Understanding Drivers of Sustained Engagement in SMS‐Based Nutrition Programmes

A Realist Evaluation With an Equity Lens in Tanzania

Dados Bibliográficos

ID15536355
AutoresInka Barnett (0000-0001-5899-4173, University of Sussex, autor correspondente), Jessica Gordon (0000-0002-6177-3002, University of Sussex), Deogardius Medardi (Institute of Finance Management), Mieke Snijder (0000-0001-8766-3015, University of Sussex)
Ano2025
Volume21
Fascículo4
Páginase70069-e70069
Data de publicação2025-07-29
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoMaternal and Child Nutrition (JOURNAL)
Identificadores do periódicoISSN: 1740-8695 • E-ISSN: 1740-8709
EditoraWiley (PUBLISHER • GB)
DOI10.1111/mcn.70069
PMID40728033
OpenAlexW4412725593
IdiomaEN
Referências citadas45

Child undernutrition remains a global challenge, intricately linked to systemic inequities in access to maternal and child health and nutrition (MCHN) services. While SMS-based behaviour change communication (BCC) offers a scalable strategy to address this challenge, its effectiveness is often undermined by low and inconsistent user engagement. This study extends the impact evaluation of the mNutrition programme in Tanzania-a nationwide SMS-based BCC programme aimed at improving maternal and child nutrition (MCN)-to investigate what drives sustained, long-term engagement-an important but underexplored gap. The objective is to explore the mechanisms driving sustained engagement among mothers in rural Tanzania and how these are triggered by specific contextual factors and inequities. A realist approach was used, combining realist interviews with 40 sustained engagers (conducted across three sites between February and April 2019) and quantitative endline survey data. Retroductive analysis iteratively tested initial programme theories (IPTs) and derived Context-Mechanism-Outcome (CMO) configurations explaining sustained engagement. Findings showed sustained engagement resulted from the interplay between programme elements-such as content, SMS delivery (regularity, convenience, privacy), message tone (non-judgmental, supportive), and perceptions of the sender-and inequity-laden contextual realities, including time poverty, social isolation, undervaluation of women, gendered power dynamics within households and healthcare settings. The study concludes that digital BCC programmes must be context-sensitive and equity-oriented to achieve sustained engagement. Designing messages and delivery systems that reflect users' lived experiences and address structural vulnerabilities can enhance engagement and support more equitable nutrition outcomes

Equity (law · Socioeconomics · Tanzania · Child Development and Digital Technology · ICT in Developing Communities · Medicine · Mobile Health and mHealth Applications · Optometry