Using Participatory Methods To Improve Health Literacy Of Mothers In Northern Nigeria: An Action Research Project

Background: Maternal and neonatal health is an important global public health priority. Outcomes remain poor, especially in rural, peri-urban or marginalised communities. Public health interventions and conventional health promotion programmes are often challenging to implement and can fail to lead to sustainable change. Research suggests that participation influences literacy; which in turn is more likely to lead to sustainable health-related changes especially in marginalised settings, but there are challenges to implementation. Aim: To assess whether an action research approach using a mix of participatory methods can improve the health literacy of women living in peri-urban and rural areas of Northern Nigeria Methods: Three communities were recruited into the project; one as comparison and two in which women’s groups were established. The research project had three stages: designing, implementing and evaluating the complex (health promotion) intervention. A range of participatory approaches (Community-Based Participatory Research, Auto-diagnosis, Most Significant Change) were adopted. Qualitative methods including interviews, focus group discussions, storytelling, group discussions and visual methods were used during group development; and to explore mechanisms and factors that determine the development and impact of women's groups. Findings: The planned transition from facilitator-led to a peer-led women's group was achieved by women's group members during the project's duration. Evaluation of the complex process of co-designing and co-implementing this complex intervention showed that peer-led participatory learning sessions with participatory visual methods were feasible and were used effectively by groups in addressing maternal and neonatal danger signs and promotion of healthy nutrition. Conclusion: Action research approach and combination of participatory methods enabled the development of women's groups with the potential to empower women with knowledge and skills for local maternal health actions. Further work is needed to understand whether groups are sustainable and can have a direct impact on maternal and neonatal morbidity and mortality over time.