PT - JOURNAL ARTICLE AU - Avishek Hazra AU - Aikantika Das AU - Jaleel Ahmad AU - Shivani Singh AU - Indrajit Chaudhuri AU - Apollonius Purty AU - Audrey Prost AU - Sapna Desai TI - Matching Intent With Intensity: Implementation Research on the Intensity of Health and Nutrition Programs With Women’s Self-Help Groups in India AID - 10.9745/GHSP-D-21-00383 DP - 2022 Apr 05 TA - Global Health: Science and Practice 4099 - http://www.ghspjournal.org/content/early/2022/03/23/GHSP-D-21-00383.short 4100 - http://www.ghspjournal.org/content/early/2022/03/23/GHSP-D-21-00383.full AB - Key MessagesWomen’s self-help groups in 2 Indian states discussed health issues for approximately 30 minutes per month in group meetings, with wide variation in member participation across interventions.Home visits that aimed to reach women with health information outside of group meetings reached between 30%–40% of households with a group member. Women’s participation in community events was low.Group-based interventions commonly employed a range of social and behavior change techniques that aimed to increase women’s individual knowledge and build social networks.Key ImplicationsApproaches to layering health activities onto existing women’s groups should carefully consider the time available in group meetings to discuss health and calibrate intervention goals accordingly.Implementers and researchers should monitor, evaluate, and report implementation intensity of layered interventions, including group meetings, individual visits, and community-based events.Policy makers can explore a range of approaches to address health through working with groups, ranging from information dissemination to community mobilization. They should consider women’s health priorities, time availability to participate in intervention activities, and the intensity required to improve health outcomes.Introduction:In India, a large network of self-help groups (SHGs) implements interventions to improve women’s and children’s health and nutrition. There is growing evidence on the effectiveness of women’s group interventions to improve health but limited information on implementation intensity, including how often groups meet, for how long, and with whom, despite this often being cited as a key factor for success. We aimed to assess the implementation intensity of large SHG-based health and nutrition interventions with rural, low-income women, to inform program design, delivery, and measurement.Methods:We synthesized process data from surveys, meeting observations, and process evaluations across 8 maternal and child health and nutrition interventions in India. We examined the implementation intensity of 3 common intervention delivery channels: group meetings, home visits, and community-level activities.Results:SHG members spent approximately 30 minutes in monthly meetings discussing health or nutrition. SHG dissolution or limited participation in meetings was a common challenge. Beyond group meetings, home visits reached approximately 1 in 3 households with an SHG member. Pregnant and breastfeeding women’s participation in community events varied across interventions.Discussion:Interventions that aim to capitalize on existing networks of financial women’s groups not specifically formed for health and nutrition objectives, such as SHGs, will need to have an implementation intensity that matches the ambition of their health objectives: substantial changes in behavioral or mortality outcomes are unlikely to be achieved with relatively light intensity. Interventions that require sustained interactions with members to achieve health outcomes need to ensure adequate community and individual outreach to supplement group meetings, as well as improved participation through more intensive community mobilization approaches. Evaluations of group-based interventions should report on implementation intensity to support the interpretation of evaluation evidence and to inform further scale-up.