Harnessing Participatory Formative Research to Inform Women’s Preferences on Multiple Micronutrient Supplement (MMS) Design Considerations Across Four Country Contexts

To determine universally acceptable MMS box design inputs including preferred color scheme, logo, and slogan options to include in demonstration projects across four countries. Design: This multi-phased, formative study was conducted between Oct. 2020 - Feb. 2021 in Burkina Faso, Bangladesh, Tanzania, and Madagascar. It was designed using a social marketing framework and employed Rapid Assessment Procedures (RAP). Data collection methods and sampling: Qualitative methods were used to inform MMS product design and promotional strategies, including 40 participatory workshops and 32 focus group discussions with pregnant women across four countries. In Burkina Faso, a survey was administered to pregnant women (n = 30) for further triangulation. During data collection, several mock MMS box designs, with design options based on local contexts, were used as stimulus prompts for discussion and voting on preferred MMS design color schemes, logos, and slogans. Analysis: Data across methods were synthesized to identify the most preferred MMS characteristics. Color scheme: Overall, a white/pink MMS box color scheme was the most preferred, universal packaging color across countries. Participants explained that white was “clean”, and in Burkina Faso, it reminded participants of a local paracetamol package “which has no side effects.” The pink was described as “soft and attractive.” In Madagascar, there was a stronger preference for an orange/green color scheme, with pink as a second choice. Box logo: Across countries, participants suggested an image of a pregnant woman on the box design to ensure it is recognizable for its intended purpose. In Burkina Faso, participants voted for a ‘healthy pregnant woman smiling, holding the supplement’ and in Madagascar, participants preferred a ‘healthy, pregnant woman taking the supplement.’ Promotional slogans: While there was variation in specific slogan recommendations to promote MMS by country, shared themes related to good health, strength, happiness, and God. The MMS box design was thus tailored to reflect a combination of preferences. Engaging pregnant women who will be end-users of MMS through participatory methods in four countries aided to inform programming that may improve supplement acceptability and compliance across contexts. Bill and Melinda Gates Foundation.