Abstract
BACKGROUND: The Western Cape region of South Africa has one of the highest global rates of Fetal Alcohol Spectrum Disorder (FASD), underscoring the urgent need for effective interventions. This qualitative study, designed as a process evaluation, explores pregnant and lactating participants' perceptions and experiences of a text message and contingency management (CM) intervention. METHODS: The study involved post-intervention interviews with 10 pregnant participants and 10 post-partum lactating participants. Coding and a thematic analysis approach were applied to the collected data using NVivo 12. RESULTS: Participants identified key factors influencing their engagement in the intervention. Participants faced logistical barriers, but supportive social networks and flexible program components encouraged participation. Increased self-efficacy and external accountability also facilitated behavior change. Furthermore, participants suggested improvements for accessibility and tailored support, highlighting important considerations for future interventions. CONCLUSION: The findings highlighted the potential benefits of the intervention in improving individuals' health behaviors. However, logistical barriers and the need for expanded support services were identified, emphasizing the importance of refining intervention strategies in resource-limited settings. CLINICAL TRIAL REGISTRATION: NCT05319977.