Process evaluation of a community-based intervention promoting multiple maternal and neonatal care practices in rural Nepal

We examined use of the booklet and factors affecting adoption of practices through semi-structured interviews with district and community-level government health personnel, staff from the Nepal Family Health Program, FCHVs, recently delivered women and their husbands and mothers-in-law.The booklet is shared among household members, promotes discussion, and is referred to when questions arise or during emergencies. Booklet cards on danger signs and nutritious foods are particularly well-received. Cards on family planning and certain aspects of birth preparedness generate less interest. Husbands and mothers-in-law control decision-making for maternal and newborn care-seeking and related household-level behaviors.Interpersonal peer communication through trusted community-level volunteers is an acceptable primary strategy in Nepal for promotion of household-level behaviors. The content and number of messages should be simplified or streamlined before being scaled-up to minimize intervention complexity and redundant communication.Nepal is projected to meet the Millennium Development Goal to reduce under-five mortality by two-thirds by 2015 [1,2]. Child mortality (children aged 12 to 59 months) has declined notably in Nepal over the past 15 years while neonatal mortality has declined more modestly; an apparent reduction in maternal mortality over the same period is practically significant but has borderline statistical significance [1,3].Improved maternal and newborn health (MNH) outcomes can be achieved by improving quality of and access to services and through positive changes in household practices and care-seeking. In Nepal, the potential impact of strengthened antenatal, delivery and postpartum care in community-level and referral facilities is constrained by a preference for home delivery and poor geographic access to health facilities.Positive changes in MNH-related household behaviors and care-seeking can be achieved through a variety of strategies. Community mobi