Commonly Applied Behavior Change Techniques Used in Complementary Feeding Programs in Low and Middle Income Countries: A Scoping Review (OR13-01-19)

Abstract

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.

Engaging family members in maternal, infant and young child nutrition activities in low‐ and middle‐income countries: A systematic scoping review

“…This is similar to findings from a meta-analysis of intervention studies, which reported only 23% of included studies used a behaviour change theory (Davies et al, 2010). The lack of theories in the design of social and behavioural interventions has also been identified previously for breastfeeding (Bai et al, 2019;Wood et al, 2016) and complementary feeding (Pelto et al, 2016;Webb-Girard et al, 2019) interventions. In order to increase the likelihood for success, future interventions to engage family members should be designed based on appropriate theories and models that explain behaviour and systems.…”

“…Programmatic learning from this review was limited by lack of detail and clarity on intervention design and delivery, particularly on engagement of family members. Lack of intervention detail is a common limitation reported by other reviews of nutrition interventions, and others have called for increased sharing of information about intervention design, theoretical basis, and implementation (Webb‐Girard et al, 2019 ). Future intervention studies should provide additional details about the intervention and describe standard intervention components such as using the Behavior Change Techniques (BCT) taxonomy (Michie et al, 2013 ).…”

“…Notably, none of the studies directly addressed obesity prevention, other than a follow-up study with participants from a breastfeeding intervention engaging grandmothers in Brazil (Schwartz et al, 2015). In high-income countries, there is growing attention to the need for interventions to engage fathers, and to a lesser extent grandparents and other family members, in obesity prevention interventions during the first 1,000 days (An et al, 2020;Ciampa et al, 2010;Davison et al, 2020;Jansen et al, 2018;Wasser et al, 2013). As the nutrition transition accelerates in LMICs and the double burden of malnutrition increases, expanding family support to address both undernutrition and overweight and obesity through double-duty actions for nutrition (Hawkes et al, 2020;World Health Organization, 2017) will be important (Williams et al, 2019).…”