Caregiver perceptions of nutrition interventions in infants and children under 24 months of age: a systematic review

Abstract

Objective: Efficacy studies show early nutrition interventions improving infant nutrition status, but understanding caregiver acceptability is required for implementation of such interventions. This systematic review examines caregivers’ perceptions of nutrition interventions in young children. Design: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL and PsychINFO from date of online journal inception through December 2020. Interventions included oral (powder/liquid/tablet) and/or intravenous supplementation, food fortification, and nutrition counselling. Inclusion criteria included primary research, data presented on caregiver perception, and studies published in English. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Studies underwent narrative synthesis using inductive thematic analysis. Setting: No restriction. Participants: Caregivers of children under 24 months of age. Results: Of 11,798 records identified, 37 publications were included. Interventions included oral supplementation, food fortification, and nutrition counselling. Caregivers included mothers (83%), fathers, grandparents, and aunts. Perceptions were gathered through individual interviews, focus group discussions, questionnaires, surveys, and ratings. 89% of studies noted high acceptability (N=33 most notably increased appetite (N=17). 57% of studies (N=21) cited low acceptability, commonly from side effects (N=13) such as gastrointestinal issues, appetite loss and stained teeth. Conclusions: Positive perceptions and enthusiasm for interventions were frequently reported. Key to implementation was the increased appetite noted by caregivers. A substantial proportion of studies reported negative perceptions, mainly due to side effects. In future interventions mitigation and education around common side effects is crucial for acceptability. Understanding both positive and negative caregiver perceptions is important for informing future nutrition interventions and strengthening sustainability and implementation.