles Prober, Till Bärnighausen

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

In South Africa, rates of exclusive breastfeeding remain low and breastfeeding promotion is a national health priority. Mobile health and narrative entertainment-education are recognized strategies for health promotion. In-home counseling by community health workers (CHWs) is a proven breastfeeding promotion strategy. This protocol outlines a cluster-randomized controlled trial with a nested mixed-methods evaluation of the MObile Video Intervention for Exclusive breastfeeding (MOVIE) program. The evaluation will quantify the causal effect of the MOVIE program and generate a detailed understanding of the context in which the intervention took place and the mechanisms through which it enacted change. Findings from the study will inform the anticipated scale-up of mobile video health interventions in South Africa and the wider sub-Saharan region.

Methods

We will conduct a stratified cluster-randomized controlled trial in urban communities of the Western Cape, to measure the effect of the MOVIE intervention on exclusive breastfeeding and other infant feeding practices. Eighty-four mentor-mothers (CHWs employed by the Philani Maternal Child Health and Nutrition Trust) will be randomized 1:1 into intervention and control arms, stratified by neighborhood type. Mentor-mothers in the control arm will provide standard of care (SoC) perinatal in-home counseling. Mentor-mothers in the intervention arm will provide SoC plus the MOVIE intervention. At least 1008 pregnant participants will be enrolled in the study and mother-child pairs will be followed until 5 months post-delivery. The primary outcomes of the study are exclusive breastfeeding at 1 and 5 months of age. Secondary outcomes are other infant feeding practices and maternal knowledge. In order to capture human-centered underpinnings of the intervention, we will conduct interviews with stakeholders engaged in the intervention design. To contextualize quantitative findings and understand the mechanisms through which the intervention enacted change, end-line focus groups with mentor-mothers will be conducted.

Discussion

This trial will be among the first to explore a video-based, entertainment-education intervention delivered by CHWs and created using a community-based, human-centered design approach. As such, it could inform health policy, with regards to both the routine adoption of this intervention and, more broadly, the development of other entertainment-education interventions for health promotion in under-resourced settings.

Trial Registration

The study and its outcomes were registered at clinicaltrials.​gov (#NCT03688217) on September 27th, 2018.
Literature
1.
World Health Organization (WHO). World health statistics 2016: monitoring health for the sustainable development goals. Geneva: WHO Report; 2016.
2.
Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet. 2016;388(10063):3027–35.PubMedPubMedCentralCrossRef
3.
Kuruvilla S, Bustreo F, Kuo T, Mishra CK, Taylor K, Fogstad H, Gupta GR, Gilmore K, Temmerman M, Thomas J, Rasanathan K. The Global strategy for women’s, children’s and adolescents’ health (2016–2030): a roadmap based on evidence and country experience. Bull World Health Organ. 2016;1;94(5):398.
4.
You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN inter-agency Group for Child Mortality Estimation. Lancet. 2015;386(10010):2275–86.PubMedCrossRef
5.
Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.PubMedCrossRef
6.
Doherty T, Sanders D, Jackson D, Swanevelder S, Lombard C, Zembe W, et al. Early cessation of breastfeeding amongst women in South Africa: an area needing urgent attention to improve child health. BMC Pediatr. 2012;12(1):105.PubMedPubMedCentralCrossRef
7.
National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF. South Africa Demographic and Health Survey 2016. Pretoria and Rockville: NDoH, Stats SA, SAMRC, and ICF; 2019.
8.
Du Plessis L, Peer N, English R, Honikman S. Breastfeeding in South Africa: are we making progress? South African Health Review. 2016;2016(1):109–23.
9.
Cohen RJ, Brown KH, Dewey K, Canahuati J, Rivera LL. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras. Lancet. 1994;344(8918):288–93.PubMedCrossRef
10.
Kimmons JE, Dewey KG, Haque E, Chakraborty J, Osendarp SJ, Brown KH. Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods. J Nutr. 2005;135(3):444–51.PubMedCrossRef
11.
Haroon S, Das JK, Salam RA, Imdad A, Bhutta ZA. Breastfeeding promotion interventions and breastfeeding practices: a systematic review. BMC Public Health. 2013;13(3):S20.PubMedPubMedCentralCrossRef
12.
Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R. Breastfeeding peer counseling: from efficacy through scale-up. J Hum Lact. 2010;26(3):314–26.PubMedPubMedCentralCrossRef
13.
Imdad A, Yakoob MY, Bhutta ZA. Effect of breastfeeding promotion interventions on breastfeeding rates, with special focus on developing countries. BMC Public Health. 2011;11(3):S24.PubMedPubMedCentralCrossRef
14.
15.
Slater MD. Entertainment education and the persuasive impact of narratives. Mahwah: Lawrence Erlbaum Associates Publishers; 2002.
16.
Hinyard LJ, Kreuter MW. Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Educ Behav. 2007;34(5):777–92.PubMedCrossRef
17.
Rogers EM, Vaughan PW, Swalehe R, Rao N, Svenkerud P, Sood S. Effects of an entertainment-education radio soap opera on family planning behavior in Tanzania. Stud Fam Plan. 1999;30(3):193–211.CrossRef
18.
Shen F, Han J. Effectiveness of entertainment education in communicating health information: a systematic review. Asian J Commun. 2014;24(6):605–16.CrossRef
19.
Slater MD, Rouner D. Entertainment—education and elaboration likelihood: understanding the processing of narrative persuasion. Commun Theory. 2002;12(2):173–91.
20.
Wilson KE, Beck VH. Entertainment outreach for women's health at CDC. J Womens Health Gend Based Med. 2002;11(7):575–8.PubMedCrossRef
21.
Aranda-Jan CB, Mohutsiwa-Dibe N, Loukanova S. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health. 2014;14(1):188.PubMedPubMedCentralCrossRef
22.
Gurman TA, Rubin SE, Roess AA. Effectiveness of mHealth behavior change communication interventions in developing countries: a systematic review of the literature. J Health Commun. 2012;17(sup1):82–104.PubMedCrossRef
23.
Sondaal SFV, Browne JL, Amoakoh-Coleman M, Borgstein A, Miltenburg AS, Verwijs M, et al. Assessing the effect of mHealth interventions in improving maternal and neonatal care in low-and middle-income countries: a systematic review. PLoS One. 2016;11(5):e0154664.PubMedPubMedCentralCrossRef
24.
World Health Organization (WHO). mHealth: new horizons for health through mobile technologies: second global survey on eHealth. Geneva: WHO; 2011.
25.
Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Glob Health: Sci Pract. 2013;1(2):160–71.
26.
Källander K, Tibenderana JK, Akpogheneta OJ, Strachan DL, Hill Z, ten Asbroek AH, Conteh L, Kirkwood BR, Meek SR. Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low-and middle-income countries: a review. J Med Internet Res. 2013;15(1).
27.
Diamond L. In search of democracy. Oxon: Routledge; 2015.
28.
Kakihara M. Grasping a global view of smartphone diffusion: an analysis from a global smartphone study. 2014 International Conference on Mobile Business; 2014.
29.
Kreutzer T. Generation mobile: online and digital media usage on mobile phones among low-income urban youth in South Africa. Cape Town: University of Cape Town; 2009.
30.
Barron P, Pillay Y, Fernandes A, Sebidi J, Allen R. The MomConnect mHealth initiative in South Africa: early impact on the supply side of MCH services. J Public Health Policy. 2016;37(2):201–12.PubMedCrossRef
31.
Seebregts C, Barron P, Tanna G, Benjamin P, Fogwill T. MomConnect: an exemplar implementation of the health normative standards framework in South Africa. South Afr Health Rev. 2016;2016(1):125–35.
32.
Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies. Pew Res Cent. 2016;22:1–44.
33.
Shambare R. The adoption of WhatsApp: breaking the vicious cycle of technological poverty in South Africa. J Econ Behavior Stud. 2014;6(7):542.
34.
Watkins JO, Goudge J, Gómez-Olivé FX, Griffiths F. Mobile phone use among patients and health workers to enhance primary healthcare: A qualitative study in rural South Africa. Soc Sci Med. 2018;198:139–47.
35.
Coetzee B, Kohrman H, Tomlinson M, Mbewu N, Le Roux I, Adam M. Community health workers’ experiences of using video teaching tools during home visits—a pilot study. Health Soc Care Community. 2018;26(2):167–75.PubMedCrossRef
36.
Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491–504.PubMedCrossRef
37.
Tomlinson M, Rotheram-Borus MJ, Le Roux IM, Youssef M, Nelson SH, Scheffler A, et al. Thirty-six-month outcomes of a generalist paraprofessional perinatal home visiting intervention in South Africa on maternal health and child health and development. Prev Sci. 2016;17(8):937–48.PubMedPubMedCentralCrossRef
38.
Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Chowdhury AM, Kirkwood BR, Kureshy N, Lanata CF, Phillips JF, Taylor M. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel. J Glob Health. 2017;7(1):010908. https://​doi.​org/​10.​7189/​jogh.​07.​010908.
39.
Mosavel M, Simon C, Van Stade D, Buchbinder M. Community-based participatory research (CBPR) in South Africa: engaging multiple constituents to shape the research question. Soc Sci Med. 2005;61(12):2577–87.PubMedPubMedCentralCrossRef
40.
Bazzano AN, Martin J, Hicks E, Faughnan M, Murphy L. Human-centred design in global health: a scoping review of applications and contexts. PLoS One. 2017;12(11):e0186744.PubMedPubMedCentralCrossRef
41.
Adam M, McMahon SA, Prober C, Bärnighausen T. Human-centered Design of Video-Based Health Education: an iterative, collaborative, community-based approach. J Med Internet Res. 2019;21(1):e12128.PubMedPubMedCentralCrossRef
42.
Brown T, Wyatt J. Design thinking for social innovation. Dev Outreach. 2010;12(1):29–43.CrossRef
43.
Groenewald P, Berteler M, Bradshaw D, Coetzee D, Cornelius K, Daniels J, et al. Western cape mortality profile 2010. Cape Town: South African Medical Research Council; 2013.
44.
Goosen C, McLachlan M, Schübl C. Infant feeding practices during the first 6 months of life in a low-income area of the Western Cape Province. South Afr J Child Health. 2014;8(2):50–4.CrossRef
45.
le Roux IM, Tomlinson M, Harwood JM, O’Connor MJ, Worthman CM, Mbewu N, et al. Outcomes of home visits for pregnant mothers and their infants: a cluster randomised controlled trial. AIDS. 2013;27(9):1461.
46.
Rotheram-Borus MJ, Le Roux IM, Tomlinson M, Mbewu N, Comulada WS, Le Roux K, et al. Philani plus (+): a Mentor mother community health worker home visiting program to improve maternal and infants’ outcomes. Prev Sci. 2011;12(4):372–88.PubMedPubMedCentralCrossRef
47.
Hanington B, Martin B. Universal methods of design: 100 ways to research complex problems, develop innovative ideas, and design effective solutions. Beverly: Rockport Publishers; 2012.
48.
Medlock MC, Wixon D, Terrano M, Romero R, Fulton B. Using the RITE method to improve products: A definition and a case study. Usability Professionals Association. 2002;51.
49.
Burns C, Dishman E, Verplank W, Lassiter B. Actors, hairdos & videotape—informance design. Boston: Conference Companion on Human Factors in Computing Systems; 1994.
50.
51.
European Medicines Agency (EMA) Committee for Medicinal Products for Human Use. Guideline on adjustment for baseline covariates. London: EMA; 2014.
52.
Bai Y, Middlestadt SE, Peng C-YJ, Fly AD. Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact. 2010;26(1):26–34.PubMedCrossRef
53.
Barennes H, Empis G, Quang TD, Sengkhamyong K, Phasavath P, Harimanana A, et al. Breast-milk substitutes: a new old-threat for breastfeeding policy in developing countries. A case study in a traditionally high breastfeeding country. PLoS One. 2012;7(2):e30634.PubMedPubMedCentralCrossRef
54.
Dennis CL. Breastfeeding initiation and duration: a 1990-2000 literature review. J Obstet Gynecol Neonatal Nurs. 2002;31(1):12–32.
55.
Kitano N, Nomura K, Kido M, Murakami K, Ohkubo T, Ueno M, et al. Combined effects of maternal age and parity on successful initiation of exclusive breastfeeding. Prev Med Rep. 2016;3:121–6.PubMedCrossRef
56.
McCann MF, Liskin L, Piotrow PT, Rinehart W, Fox G. Breast-feeding fertility and family planning. Popul Rep J Fam Plan Programs. 1981;24:1–51.
57.
Goga AE, Doherty T, Jackson DJ, Sanders D, Colvin M, Chopra M, et al. Infant feeding practices at routine PMTCT sites, South Africa: results of a prospective observational study amongst HIV exposed and unexposed infants-birth to 9 months. Int Breastfeed J. 2012;7(1):4.PubMedPubMedCentralCrossRef
58.
Meedya S, Fahy K, Kable A. Factors that positively influence breastfeeding duration to 6 months: a literature review. Women Birth. 2010;23(4):135–45.PubMedCrossRef
59.
Mogre V, Dery M, Gaa PK. Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers. Int Breastfeed J. 2016;11(1):12.PubMedPubMedCentralCrossRef
60.
Hemming K, Girling A, Sitch A, Marsh J, Lilford R. Sample size calculations for cluster randomised controlled trials with a fixed number of clusters. BMC Medical Research Methodology. 2011;11:1.CrossRef
61.
Barnhart D, Hertzmark E, Liu E, Mungure E, Muya AN, Sando D, et al. Intra-cluster correlation estimates for HIV-related outcomes from care and treatment clinics in Dar Es Salaam, Tanzania. Contemp Clin Trials Commun. 2016;4:161–9.PubMedPubMedCentralCrossRef
62.
Du Plessis LM. Commitment and capacity for the support of breastfeeding in South Africa: a paediatric food-based dietary guideline. South Afr J Clin Nutr. 2013;26(3):S120–S8.
63.
Siziba L, Jerling J, Hanekom S, Wentzel-Viljoen E. Low rates of exclusive breastfeeding are still evident in four south African provinces. South Afr J Clin Nutr. 2015;28(4):170–9.CrossRef
64.
World Health Organization (WHO). Indicators for assessing infant and young child feeding practices. Part 1: definition. Geneva: WHO; 2008.
65.
66.
Patton MQ. Qualitative evaluation and research methods. Thousand Oaks: SAGE Publications; 1990.
67.
Bowen GA. Naturalistic inquiry and the saturation concept: a research note. Qual Res. 2008;8(1):137–52.CrossRef
68.
69.
McMahon SA, Winch PJ. Systematic debriefing after qualitative encounters: an essential analysis step in applied qualitative research. BMJ Glob Health. 2018;3(5):e000837.
70.
Creswell JW, Clark VLP. Designing and conducting mixed methods research. Thousand Oaks: SAGE publications; 2017.
71.
Marcus AC, Crane LA. Telephone surveys in public health research. Med care. 1986;24(2):97–112.
72.
73.
Weeks MF, Kulka RA, Lessler JT, Whitmore RW. Personal versus telephone surveys for collecting household health data at the local level. Am J Public Health. 1983;73(12):1389–94.PubMedPubMedCentralCrossRef
74.
Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.PubMedCrossRef
75.
Charmaz K, Belgrave L. Qualitative interviewing and grounded theory analysis. The SAGE handbook of interview research: the complexity of the craft. Thousand Oaks: SAGE Publications; 2012.
76.
Bazeley P, Jackson K. Qualitative data analysis with NVivo. Thousand Oaks: SAGE Publications; 2013.
77.
NVivo qualitative data analysis Software (edition 10). QSR International Pty Ltd; 2014.
78.
Petty RE, Cacioppo JT. The elaboration likelihood model of persuasion. InCommunication and persuasion. New York: Springer; 1986. pp. 1–24.
79.
Moyer-Gusé E. Toward a theory of entertainment persuasion: explaining the persuasive effects of entertainment-education messages. Commun Theory. 2008;18(3):407–25.CrossRef
80.
Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19(1):173–202.PubMedCrossRef
81.
Viswanathan M, Ammerman A, Eng E, Garlehner G, Lohr KN, Griffith D, et al. Community-based participatory research: assessing the evidence. Evid Rep Technol Assess. 2004;(99):1–8.
82.
Noel-Weiss J, Taljaard M, Kujawa-Myles S. Breastfeeding and lactation research: exploring a tool to measure infant feeding patterns. Int Breastfeed J. 2014;9(1):5.PubMedPubMedCentralCrossRef
83.
Tylleskär T, Jackson D, Meda N, Engebretsen IMS, Chopra M, Diallo AH, et al. Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet. 2011;378(9789):420–7.PubMedCrossRef
84.
Centers for Disease Control (CDC). Infant Feeding Practices Study II (IFPS II). Atlanta: CDC; 2007.
85.
LeFevre A. Impact evaluation of maternal messaging in India: study protocol. Baltimore: Johns Hopkins University; 2018.
86.
Akinyinka MR, Olatona FA, Oluwole EO. Breastfeeding knowledge and practices among mothers of children under 2 years of age living in a military barrack in Southwest Nigeria. Int J MCH AIDS. 2016;5(1):1.PubMedPubMedCentralCrossRef
87.
Mbada CE, Olowookere AE, Faronbi JO, Oyinlola-Aromolaran FC, Faremi FA, Ogundele AO, et al. Knowledge, attitude and techniques of breastfeeding among Nigerian mothers from a semi-urban community. BMC Res Notes. 2013;6(1):552.PubMedPubMedCentralCrossRef
Metadata
Title
The Philani MOVIE study: a cluster-randomized controlled trial of a mobile video entertainment-education intervention to promote exclusive breastfeeding in South Africa
Authors
Maya Adam
Mark Tomlinson
Ingrid Le Roux
Amnesty E LeFevre
Shannon A McMahon
Jamie Johnston
Angela Kirton
Nokwanele Mbewu
Stacy-Leigh Strydom
Charles Prober
Till Bärnighausen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4000-x

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