Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review

Abstract

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.

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“…[65][66][67][68] mHealth behavior change interventions have the potential to improve maternal and fetal health outcomes. 64,[69][70][71][72][73] They have a moderate to large effect size in promoting maternal physical health including weight and GDM management. 74,75 The large effect sizes were seen in improving maternal knowledge about pregnancy and maternal mental health.…”

Pemberdayaan Kader Posyandu Tentang Praktik Pembuatan MPASI-Lokal ”Ikan Kembung Como” di Wilayah RW021 Serua-Ciputat

“…et al, 2023). Dengan demikian, adanya intervensi >2 fungsi perubahan perilaku (termasuk persuasi, insentif, restrukturisasi lingkungan) adalah hal yang paling efektif (Watson et al, 2023). Kegiatan ini memiliki keterbatasan dimana penyesuaian waktu dengan subjek menjadi salah satu kendala, dikarenakan kesiapan dan kenyamanan dalam intervensi perlu mendapat perhatian yang lebih.…”

Promoting Supportive and Respectful Maternity Care in Public Health Facilities in Sindh, Pakistan: A Theory-Informed Health System Intervention

“… 10 The COM-B is a well-studied model used to develop an in-depth understanding of the behavior change of health care staff. 11 , 12 Its premise, a particular behavior, is a function of both psychological and physical abilities, along with the social and physical opportunity to perform that behavior more than other competing behavior possibilities. Our behavior of interest was positive change in the provision of S-RMC.…”