Engaging a rural community in identifying determinants of low birth
weight and deciding on measures to improve low birth weight: an
experience from a Sri Lankan study
Background: Involving communities in identifying and addressing
determinants of their own health is effective in addressing complex
problems, such as low birth weight (LBW). LBW is an important public
health problem which has not improved significantly in Sri Lanka in the
last 10 years. This study reports the ability of lay persons to
identify and address determinants of LBW. Methods: A health promotion
intervention was conducted among 403 mothers registering at 26
antenatal clinics in the district of Anuradhapura, in Sri Lanka. The
components of a health promotion process\u2014initiation, maintenance
and continual monitoring, and re-direction towards greater
effectiveness\u2014were explained to the mothers. Inputs were
initially provided through different methods to enable mothers\u2019
groups to identify determinants of LBW and to decide actions to address
those identified determinants. The overall study was carried out over a
period of 1 year, of which the intervention phase took around 7 months.
The mothers in the clinic group were encouraged to continue an ongoing
process in smaller \u201cneighborhood action committees\u201d
(NACs)\u2014of which there were 71. The findings are based on field
notes maintained during the process, analyzed using thematic analysis.
Results: Each group of mothers identified at least eight determinants
of LBW at the first attempt (without first author\u2019s guidance),
four of which corresponded with those already mentioned in published
studies. Up to five other determinants were agreed, after facilitation
by the first author, at the second attempt. Of the total, 10
determinants of LBW were finally prioritized. Twenty actions to address
the 10 selected prioritized determinants were agreed through a
collective consensus development process. Conclusions: Lay communities
successfully identified determinants of LBW and household level actions
to address these, with relatively simple guidance, when stimulated to
initiate the relevant process. This capacity should be nurtured and
better used in interventions to improve LBW