Education and other strategies to promote optimal complementary feeding can significantly improve practices, but little is known about the specific techniques successful interventions use to achieve behaviour change. We reviewed the literature for complementary feeding interventions in low-/middle-income countries (LMIC) published since 2000. We systematically applied a validated taxonomy mapping process to code specific behaviour change techniques (BCTs) used in each intervention; effectiveness ratios for each BCT were estimated. Sixty-four interventions met inclusion criteria, were abstracted, BCTs identified, and coded. Dietary diversity was the most commonly assessed component of complementary feeding, and interpersonal communication, either individually or in groups, was the most commonly used delivery platform. Of the 93 BCTs available for mapping, the 64 interventions included in this review applied a total of 28 BCTs. Interventions used a median of six techniques (max = 13; min = 2). All interventions used "instruction on how to perform the behaviour." Other commonly applied BCTs included "use of a credible source" (n = 46), "demonstration of the behaviour" (n = 35), and "providing information about health consequences" (n = 30). Forty-three interventions reported strategies to shift the physical or social environment. Among BCTs used in >20 interventions, five had effectiveness ratios >0.8: "provision of/enabling social support"; "providing information about health consequences"; "demonstration of the behaviour"; and "adding objects to the environment" namely, food, supplements, or agricultural inputs. The limited reporting of theory-based BCTs in complementary feeding interventions may impede efforts to improve and scale effective programs and reduce the global burden of malnutrition.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity. Conclusions Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting.

The coronavirus disease 19 (COVID-19) pandemic is broadly affecting the mental health and well-being of people around the world, and disproportionately affecting some groups with already pre-existing health inequities. Two groups at greater risk of physical and/or mental health detriments from COVID-19 and more profoundly impacted by the pandemic include frontline workers and American Indian/Alaska Native (AI/AN) communities. To provide support and prevent long-term mental health problems, we culturally adapted a psychological first aid guide specifically for COVID-19 frontline workers serving AI/AN communities. We engaged a diverse, collaborative work group to steer the adaptation content and process. We also held two focus group discussions with frontline workers in AI/AN communities to incorporate their perspectives into the adapted guide. Results from the group discussions and the collaborative work group were compiled, analyzed to extract themes and suggestions, and integrated into the adapted content of the guide. Main adaptations included updating language (i.e., to be more culturally appropriate, less prescriptive, and less text heavy), framing the guide from a harm-reduction lens, incorporating cultural activities, values, and teachings common across diverse AI/AN communities (e.g., importance of being a good relative), and validating feelings and experiences of frontline workers. The resulting adapted guide includes four modules and is available as a free online training. Our adaptation process may serve as a guiding framework for future adaptations of similar resources for specific groups. The adapted guide may stand as an enduring resource to support mental well-being, the prevention of mental health problems, and reduction of health inequities during the pandemic and beyond.

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Objectives Suboptimal complementary feeding (CF) practices stunt child growth. Promotion of optimal CF can improve practices but little is known about how these interventions change behavior, limiting scalability. We conducted a systematic review of the literature for CF interventions in low/middle income countries and mapped behavior change techniques (BCT) using a previously validated method and taxonomy. Methods We searched peer-reviewed and grey literature for interventions published in English, since 2000. Interventions were eligible for inclusion if they aimed to shift CF behaviors among children 6–24 months using social and/or individual behavior change strategies. Reviewers abstracted 64 interventions meeting inclusion criteria. We applied a validated taxonomy mapping approach to identify and code BCTs. For interventions with plausibility or probability evaluation designs, we estimated effectiveness ratios for each BCT (n = 30). Results 22 interventions occurred in sub-Saharan Africa, 23 in South-East Asia, 8 in the Americas, 10 in the Western Pacific and two in the Eastern Mediterranean region. Interventions applied a total of 28 unique BCTs (out of a possible 96). The median number of BCTs used was 6; the maximum 13 and the minimum two. All interventions applied instruction on how to perform the CF behavior of interest. Other commonly applied BCTs were 1) use of a credible source (n = 46); 2) demonstration of the behavior (n = 35); and 3) information about health consequences (n = 30). Forty-three interventions used strategies to shift the physical or social environment. Four BCTs had effectiveness ratios >0.8: provision of/enabling social support; providing information about the consequences of the behavior; demonstration of the behavior; and adding objects to the environment (ie. food, supplements, agricultural inputs). Conclusions Limited reporting of intervention details hindered our ability to identify and map BCTs. For those with sufficient detail, we noted limited application of theory based behavior change techniques; interventions relied predominantly on the provision of instruction. Research that develops, tests and scales theory-based behavior change techniques for CF interventions would hasten our ability to accelerate social and behavior change for child nutrition. Funding Sources The Bill and Melinda Gates Foundation and Cornell University.