Is the Maternal and Child Health (MCH) handbook effective in improving health-related behavior? Evidence from Palestine

Objective: This study examines the effect of the Maternal and Child Health (MCH) handbook - a home-based health record - on women's knowledge and behavior in the Jericho and Ramallah Governorates of Palestine. Methods: This study uses a repeated, cross-sectional data set in which pre- and post-intervention situations are incorporated on two groups: those exposed and those not exposed to the MCH handbook. We employed a difference-in-difference regression analysis utilizing a pre-tested knowledge, attitude, and practice survey of women at 24 MCH 'treatment' centers (N = 260, 270, pre-/post-) in comparison with the women at 6 MCH centers (N = 70, 70, pre-/post-) where the MCH handbook was not released. A trained facilitator conducted a series of focus group discussions with 42. women who were the clients of MCH services and 25 health providers, both from the intervention area, to confirm the results obtained from the quantitative study. Findings: Knowledge related to MCH such as the importance of exclusive breastfeeding and how to cope with the risks of rupture of membranes during pregnancy increased among MCH handbook users, especially among less-educated women. The MCH handbook may be an effective tool for communication with health providers and husbands, for both highly educated and less-educated women during their first pregnancy. Our results suggest that although less-educated women rarely read the handbook themselves at home, they became familiar with health information and options related to MCH through personalized guidance that was provided by health providers at health facilities utilizing MCH handbook. Conclusion: The MCH handbook may be an effective tool to improve (i) communication between the client and the health provider and (ii) women's knowledge- and health-seeking behaviors related to maternal, newborn, and child health. Journal of Public Health Policy (2013) 34, 31-45. doi:10.1057/jphp.2012.56; published online 15 November 2012