Evaluating Communication Performance Through Mothers' Feedback

Mothers, difficulties encountered when breastfeeding and how to solve them. Giving ABS to children: The most appropriate time to start giving ABS; Which ABS foods are suitable for each stage of development of children from 6-23 months old; How to ensure hygiene when preparing food and feeding children; How to know if your child is developing well, taking care of sick children, difficulties encountered when giving ABS to children and how to solve them...

Table 3.8: Number of customers consulted by target group

Number of consultations

target group*

CTTT	CTNT	Total
Pregnant mother from 7-9 months	70	32	102
Mother/caregiver of child under 6 months	254	126	380
Mother/caregiver child care 6-23 months	211	104	315
Total	535	262	797

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*Note: The number of consultations includes both individual and group consultations. CTTT commune organized 12 group consultations, CTNT commune organized 15 group consultations. Each group had 5-8 mothers.

Table 3.8 shows the number of individual or group counseling sessions for target groups at Mat Troi Be Tho PTV. The number of counseling sessions for PNMT from 7-9 months and caregivers of children under 6 months old is higher than the number of caregivers of children from 6-23 months old in both CTNT and CTTT communes. This means that counseling and education on breastfeeding is more frequent than counseling and education on ABS.

Interviewee's assessment of direct communication type

Health workers believe that group counseling/group communication is an effective measure to quickly increase coverage. “ With my workload, I should organize small group communication. Every time I focus on mothers like that, I will save more time, the mothers will be in the same group, I will convey the necessary content. Questions

One person's questions will be answered with knowledge for another person. At the same time, I can answer many people, but individual consultation takes a lot of time and medical staff is limited" (Head of the health center). Thus, direct communication forms such as group consultation/group communication at PTV are very suitable measures.

Through the interview, the counseling activities at the health center were evaluated as useful by the mothers. A mother's opinion : "It is useful. Before, when I raised my first child, there was no counseling room, so I found it a bit difficult. Now that there is this room, when I have any questions, it is easier to ask them " (BM 43). The mother chose Mat Troi Be Tho PTV because it was convenient, close to home, easy to access, friendly, and the mother trusted the health workers at the station : "First of all, it is close, close to my area, secondly, I have been here since I came to this health center, in general, I know Ms. S, I trust Ms. S and the health center, so I came here" (BM-CTTT). And when asked what this health center needs to improve to further improve the quality of this service, the mother replied: " In general, I think it is perfect" (BM58-CTTT). However, there were also mothers who had been counseled but they were not completely satisfied. They believe that commune health station staff still have limited qualifications and want doctors with higher qualifications to provide consultation at commune health stations.

Interviewee's assessment of consulting room branding

Brand identity system

The Little Sun brand logo has been displayed on all types of promotional items and other products such as invitations, raincoats, wall clocks, etc. The brand has been easily recognized by mothers: " I saw Little Sun at the Mother and Child Center, here (TYT) I saw the sign right at the gate and said yes..." (BM-CTTT).

Building a brand through service quality

The intervention was implemented until the evaluation was only one year old, so it was not possible to build a brand for mothers and the community. Mothers who had used DVTV knew the brand and believed that TYT would build a brand. “The more we promote it, the more mothers will know about it in the future. For example, I have only given birth to one child, now that I know about this Little Sun Room, I will know how to ask for help when I have my second child” (BM64).

3.2.2.2. Direct communication in the community

Table 3.9: Number of direct communication sessions for target groups in the community

Content

CTTT Commune		CTNT Commune		Total
Number of sessions	Total number of people	Number of sessions	Total number of people	Number of sessions	TS People
Number of group communication sessions in villages/residential groups	6	120	7	174	13	294
Number of sessions integrating propaganda with other meetings	5	300	18	341	23	641
Propaganda for teachers, nannies, family childcare groups and food safety inspections	2	20	2	16	4	36
Total	13	440	27	531	40	971

Table 3.9 shows the results of direct communication in villages/residential groups for diabetes groups, communication integrated into meetings and other health care programs. Communication for the group of teachers and nannies in family childcare groups was integrated into the food safety and hygiene (FSH) inspections. The number of sessions and the number of participants in communication in villages/residential groups in CTNT commune was higher than in CTTT commune. Similarly, the number of communication sessions integrated into other programs and meetings in CTNT commune was also higher than in CTTT commune.

3.2.2.3. Indirect forms of communication

- Broadcast on the commune's loudspeaker: Each commune broadcasts two sessions, each session lasts 2 months with a duration of 45 minutes per session, 3 sessions per week. The total number of broadcasts is

48 times per commune. Broadcast content: 01 PTV advertisement bulletin Baby Sun, many small bulletins about NDTN such as news on NCBSM, ABS, eating iron-rich foods, taking care of sick children, ensuring food hygiene and safety, etc.

- PTV Little Sun commercials and iron-rich food commercials are broadcast on KTV twice a week, for 3 weeks/session and 2 sessions. A total of 12 commercials (produced by A&T).

- Develop and broadcast 2 reports on NDTN and PTV Little Sun advertisement made by researchers.

- PTV advertisement in Khanh Hoa province health education magazine

- Propaganda through billboards, posters, booklets and leaflets

- Organize 01 media event at PTV Mat Troi Be Tho. Content introduces PTV, consulting service packages, staff, marketing to mothers about consulting services, giving PTV advertising gifts to the group of mothers attending.

Various forms of propaganda for target groups were carried out right after the opening day of the PTV. Interviews with mothers showed that the forms of propaganda were evaluated as very effective and diverse. Public information through loudspeakers were also considered useful in CTNT commune. Leaflets and small books were popular with mothers. The following are the opinions of mothers: "Yes, health workers coming to the house is the most effective, when the nurses (collaborators) come to the house, they also propagate, and broadcasting on the radio (commune loudspeaker) is also effective. Because sometimes when the mothers are not at home, people go to work in the fields and they can also listen to the radio" (BM 48-CTNT). Comments of mothers about the leaflets: " I find the leaflets useful for me to know how to take care of my children and eat nutritious food. If I don't understand anything, I go and ask Ms. L, she will advise me in detail" (BM 75-CTNT).

3.2.2.4. Development and production of communication materials

Table 3. 10: Types of training materials

STT

Document name	Target audience	Document lecturer	Document student
1	Management and operation of the Childcare consulting room "Little Sun"	Project Management Board and Management Boards at all levels	1	1
2	Childcare counseling at medical facilities	Medical staff directly implement intervention model	1	1
3	Behaviour change communication on child feeding in the community	Collaborators and health workers deploy intervention models	1	1
	Total		3	3

Table 3.10 presents three types of training materials that were developed and printed for the target groups participating in the intervention implementation. Each type includes two books, one for trainers and one for trainees (see Appendix 5).

Many types of communication materials have been produced and put into use. In each intervention commune, 700 copies of the Child Feeding Handbook were distributed; NCBSM leaflets, 2 types of complementary feeding leaflets (2100 copies/each); 1 Panel (introducing PTV, food diversity, NCBSM); 1 Poster (NCBSM and giving children ABS); 3 Posters on NCBSM; 3 posters on eating iron-rich foods, The importance of 1000 days, ABS at the right time); Each intervention commune was also provided with 100 Mother and Baby Handbooks; 1 set of flipcharts, 3 communication CDs, some visual aids (baby models, breast milk) and many other types of documents. Most of these communication materials were produced and provided by NCBSM, the rest were provided by A&T.

Table 3.11: Number of medical staff and collaborators trained

Content

CTTT Commune (9 villages)	CTNT Commune (7 villages)	Total
Training for PTV managers	4	4	8
Medical staff, resource lecturers district/town line	4	4	8
Commune health workers training	3	3	6
Training collaborators	9	7	16
Total	20	18	38
Workshop on implementing Decree 21 *	25

Note: * Participants are leaders of hospitals, reproductive health centers, and district health centers that have interventions.

Table 3.11 describes the training results of health workers, collaborators of the two communes and other staff related to the intervention. The training content is appropriate to the tasks of each group of subjects participating in the intervention model.

- Training staff managing PTVs and leaders of health centers on operation and management of Little Sun PTVs, Decree 21.

- Training provincial and district level trainers on teaching skills, group counseling, and individual counseling. Providing updated information on NDTN, how to assess children's nutritional status, and Decree 21

- Training health workers of commune health stations on group counseling skills, individual counseling, updated information on NDTN, communication planning, and Decree 21.

- Training collaborators of 2 communes on communication skills, personal counseling, and updated information on NDTN. Developing communication plans for households with target groups.

3.2.2.5. Collaborator activities

Table 3.12: Comparison of the proportion of mothers approached by collaborators before and after the intervention

Research Society

TCT		SCT		Statistical significance	HQCT (%)
n	( %)	n	( %)	Statistical significance	HQCT (%)
CTTT Commune	74	27.4	165	61.1	χ 2 =62.2; P<0.0001	86.1
CTNT Commune	51	18.9	117	56.7	χ 2 =81.9; P<0.0001	163.1
Social proof	63	23.3	86	31.9	χ 2 = 4.9; P<0.05

Table 3.12 shows the percentage of mothers reached by nutrition collaborators at households in the past year at the two time points of TCT and SCT. SCT, the percentage of mothers reached by collaborators increased in all 3 study communes, but increased significantly in intervention communes with the following corresponding rates: CTTT (from 27.4% to 61.1%), CTNT (from 18.9% to 56.7%), control commune (from 23.3% to 31.9%) and was statistically significant. The intervention effectiveness in CTTT commune was 86.1%; in CTNT commune was 163.1%.

The difficulty in the activities of collaborators that many people have mentioned is the funding for training collaborators. This factor can be an important factor and affects the frequency of collaborators' activities. In addition, collaborators also need to be retrained so that they are more confident when propagating. The following is the opinion of the head of the commune health station who intervened: " Their role as a bridge is only average, not very good. If you want them to do better, the first thing is funding. When they go to the area, they have to integrate it with other programs. If they only go to propagate nutrition, they will not go. The second is knowledge, they have only been trained once. Their knowledge is not very good" (CBYT-CTNT).

3.2.3. Monitoring activities

Monitoring results show that it is necessary to develop indicators on the quality and quantity of consultation sessions or direct communication sessions in the community. Currently, there are no standards for measuring performance. To complete the model, it is necessary to develop a measurement tool.

performance. This tool is the basis for rewarding and motivating those directly involved in implementing the model. Similarly, it is necessary to build a mechanism to motivate and work hard for program implementation staff (incentive and reward mechanism).

- Number of supervision sessions by the District Management Board: Total of 12 supervision sessions. One supervision per month in a commune. The form is supportive supervision. The supervision content includes monitoring activities and monitoring the progress of implementing communication measures, directly monitoring communication sessions in the community, monitoring group consultations, and individual consultations.

- Number of monitoring sessions by the Provincial Management Board: 2 times per commune. Contents include inspection and support monitoring. Monitoring activities, monitoring the progress of implementing communication measures at the district and commune levels. Checking the implementation of Decree 21 at the provincial and district levels.

- Number of direct supervision sessions by NCV: 12 times per commune. Supportive supervision, direct supervision of community communication sessions, group counseling sessions, and individual counseling, supporting commune health stations in developing communication plans.

3.2.4. Evaluation of communication results through mothers' feedback