title: Is the Maternal and Child Health (MCH) handbook effective in improving health-related behavior? Evidence from Palestine.
abstract: 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Japan International Cooperation Agency, Human Development Department Tokyo, Japan. hagiwara.akiko@jica.go.jp
authors.forename: Akiko
authors.initials: A
authors.lastname: Hagiwara
authors.forename: Mika
authors.initials: M
authors.lastname: Ueyama
authors.forename: Asad
authors.initials: A
authors.lastname: Ramlawi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sawada
mesh_terms: D000328:Adult; D018912:Arabs; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D055991:Health Records, Personal; D006801:Humans; D008427:Maternal Health Services / Q000379:methods; D008429:Maternal Welfare; D011247:Pregnancy