Mobile Phone-Based Nutrition Education Targeting Pregnant and Nursing Mothers in Sri Lanka.

INTRODUCTION: A woman's nutrition during pregnancy and nursing affects the mother and the growing child. Similarly, the first two years of a child's life are critical to their growth and development and are facilitated by optimum nutrition. Women's nutrition-related knowledge, attitudes, and practices influence household food and nutrition security. Mobile health (mHealth) is a potentially effective health intervention in pandemic situations when physical gatherings are restricted. OBJECTIVES: To examine the effectiveness of a mobile phone-based nutrition education intervention targeting pregnant and nursing mothers in six Sri Lankan divisional secretariat areas. METHOD: This intervention was evaluated using a before and after within-subjects design. The intervention included 19 messages over four weeks sent via mobile phone, covering nutrition themes such as pregnancy care, infant and young child-feeding, diet, family care for mother and child, and cash management. The intervention was evaluated based on a quantitative survey using a structured interviewer-administered questionnaire and qualitative interviews using a semi-structured questionnaire. The study population was pregnant and nursing mothers. The objective of the qualitative interviews was to identify how respondents used messages and how satisfied they were with the project. The outcome measures were awareness/knowledge, attitudes, social norms, self-efficacy, behaviour intentions, and practices of pregnant and nursing mothers. Trained enumerators collected data using a mobile phone. RESULTS: A total of 996 pregnant and nursing mothers participated in the pre-assessment survey, of which 720 completed the post-assessment. Most were nursing mothers (84.2% pre- and 78.9% post-assessment). Participants provided positive feedback on the intervention. Knowledge/awareness (t = -18.70, p < 0.01) and attitudes (t = -2.00, p < 0.05) increased when exposed to the intervention. Favourable improvements in the practices were also observed. Mothers' practices related to breastfeeding and 24-h dietary diversity showed a statistically significant improvement. However, social norms and behaviour intentions did not significantly improve. The qualitative component also revealed favourable responses. CONCLUSION AND RECOMMENDATIONS: The mobile intervention improved participants' knowledge, awareness, attitude, and practices, but not social norms or behaviour intentions. This approach is recommended to be used on a larger scale in community settings. In addition, mobile technology could drive intervention in pandemic-related situations.

Strengthening social capital in the Sri Lankan population: A qualitative exploration of factors driving the mothers' support groups initiative during economic crisis.

Background: Social capital is a concept that has been identified to improve health outcomes in many populations. Due to COVID-19 and many other factors, Sri Lanka faced a massive economic crisis that affected the nutrition of communities. Many community engagement initiatives have begun to promote the country's nutrition during the worst-hit years. The Mothers' Support Groups initiative is one of the existing community engagement initiatives that is well known for strengthening community social capital. This article discusses how the Mothers' Support Groups (MSG) initiative in Sri Lanka contributed to improving social capital in Sri Lanka during the economic crisis, focusing on nutrition. Methods: We conducted a case study on the activities undertaken by mothers' support groups in view of how they focused on social capital. We selected all activities presented by districts that improved social capital related to nutrition promotion captured in the YouTube video stream. We analyzed these qualitative data to identify the main themes related to social capital and nutritional promotion. Two coders transcribed the video recordings. We analyzed the data using the iterative thematic inquiry (ITI) method and initially assessed beliefs about concepts, building new beliefs through encounters with data, listing tentative themes, and evaluating themes through coding. Results: Six major themes were identified (that social capital had been strengthened to promote nutrition): awareness creation of nutrition, home gardening promotion, promoting livestock farming, minimizing food waste, improving the home economy, and psychosocial health promotion. The most common forms of social capital encountered in these themes were bonding, bridging, and linking. Furthermore, strengthening structural social capital is more prominent than strengthening cognitive social capital. Conclusion: Social capital can improve nutritional status during crises. Activities that can be used to achieve this vary from simple awareness creation among communities to more advanced psychosocial health promotion. Overall, social capital contributed to the community development aspect of health promotion to a greater extent.

Revisiting health promotion settings: An innovative model from Sri Lanka to integrate healthy settings using mHealth.

The health promotion settings approach has been recognised as an effective method of health promotion in the recent era, and mobile health (mHealth) is a highly evolving field in the health sector. The health promotion settings are shifting the focus away from the individuals and moving towards a more holistic model of health promotion. We identified five settings in Sri Lanka to promote a mHealth model, including villages, schools, preschools, workplaces, and hospitals. The specified model using mHealth helps monitor the activities at various levels of healthcare, including regional, district and national levels. The model also maps the location of the healthy settings, which provide a visual picture to the policymakers, helpful in planning and decision-making.

Role of Religious Leaders in COVID-19 Prevention: A Community-Level Prevention Model in Sri Lanka.

The COVID-19 pandemic has affected all countries irrespective of their state of development. In countries with traditional societies, religious leaders have been acknowledged as key stakeholders in community engagement activities, including disease prevention. A community-level prevention model was established in 2020 by the Health Promotion Bureau (HPB), Sri Lanka, which incorporated mobilisation of the clergy to support the prevention and response schemes to COVID-19 with non-governmental stakeholders. This model was part of a more extensive community engagement network established by the HPB in cooperation with the country offices for WHO and UNICEF. Building trust, empowering behavioural traits applicable to minimise risks from COVID-19, leadership and coordination, message dissemination, addressing stigma and discrimination, supporting testing procedures, contact tracing activities and vaccination, building community resilience, spiritual and psychosocial support, and welfare provision are some of the useful factors that were identified in the model. Furthermore, a much broader and holistic approach is needed to focus on health behaviours and social and cultural aspects in a multi-faceted nature. This paper highlights a novel COVID-19 prevention model with active involvement of religious leaders that can be implemented in low resource settings. Our experience from Sri Lanka demonstrates the feasibility of implementing this model to mitigate the disastrous situation following the COVID-19 outbreak.