Individual focus
weakness
In addition to the difficulties in scheduling and engaging family members who were at work, observation data showed that it was difficult to engage with and make visual contact with more than one participant on a small screen. Often it was difficult to hear the counselor/participant if the screen was shared between several people which meant that family members would not be engaged throughout the VC.In addition to the difficulties with engaging family members, we also observed that counselors focused on the pregnant woman as responsible to address problems, as opposed to encouraging a shared responsibility amongst family members. This occurred even in VCs where the family members were present. This meant that action plans were often individually focused, and rarely mentioned other household members. For example, a woman experiencing weakness was listed as the responsible person to take agreed actions of drinking adequate water, consuming nutritious food, and visiting the health facility if the situation did not improve. Action plans were often unspecific. For example, an action of ‘go for ANC’ was written instead of identifying how the action would be achieved (e.g. husband to accompany or mother-in-law to support pregnant woman to ANC). This resulted in challenges in reviewing and building on the action plan in the second VC.