Of participants, 44 (76%) completed the intervention (actively participated in groups through the final session, attended the last in-person meeting, and completed follow up surveys); 11/16 group 1 participants completed, 15/20 group 2 participants completed, and 18/22 group 3 participants completed. FAMA participants were very active with a total of 19,536 messages, 1,582 pictures, and 10,369 emojis sent in the three groups. The content of messages included asking questions about the daily and weekly health topics, sharing personal experiences, and telling stories about how their situation related to the current topic. Sent pictures were mainly of participants’ newborns to provide context for questions about what was happening (i.e., a skin rash) or to share “cute” and/or meaningful moments. Moderators found themselves correcting several misconceptions about how to appropriately manage self- and infant care.
3.5. In-Depth Interviews
Results from qualitative analysis of interview transcripts (n = 27) indicated participants felt they learned a lot during the intervention and, related to our quantitative measures of social support and autonomous functioning, participants indicated they had received social support in various dimensions and were more capable of autonomous functioning after participation. Overall, participants indicated they were highly satisfied with the intervention and all participants interviewed indicated they would recommend participation in FAMA to others.
3.5.1. What Participants Learned
Twenty-four participants (88.9%) discussed having learned new information from their participation in FAMA. When participants were asked to provide specific examples, 78% mentioned learning the family planning topic and emphasized that they learned as much about what does not work to prevent pregnancy as what does. For example, one participant said, “about family planning, I loved that. There are some methods that I did not know about and through the group I learned...and that there are some myths that they [people in general] say, supposedly to not get pregnant, but in truth they are not true, like urinating, that does not prevent a pregnancy.” Similarly, another commented, “bathing after you have sex with your husband, to prevent a pregnancy, knowing that this is false, and I learned, yes, a lot from that, from [family planning] and that this is false.” Yet another said she learned “to understand things, let’s suppose, the myths that people say that after people have had sexual intercourse, that afterwards washing yourself and urinating that that prevents pregnancy and all those are myths because none of that is real.” One participant said of the family planning topic, “…they [the moderators] taught me many things for our babies and for ourselves too, of family planning for ourselves, to not get pregnant at an early age so that we can continue our studies”.
Of the participants, 63% expressed they had learned from and/or valued the topic “understanding your baby” and 55.6% indicated the same for the topic “feeding your baby”. One participant comprehensively expressed the importance of both topics: “I have learned a lot. First, I learned how to care for my baby, I know now when she cries it’s not because she is misbehaving, but because something is wrong, or something hurts. I have learned to appreciate her smile, how she grabs me or cuddles. And, in the morning when I wake her up the first thing she looks for the breast, like someone who says: ‘Give me breast, give me breast I’m hungry’, but she doesn’t cry in the morning. The first days it was very difficult to get used to it because she was crying and I did not know why, because I am a first time mother …but thank you to FAMA, I have learned a lot about breastfeeding. My mom used to say to me: ‘From the moment the child is born, you stick a bottle of milk to them’, it is not like that, the child is given the breast for the first 6 months”.
3.5.2. Social Support
There was evidence of increased social connectedness, companionship, informational support, and emotional support demonstrated in the interviews. Nearly all participants (96.3%) expressed feelings or perceptions of increased social connectedness and/or the availability of someone with whom to share enjoyable social activities as a result of the FAMA intervention. As one participant commented, “… it [the group] was practically a family, they guided us and showed us a lot of care and appreciation. You’ve seen how [the moderators] are with us, they are very playful, and I thank you and them because I have learned a lot and I have helped my baby a lot...I had to change environments and look for a job and all that so I don’t participate as much in the group now, but still I felt like I was in a family, I felt the warmth of being in a home with other girls.” Another commented, “… some of the girls, we got along well, not a simple friendship ‘Ah we talk on WhatsApp and that’, no we can already say, ‘maybe one day we can go to her house, we are going to hang out, we are going to cook with the children’, you know? And we built trust.” Emotional support was mentioned by 37.0% of the participants. As one participant said, “I felt really good and supported. It even lifted my self-esteem; that was something really nice.” Another participant reported a similar self-esteem boost sharing, “Yes, I even feel that my self-esteem has risen a little because I am a little antisocial and I have opened up a little, speaking in the conversations… I have met many people.” One participant shared that one of the facilitators provided emotional support during a difficult time, “My experience was very comfortable, I felt very trusting, I could communicate, not only in private but also with the girls, many times...I mean I’ve had a lot of relationship problems with the baby’s father, they [the moderators] have helped me a lot, they advise me, I felt comfortable, we shared a lot, I learned a lot...” Receipt of informational support was expressed by 55.6% of the participants. Many participants shared the sentiment that, “[the moderators] are really good, they helped me significantly, always attentive to whatever question, really good treatment.” Several participants provided examples of the informational support provided to them including about family planning, what to do when their baby is crying or constipated, among other information received.
3.5.3. Autonomous Functioning
There was evidence of increased autonomous functioning in the exit interviews as participants expressed heightened interest and ability to take care of themselves and their babies. As one mother said, “I learned to be more awake, like more agile, and to interact more with other people.” Another said, “before [the intervention] there were things that I didn’t feel that kind of trust [to talk about], not even to talk with my mom. Now I do it, I have opened a little, I’ve left my comfort zone.” Another said, “Oh, with my husband an example, I feel more... I mean, I tell him things he can do with the child and I explain to him that if he can, he can give him his little meal… before he gave him anise and oregano tea, and I said: ’No, you can’t give that,’ and he said to me, ’okay,’ and I explained why.” Similarly, participants indicated decreased levels of susceptibility. As one mother said, “I learned that I can have my own opinion and decide for myself.” Another demonstrated high authorship saying, “I would say in five years I will be working. I would also like to dedicate myself to my family and sometimes hang out with my girlfriends. I would like to be like that in the future.”
3.5.4. Overall Satisfaction
Overall, participants expressed general satisfaction with the FAMA intervention. As one participant shared, “It is a very excellent group, very excellent, it should be extended more in the country because it provides significant help to first time moms.” Another said, “…I learned a lot, it was really useful to me the information they gave us, the help with the babies, because I was totally inexperienced.” Every participant expressed they would recommend the FAMA program to others. As one participant summarized, “this group was really, really special, truly it was. I am really very happy, very happy, I am. The only thing that bothers me is that now we aren’t going to be able to participate because this is the end. I was really, really happy in this group, I would pass the day really happy reviewing messages. I wasn’t angry, no, because I would grab the phone and when I grabbed the phone it was for me to smile.” One participant said they would recommend the group because, “…sometimes [girls] get pregnant at an early age and they don’t know how to take care of their child, but [in the group] they deal with all topics, there are some girls who know more than others, they can help each other.”
3.5.5. Recommendations for Future Improvements
When asked what we could do to improve the intervention, one participant gave content-related feedback, suggesting expanding the baby illnesses topic to include more childhood illnesses. Others voiced other concerns related to the function of the group including the difficulty involved in juggling the group with other responsibilities, determining how to meaningfully contribute to the group, annoyance over long waits for responses to questions, and complaints that some participants did not follow group norms. For example, one participant said, “Sometimes they talked a lot, I practically didn’t talk, I only entered [into the chat] to see what interested me, and I didn’t like it, that they talked so much, many voice memos, talked about things that they shouldn’t be talking about and that’s why I didn’t talk much in the group.” Some were frustrated by the lack of participation by some of the participants. One participant said, “in reality, I didn’t like it when other participants didn’t talk much in the group… that bored me a little. But, I liked it [FAMA] a lot, it was very interesting.”