Academic journal article The Qualitative Report

Use of Mobile Phones for Infant and Young Child Feeding Counseling in Sri Lankan Tea Estates: A Formative Study

Academic journal article The Qualitative Report

Use of Mobile Phones for Infant and Young Child Feeding Counseling in Sri Lankan Tea Estates: A Formative Study

Article excerpt

Sri Lanka saw a slow decline in childhood undernutrition during the last decade (Department of Census and Statistics and Ministry of Healthcare and Nutrition, 2009), despite the availability of free health service and education for over eight decades. The nutritional status of children living in the estate sector is poor compared to urban and rural sectors in Sri Lanka. The estate sector, which comprises tea plantations, continues to report high rates of undernutrition (stunting 40.2%, wasting 13.5%, underweight 30.1%), and relatively poorer performance on infant and young child feeding (IYCF) indicators (exclusive breast feeding rate 57.7%, dietary diversity 50.7%, minimum acceptable diet 41.8%), than national averages (Department of Census and Statistics and Ministry of Healthcare and Nutrition, 2009; Senarath, Siriwardena, Godakandage, Jayawickrama, Fernando, & Dibley, 2012; Senarath, Godakandage, Jayawickrama, Siriwardena, & Dibley, 2012). There is an ongoing debate on the effectiveness of traditional methods of nutritional interventions to bring desired outcomes to this population (Weerasinghe & Bandara, 2015). Hence, it is worthy to seek new approaches for improving nutrition and overall health status.

Mobile health initiatives have been effectively used in many primary health care settings for different needs such as patient compliance for insulin therapy, HIV treatment and pediatric dental appointment reminders (Franklin, Waller, Pagliari, & Greene, 2006; Nelson, Berg, Bell, Leggott, & Seminario, 2011; Puccio et al., 2006). M-health is the use of portable electronic devices for mobile voice or data communication over a cellular or other wireless network to provide health information (Kahn, Yang, & Kahn, 2010). With the evolution of mobile phone technology and wider usage, many view m-Health as a promising tool to foster behavioral change. Systematic reviews of m-health behavioral change communications found almost no trials conducted in the low and middle income countries except for a single trial in China (Free et al., 2013; Krishna, Boren, & Balas, 2009).

According to statistics of the telecommunication regulatory commission in Sri Lanka, the number of mobile phone subscriptions by June 2014 was 21 million. Furthermore, mobile subscriptions per 100 people were 102.5, compared to fixed phone services, which were 13.1 per 100 inhabitants (Telecommunication Regulatory Commission in Sri Lanka, 2014). At individual level, 45%-50% of people in Sri Lanka own a mobile phone, which is higher than the average for the South Asian region. Expansion of mobile networks within the last decade achieved over 90% coverage of 2G and 70% of 3G facilities. In addition, the competition of several providers has reduced the prices of the services (GSMA intelligence, 2013). Current ownership of mobile phones in rural areas is less than of urban setting (53% to 42%). However, annual subscriber growth is estimated to be 7%. While coverage not-spots (signal dead zones) and digital literacy lowers usage, affordability also presents an important factor, especially in rural areas (GSMA intelligence, 2013). Still, m-health nutritional counseling has the potential to be a promising application for health care in Sri Lanka. The aim of this study is to understand the nature of mobile phone use and perceptions of m-health for IYCF counseling among the mothers, their family members, and service providers in the estate sector of Sri Lanka for establishing a mobile platform for counseling.

Estate Sector and Health Services

In the early 19th century, the predominant subsistence agrarian economy in Sri Lanka, transformed into a commercial type, with the introduction of the plantation (estate) sector to the country by the British Colonial Rule. Among the key cultivation crops in Sri Lanka, tea became the major export crop. In the failure of recruiting sufficient labor from the indigenous Sinhala community, colonial rulers brought thousands of laborers from the South India for employment. …

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