Nutrition Education and Behavioral Sciences
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).
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).
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