Driving Health and Hygiene Behaviour Change Amongst Young Mothers in Kenya Through Digital Platforms
U Afya is an online community for mums and mums-to-be living in informal settlements in Nairobi, Kenya. Designed and implemented by Every1Mobile, the U Afya digital community engages the mothers through a basic feature phone, to support them to care well for their families through driving 4 key household level behaviours – handwashing with soap, maintaining good hygiene in the home, eating a balanced diet and practicing safe menstrual hygiene.
The programme has been running since 2017, launching more content and features as the community has grown over the years.
The behaviour change strategy for the U Afya community was built around a robust user-centred design process, which led to the recognition that lack of confidence and self-efficacy were the primary barriers to the behaviours. We therefore designed U Afya to help mums find their agency in changing the way they care for their families. It uses a range of techniques to boost confidence and build a sense of confidence and self-efficacy to enact the desired behaviours, in a localised, relevant way. This includes:
- The Help a Sista section creates space for mothers to respond to real-life dilemmas from their peers. It creates an opportunity to share tips from their own experiences, reinforcing a sense that they have valuable insight to share.
- We created a 10 day handwashing challenge as a way for our users to model the desired behaviour – through simple daily challenges. For instance – today make sure your children wash their hands before eating. The mums perform the behaviour in the real world then use the challenge tool to track their own progress. The next day, the next challenge will appear. By returning over multiple days, the women start to create and reinforce the habit.
- Bite-size e-learning courses. U Afya mums work their way through a curated learning journey,testing and reinforcing their knowledge, and building confidence through interactive activities as they go.
Evidence of Behaviour Change
In 2019, Every1Mobile ran a longitudinal study with a new group of U Afya users to track changes in their knowledge, confidence and practice in relation to these healthy behaviours.
These mums were introduced to the U Afya digital platform, and one cohort received one or more supplementary online and offline interventions, including small group discussion, one-to-one engagement sessions, educational flyers or a moderated WhatsApp conversations where users could learn U Afya course material in a dynamic chat setting. By the end of the study, both cohorts of users demonstrated higher levels of knowledge about diet and health, handwashing with soap, hygiene in the home and menstrual health.
- Knowledge gains: Respondents demonstrated significant increases in knowledge about specific educational content related to the four thematic areas covered by the programme, for instance being able to name food groups unprompted, greater awareness about when women are most likely to get pregnant and establishing the link between the use of soap and improved household hygiene. For example, respondents made between 5 to 7-percentage point gains in knowledge about diet and health, showing particularly good improvements about specific information related to what constitutes a balanced diet.
- Increased confidence: Respondants reported greater confidence in their ability to undertake tasks related to these thematic areas, such as making a healthy breakfast consisting of the five food groups and maintaining good hygiene by handwashing with soap. For example, respondents reported between 7 to 13-percentage point increases in confidence levels about having sufficient knowledge about how to maintain good hygiene by handwashing with soap. There were also gains in respondents’ perception of their ability to maintain a healthy household.
- Practice of healthy behaviours: Respondents reported practicing health-influencing behaviours more often, such as making a healthy breakfast, household members washing hands with soap and respondents themselves washing their hands with soap after changing sanitary protection. In terms of menstrual hygiene, there was between an 8 and 12-percentage point increase in respondents who said they always wash their hands with soap after changing their sanitary protection.
After being part of the U Afya programme, mums feel well equipped to care well for their families: