Table 1 RANI Intervention Activities

T4 Sessions and Community Engagement Meetings

10 Participatory Learning and Action (PLA) sessions and community engagement meetings developed in collaboration with our implementation partner and another local partner specializing in the methodology based in Delhi.

Sessions and community engagement meetings include a mix of didactic learning and games focused on specific topics related to anemia prevention and theoretical constructs.

Target population: women of reproductive age (WRAs), mothers-in-law, husbands, frontline workers, and government officials/policy makers

The sessions will cover information related to anemia, knowledge and awareness about iron folic acid (IFA) supplements, dietary diversity, social norms, malaria, water and sanitary hygiene (WASH), and deworming.

Monthly

RANI Community Facilitators

Rani Comm

6 media products – 3-4 min locally shot videos complimenting the concept developed in collaboration with our implementation partners and a local media production house based in Delhi.

We show videos to small groups on smart phones.

In year three, we will have evening viewings on large projectors in each village.

Target population: women of reproductive age (WRAs), mothers-in-law, and husbands

Each video highlights the key messages of the program (including modeling positive social norms around IFA) and addresses the myths and barriers that we identified during the formative research around anemia/IFA consumption.

Ongoing basis

RANI Community Facilitators

Hemoglobin Testing and Demonstration

Fifteen women from each of the 130 intervention villages will undergo monthly hemoglobin testing in their village (n = 1950 women per month). The testing is user-friendly with instant digital results.

Their Hemoglobin levels along with their IFA consumption status will also be tracked on a monthly basis. We designed cards with different colors indicating anemia severity, (green, yellow, orange, red), along with relevant behavioral nudges to share the Hemocue results. We use individual tracking cards to monitor hemoglobin progress. We share results at the individual, group, and inter-village level to trigger demand for IFA uptake and consumption of iron rich foods.

Target population: women of reproductive age (WRAs) for testing and their families/villages for demonstrations

The goal of this activity is to promote three types of feedback – ipsative (comparisons between community hemoglobin levels in the past and the present), social (how two neighboring communities are faring, compared to participants’ results at the individual, group, and inter-village level to trigger demand for IFA uptake and consumption of iron rich foods.

Monthly

RANI Community Facilitators

mRANI

mRANI or mobile-RANI is a smaller intervention built into the larger RANI trial to increase demand and adherence to IFA supplements using interactive norms-based audio messages.

After midline data collection (Spring 2020), we will begin the 12-week intervention. We will send audio messages via automated phone calls. As this is an interactive dialogue, we will encourage participants to ask questions, seek additional information, share their experience, or provide feedback via text or phone call. We will use an open-source two-way Interactive Voice Response (IVR) system. We chose audio recordings to be able to reach women with low literacy in an approachable, efficient, and cost-effective way.

Target population: women of reproductive age (WRAs)

The primary objective of mRANI is to examine the effectiveness of automated voice call messages with a social-norms framing to increase IFA demand among women living in low-resource settings.

Each call will be 30 s long and enrolled women will receive two calls per week.

12 weeks between midline and endline assessments

Open-source Interactive Voice Response Software (IVRS)