PT - JOURNAL ARTICLE AU - Tomar, Namrata AU - Srikrishnan, Sriya AU - Lesh, Neal AU - DeRenzi, Brian TI - Using a Responsive Feedback Approach to Develop and Pilot a Counseling Chatbot to Strengthen Child Nutrition in Rural India AID - 10.9745/GHSP-D-22-00148 DP - 2023 Dec 18 TA - Global Health: Science and Practice PG - e2200148 VI - 11 IP - Supplement 2 4099 - http://www.ghspjournal.org/content/11/Supplement_2/e2200148.short 4100 - http://www.ghspjournal.org/content/11/Supplement_2/e2200148.full SO - GLOB HEALTH SCI PRACT2023 Dec 18; 11 AB - Key FindingsDimagi iteratively built and tested the Poshan Didi chatbot to facilitate direct-to-client engagement that yields improved parent awareness and knowledge of nutrition-related information.Mothers of children aged 0–12 months who tested the Poshan Didi counseling chatbot were receptive to the chatbot, appreciated the fast response time, and found the information they received useful.Key ImplicationsClient-centered care benefits from additional contact points and follow-ups with the health system.Chatbots can be an appropriate health counseling tool for the future.The successful use of a sequential design process based on a responsive feedback approach has positive implications for future demonstration projects and their scale-up, specifically in the public health space.Introduction:Nearly half of all deaths in children in India aged younger than 5 years are attributable to undernutrition. Reinforcing the caregiver's positive behaviors through multiple channels can lead to improved child nutrition outcomes. We describe the development and piloting of a chatbot to improve nutrition outcomes for children aged 0–12 months.Poshan Didi Chatbot Development Process:We engaged key stakeholders to understand existing interventions to improve nutrition outcomes and developed a theory of change that included an intervention that provides nutrition-related information directly to beneficiaries. A chatbot, Poshan Didi, was developed to provide individual counseling to mothers with children aged 0–12 months on age-appropriate, nutrition-related topics. The chatbot was piloted in Katni district from February 2019 to October 2019 in 2 phases to investigate the acceptability and feasibility of the chatbot (Phase 1, n=10 mothers) and to assess whether users would continue to be engaged and would engage with both the automated content as well as through free form questions (Phase 2, n=100 mothers). Quantitative and qualitative data were collected in focus group discussions with health care workers and mothers (n=4) and interviews with mothers (n=26).Results:Mothers viewed the chatbot as being a private channel to discuss topics and referred to Poshan Didi's persona as being knowledgeable. Eighty percent of users replied at least once to a chatbot-generated message. Sixty-four percent engaged beyond the standard chatbot content by discussing at least 1 issue with a nurse who responded to escalated messages.Conclusion:This work demonstrates how chatbots could create multiple interaction touchpoints between caregivers and health care workers to increase caregivers' access to age-appropriate nutrition counseling and information. The study shows the value of using the responsive feedback approach in the chatbot design and implementation to improve the efficacy of the digital tool.