JMIR Publications

ABSTRACT

Background:

More than half of women of reproductive age (15-49 years old) are anemic in India. Uptake of and adherence to iron folic acid supplements remain low despite sustained efforts to increase use. With India’s burgeoning digital environment, mobile phones offer a potential medium to increase uptake, especially when combined with interactive voice-messages that deliver entertaining stories infused with norms-based educational messages.

Objective:

This study investigates whether a norms-based entertainment education mHealth intervention can increase self-efficacy for iron folic acid adherence among women of reproductive age in Odisha, India. mRANI is a randomized two-arm study that includes assessments before and after the intervention.

Methods:

All study participants are recruited from only the intervention arm of the parent RANI trial. Whereas the usual practice is to randomize participants either to a treatment arm or to a usual-care control arm, we are assigning the mRANI control group to another entertainment education-based treatment group – one designed to improve bystander intervention to reduce violence against women. Data collection for mRANI is embedded in the parent trial and will include baseline and end-line assessments. Primary outcomes are self-efficacy for iron folic acid adherence and violence against women-related bystander intervention. Inclusion criteria for mRANI is participation in the parent trial and phone ownership. Women (approximate n = 400) who meet mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust standard errors will be conducted to assess between-group comparisons at end-line. A mediation analysis will examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement.

Results:

This study will provide evidence on whether an mHealth norms-based entertainment education intervention can increase self-efficacy for iron folic acid adherence and violence against women-related bystander intervention.

Conclusions:

mRANI may provide an efficient and digital medium to reduce anemia and violence against women in an increasingly digital and socially distanced world owing to COVID-19. Clinical Trial: The parent trial (RANI) was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.