Acceptability, feasibility, appropriateness, uptake and cost perceptions of family mid-upper arm circumference supported by two-way SMS in western Kenya

@article{choo2026acceptability,
  title = {{Acceptability, feasibility, appropriateness, uptake and cost perceptions of family mid-upper arm circumference supported by two-way SMS in western Kenya}},
  author = {Esther M. Choo and Jonathan Lara-Arevalo and Catherine Achieng and Merceline Odhiambo and Maurine Anyango Okello and Mary Masheti and Kirkby D. Tickell and Mame M. Diakhate and Benson O. Singa and Christine J. McGrath and Arianna Rubin Means},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0358775},
  url = {https://doi.org/10.1371/journal.pone.0358775},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Acceptability, feasibility, appropriateness, uptake and cost perceptions of family mid-upper arm circumference supported by two-way SMS in western Kenya
AU  - Esther M. Choo
AU  - Jonathan Lara-Arevalo
AU  - Catherine Achieng
AU  - Merceline Odhiambo
AU  - Maurine Anyango Okello
AU  - Mary Masheti
AU  - Kirkby D. Tickell
AU  - Mame M. Diakhate
AU  - Benson O. Singa
AU  - Christine J. McGrath
AU  - Arianna Rubin Means
PY  - 2026
DA  - 2026/09/23
JO  - PLOS One
DO  - 10.1371/journal.pone.0358775
UR  - https://doi.org/10.1371/journal.pone.0358775
AB  - Early identification and treatment of acute malnutrition can decrease mortality and morbidity related to wasting or low weight-for-height. Teaching caregivers to measure mid-upper arm circumference (MUAC), an approach known as Family MUAC, may support early diagnosis of wasting. Family MUAC paired with mobile support from healthcare workers resulted in a 37% reduction in child wasting in the Mama Aweza trial in Kenya. This study examines the intervention’s acceptability, feasibility, appropriateness, uptake, perceptions of cost savings, and factors influencing engagement with Family MUAC. This qualitative study involved eight focus group discussions with caregivers enrolled in the Mama Aweza trial and fourteen in-depth interviews with caregivers who participated in the intervention arm, Family MUAC supported by two-way short message service (SMS). Caregivers were purposively selected based on engagement level with the intervention. Eighteen program staff and healthcare workers from three facilities in western Kenya participated in in-depth interviews. The Theoretical Domains Framework informed design of data collection tools. Caregiver and healthcare worker perceptions of Family MUAC with two-way SMS centered on seven themes. The intervention was viewed as acceptable, cost-saving, appropriate, feasible, and empowering. Caregiver uptake was high, and integrating child growth monitoring with other health services may help enhance sustainability. Barriers to uptake included inconsistent MUAC measurements, limited social support, and issues with phone sharing. Refresher trainings could increase accuracy of MUAC measurements and improve engagement. Direct communication with healthcare workers via SMS built trust and strengthened patient-provider relationships. Caregivers also reported perceived cost savings, as SMS communication reduced unnecessary travel to health centers when children were not malnourished. This study supports Family MUAC with two-way SMS as a promising approach to empower caregivers and highlights their critical role in child health and nutrition interventions. Future interventions can focus on improving measurement accuracy and mitigating negative social influences on caregiver-led interventions.
SN  - 1932-6203
ER  -