Barriers and Enablers in Implementing Tele-Counselling for Postnatal Care of Low-Birth-Weight Infants in Rural India: A Qualitative Study

Introduction: Tele-counselling may emerge as a promising strategy for improving neonatal outcomes in low-birthweight (LBW) babies especially in resource-constrained settings. Objective: To explore barriers and enablers in implementing tele-counselling for caregivers of LBW infants in a rural Indian setting drawing insights from a community based interventional study. Methods: This qualitative study was nested within a larger community based interventional study, conducted in Agra, Uttar Pradesh, the qualitative component is presented. Tele-counselling was provided to caregivers of 40 LBW infants over eight weeks selected consecutively. Data related to challenges were collected through in-depth interviews and analysed by thematic analysis, supplemented with qualitative reflections and case narratives. Results: Key barriers included poor network coverage (35%), lack of willingness to talk (35%), time constraints (25%) and comprehension difficulties (7.5%). Enablers included ASHA worker involvement, flexible scheduling and personalized support. Six themes emerged: technological barriers, communication and comprehension gaps, trust and reluctance, time constraints and competing priorities, role of Community Health Workers, and personalization and case-based support. Conclusion: Despite technological and behavioural barriers, tele-counselling can serve as an effective postnatal intervention tool when combined with trust-building, flexible timing and collaboration with frontline workers. Tailored counselling, regular follow-up and community integration are critical for success.