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Using a Responsive Feedback Approach to Develop and Pilot a Counseling Chatbot to Strengthen Child Nutrition in Rural
Namrata Tomar1, Sriya Srikrishnan2, Neal Lesh3
1Dimagi India, New Delhi, India. ntomar@dimagi.com.
Insights
A chatbot named Poshan Didi was developed to provide nutrition counseling to mothers in India. The pilot study showed high user engagement and acceptance, indicating potential for improved child nutrition outcomes.
Area of Science:
- Digital health interventions
- Public health
- Child nutrition
Background:
- Undernutrition causes nearly half of deaths in Indian children under 5.
- Caregiver support through multiple channels can improve child nutrition.
- Digital tools offer a scalable solution for nutrition education.
Purpose of the Study:
- To develop and pilot a chatbot, Poshan Didi, for improving child nutrition outcomes in India.
- To assess the acceptability, feasibility, and engagement of the chatbot among mothers with children aged 0-12 months.
Main Methods:
- Stakeholder engagement and theory of change development.
- Chatbot (Poshan Didi) creation for individual counseling on nutrition.
- Two-phase pilot study (n=10, then n=100 mothers) in Katni district, India, collecting quantitative and qualitative data.
Main Results:
- Mothers perceived the chatbot as a private, knowledgeable resource.
- 80% of users responded to chatbot messages.
- 64% engaged beyond automated content, seeking nurse support for escalated issues.
Conclusions:
- Chatbots can increase caregiver access to nutrition counseling by creating interaction touchpoints.
- Responsive feedback in chatbot design enhances the efficacy of digital health tools.
- Poshan Didi demonstrates a promising approach to improving child nutrition through accessible digital information.
Introduction:
Nearly half of all deaths in children in India aged younger than 5 years are attributable to undernutrition. Reinforcing the caregiver's positive behaviors through multiple channels can lead to improved child nutrition outcomes. We describe the development and piloting of a chatbot to improve nutrition outcomes for children aged 0-12 months.
Poshan Didi Chatbot Development Process:
We engaged key stakeholders to understand existing interventions to improve nutrition outcomes and developed a theory of change that included an intervention that provides nutrition-related information directly to beneficiaries. A chatbot, Poshan Didi, was developed to provide individual counseling to mothers with children aged 0-12 months on age-appropriate, nutrition-related topics. The chatbot was piloted in Katni district from February 2019 to October 2019 in 2 phases to investigate the acceptability and feasibility of the chatbot (Phase 1, n=10 mothers) and to assess whether users would continue to be engaged and would engage with both the automated content as well as through free form questions (Phase 2, n=100 mothers). Quantitative and qualitative data were collected in focus group discussions with health care workers and mothers (n=4) and interviews with mothers (n=26).
Results:
Mothers viewed the chatbot as being a private channel to discuss topics and referred to Poshan Didi's persona as being knowledgeable. Eighty percent of users replied at least once to a chatbot-generated message. Sixty-four percent engaged beyond the standard chatbot content by discussing at least 1 issue with a nurse who responded to escalated messages.
Conclusion:
This work demonstrates how chatbots could create multiple interaction touchpoints between caregivers and health care workers to increase caregivers' access to age-appropriate nutrition counseling and information. The study shows the value of using the responsive feedback approach in the chatbot design and implementation to improve the efficacy of the digital tool.
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