Qualitative Study of Healthcare Seeking Behavior and Development of Behavioural Nudges for a Nutrition Program in Gombe State, Nigeria

Objective: This qualitative study aimed to identify and explain healthcare seeking behaviours among caregivers of young children and apply these findings to develop a mobile phone-based messaging intervention to encourage sustained attendance at a community-based management of acute malnutrition (CMAM) program in Gombe state, Nigeria. Design: Researchers conducted focus group discussions (n=6) and key informant interviews (n=3) with 33 subjects. Transcripts were independently coded and thematic analysis was conducted to gain an understanding of the facilitators, barriers, and motivators shaping caregivers’ decisions to attend health services for malnourished children, as well as access to and use of mobile phones. Participants: Focus groups and interviews were conducted with caregivers of children aged 6-59 months living within travelling distance of three CMAM sites in Gombe state, Nigeria. Results: Barriers to seeking health services included high costs; perceptions of poor quality of care, including poor treatment by health workers; and female caregivers’ limited autonomy. Despite barriers, participants recommended seeking hospital care for a malnourished child. Participants described widespread mobile phone use and recommended messages emphasising that CMAM services are free, conveying respect for caregivers, and reminding caregivers to continue making an effort to attend the CMAM program even as their child began to appear healthier. Conclusions: This study provides a framework for developing contextually salient behavioural nudges for child health and nutrition programs which, in combination with other community outreach strategies, could help motivate and sustain care seeking behaviour.