Objectives In this qualitative study, we examined the impact of the COVID-19 pandemic on motivations, decision-making, and food shopping among dollar store shoppers in Fresno, CA and Boston, MA. Eligible participants were ≥18 years old, lived in Boston or Fresno, spoke English or Spanish, and shopped at a dollar store within the past month. Methods Using convenience sampling, participants were recruited via flyers at 10 dollar stores in low-income neighborhoods in Fresno and Boston and posts in community Facebook groups. Interviews in Boston (n = 25) and Fresno (n = 26) were conducted remotely from August-December 2020. Results Our participants were primarily low-income, English-speaking women who shopped at dollar stores about once per week. Preliminary qualitative content analysis shows that key shopper motivations included low prices, product variety, and convenience. Shelf-stable foods and snacks were frequently purchased, especially for children. Shoppers in Fresno relied more on dollar stores for groceries and fresh produce, while Boston shoppers primarily purchased shelf-stable foods or snacks. Shoppers in both cities desired increased availability of fresh foods. Shoppers reported fear of shopping, limited stock, financial stress, and fewer trips early in the pandemic. Shopping increased by summer. Shoppers with children reported increased food expenditures during the pandemic, including at dollar stores, as closed schools meant that children consumed meals at home. Conclusions Dollar stores continue to be an important food resource despite challenges related to the pandemic. Considering frequent use, food purchases, and desire for more fresh foods among shoppers, dollar stores chains may find a receptive audience for increasing their fresh food stock. Funding Sources Ethical approval was provided by the Tufts University Social, Behavioral & Educational Research Institutional Review Board. Funding was provided by the Bergstrom Foundation and Tufts Friedman School of Nutrition Science and Policy.

Objectives Two field studies assessed the effectiveness and cost-effectiveness of specialized nutritious foods (SNF) to prevent and treat malnutrition among children 6–24 months old in Burkina Faso and 6–59 months old in Sierra Leone. In-home observations (IHO) were conducted to understand household use of SNFs. The IHO data are unique, as local enumerators directly observed caregiver behaviors that would otherwise be provided by self-report. In this study, we examined household factors that may influence child nutrition, including child feeding, care, and hygiene practices among caregivers, and sanitary conditions of the home environment. Methods Local enumerators conducted 3–5-day IHO among a subset of 321 and 176 beneficiary households in Sierra Leone and Burkina Faso, respectively. Using time-stamped checklists and detailed observation notes, they recorded household activities, focused on feeding and care of beneficiary children. Detailed enumerator notes were analyzed using qualitative content analysis. Results Similar trends emerged in both countries. Poor hand-washing and food hygiene practices were common among caregivers; children consumed poor quality, starchy diets; children were most often cared for by their mothers and other adult, female relatives. Child feeding during illness was poor, and child mouthing of unsanitary household objects was common. In Burkina Faso, domestic animals were frequently present in the courtyard and near children during meals. Conclusions Future nutrition interventions may consider approaches that address multiple household factors that contribute to an enabling environment for child nutrition. Further, considering the feasibility of field application, the IHO method may be used in future nutrition programs to provide information beyond what could be obtained accurately from caregiver self report, and thus help inform nutrition behavior change strategies. Funding Sources Support for this research was provided by the USAID Bureau for Humanitarian Assistance.

Objectives To design of a tailored social and behavior change communication (SBCC) strategy to improve program coverage and key nutrition behaviors of internally displaced persons (IDP) in northeast Nigeria, To determine preferred and appropriate ways of integrating one- and two-way mobile communication tools into SBCC activities, To demonstrate application of the Rapid Assessment Procedures (RAP) formative research approach in a humanitarian context with severe insecurity. Methods A RAP approach and was conducted over 4 weeks in August, 2018. It included multiple qualitative methods and various participant types for triangulation. In-depth interviews (IDI), open-ended interviews and focus group discussions (FGD) were conducted among mothers and fathers of children under 5 years, local community leaders and health workers. Semi-structured interviews were conducted among professionals (nutrition and technology experts) with contextual programming knowledge. Interviews and FGD were digitally recorded in Hausa or Kanuri before translation and transcription into English. Textual data were managed in NVivo software, where salient themes pertinent to the research questions were identified. Results A total of 29 IDI, 12 FGD and 10 semi-structured interviews were conducted among diverse stakeholders. An SBCC strategy was designed with preferred communication channels, defined audience segments and tailored messages using emic terms in local languages. Primary caregivers, typically female in this context, were identified as the primary audience. Community health workers, local leaders (e.g., imams) and husbands were identified as secondary audiences who influence the primary caregivers’ nutrition behaviors. Interpersonal (care groups), media (radio) and mobile technologies (interactive voice response calls; SMS; chatbots in low-cost websites) emerged as preferred and viable communication channels. Salient terms and phrases were applied to standard biomedical nutrition messages about breastfeeding and complementary feeding. Conclusions A RAP approach offers a viable formative research model in humanitarian contexts where security challenges might not allow for desired lengthy, in-depth formative work typical of high-quality SBCC strategy design. Funding Sources World Food Program, Korea International Cooperation Agency (KOICA). Supporting Tables, Images and/or Graphs

Objectives Amalima, a USAID Development Food Aid Program (2013–2020) led by Cultivating New Frontiers in Agriculture, supported Zimbabwean communities in Matabeleland North and South to improve food security and nutrition. In 2016, Amalima developed Indoda Emadodeni (IE), a behavior-change campaign which trained local men as Male Champions (MC) and aimed to increase their involvement in childcare, domestic chores, and support for women's participation in Amalima. Methods The IE pilot occurred in six wards in Tsholotsho and Bulilima districts from April to October 2016, involving 60 MC aged 25–67. Each MC recruited ≥ 10 male peers and hosted monthly sessions, where men discussed IE behavior change topics (i.e., men's roles in child feeding and care, household chores, and support for women in Amalima), followed by team-building soccer matches. In December 2016 during an Amalima supplementary food distribution, 100 mothers in Amalima with children < 2 years old, half with husbands in the IE pilot and half not, were randomly selected for a questionnaire about their husbands’ practice of the 12 IE target behaviors. The 12 IE behaviors in the cross-sectional questionnaire were organized by category 1) child feeding and care, 2) support for women in Amalima, and 3) household chores. Behaviors in each category were ordered and scored from poor to ideal. Each behavior was worth 1–4 points, with a total possible score of 30. An independent t-test was conducted to compare mean scores between the two groups of women sampled for the questionnaire. Results The average age of women sampled was 27.7, with a range of 17–45 years old. Most women had three children, with at least one < 2 years old. The average score among women with husbands in the IE pilot was 21.3 and the average score among women in the control group was 16.6, representing a significant difference (p value = 0.013). Conclusions These results suggest that men's participation in the Indoda Emadodeni pilot supported their improved practice of the IE target behaviors, including child feeding, care, and domestic chores. Male change agent-focused behavior change approaches, like Amalima's Indoda Emadodeni, offer a promising opportunity to increase male participation in childcare and domestic chores. Funding Sources Funding for the Amalima Development Food Aid Program was provided by the US Agency for International Development.