The Pathways from a Behavior Change Communication Intervention to Infant and Young Child Feeding in Bangladesh Are Mediated and Potentiated by Maternal Self-Efficacy

Zongrone, Amanda; Menon, Purnima; Pelto, Gretel H.; Habicht, Jean‐Pierre; Rasmussen, Kathleen M.; Constas, Mark A.; Vermeylen, Françoise; Adiba, Khaled; Saha, Kuntal K.; Stoltzfus, Rebecca J.

doi:10.1093/jn/nxx048

Cited by 19 publications

(18 citation statements)

References 45 publications

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“…This can also be used to quantify “moderation”—which can be conceptualized as the role of facilitating and inhibiting factors on mediations. This is exemplified in the study reported by Zongrone et al (7). The flow depends on the quality (Q) of the intervention.…”

Section: Introductionsupporting

confidence: 52%

Program Impact Pathways and Contexts: A Commentary on Theoretical Issues and Research Applications to Support the EsIAN Component of Mexico's Conditional Cash Transfer Program

Habicht

2019

The Journal of Nutrition

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This commentary on the Integrated Strategy for Attention to Nutrition (EsIAN) journal supplement begins with a discussion about the challenges that implementation researchers confront with respect to analyzing complex impact pathways. We note that the research on the implementation of the EsIAN component of Mexico's conditional cash transfer program was based implicitly or explicitly on a program impact pathway approach, which used both quantitative and qualitative methods to examine bottlenecks in program implementation. We then identify 5 categories of contexts that affect the impact, implementation, and survival of intervention programs: 1) biological, 2) social-cultural, 3) delivery modalities and platforms, 4) bureaucratic, and 5) political. Each of these contexts presents theoretical and methodological challenges for investigators. In this commentary, we focus primarily on biological and social-cultural contexts, discussing the theoretical and methodological challenges the investigators faced and the research strategies they used to address them, which have produced a unique compilation of “learning by doing” studies. We also touch briefly on the political context in which the Prospera program research was conducted. We conclude with statements that highlight the exceptional value of the journal supplement, not only with respect to the analysis of the interventions the studies cover and the sustained examination of a long-term program but also as a major contribution to the literature in implementation science in nutrition.

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Section: Introductionsupporting

confidence: 52%

Program Impact Pathways and Contexts: A Commentary on Theoretical Issues and Research Applications to Support the EsIAN Component of Mexico's Conditional Cash Transfer Program

Habicht

2019

The Journal of Nutrition

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“…Indeed, both household water management and infant feeding are considered the domains of women and mothers globally (Pickering & Davis, ). And maternal self‐efficacy predicts optimal breastfeeding behaviors (Dennis, ; Nichols, Schutte, Brown, Dennis, & Price, ) and mediates uptake of complementary feeding interventions and behaviors (Sanghvi, Jimerson, Hajeebhoy, Zewale, & Nguyen, ; Zhang, Shi, Chen, Wang, & Wang, ; Zongrone et al, ). Our findings suggest that water insecurity further complicates the already‐difficult context that caregivers are forced to navigate to feed their child; this is important because it is often not a lack of knowledge but rather exactly those contextual barriers that shape caregiver behavior related to child feeding (Schuster, Szpak, Klein, Sklar, & Dickin, ).…”

Section: Discussionmentioning

confidence: 99%

“If there is no water, we cannot feed our children”: The far‐reaching consequences of water insecurity on infant feeding practices and infant health across 16 low‐ and middle‐income countries

Schuster

Butler

Wutich

et al. 2019

American J Hum Biol

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Objectives: Infant feeding plays a critical role in child health and development.Few studies to date have examined the link between household water insecurity and infant feeding, and none in a cross-cultural context. Therefore, we examined the perceived impact of household water insecurity in four domains: breastfeeding, non-breastmilk feeding, caregiver capabilities, and infant health. Our research was conducted as part of the Household Water Insecurity Experiences (HWISE) study. Methods:We interviewed respondents from 19 sites in 16 low-and middleincome countries (N = 3303) about the link between water insecurity and infant feeding. We then thematically analyzed their open-ended textual responses. In each of the four domains (breastfeeding, non-breastmilk feeding, caregiver capabilities, infant health), we inductively identified cross-cultural metathemes. We analyzed the distribution of themes across sites quantitatively and qualitatively.Results: Water was perceived to directly affect breastfeeding and nonbreastmilk feeding via numerous pathways, including timing and frequency of feeding, unclean foods, and reduced dietary diversity. Water was perceived to indirectly affect infant feeding through caregiver capabilities by increasing time demands, exacerbating disease, undernutrition, and mortality, and requiring greater efficacy of caregivers. Respondents made connections between water challenges and infant health, for example, increased risk of infectious diseases, undernutrition, and mortality.Conclusions: These findings suggest that water presents many, and sometimes unexpected, challenges to infant feeding. By systematically investigating HWISE-RCN Co-Authors: Jam

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“…Different from breastfeeding practices that mainly depend on social and behavioral determinants, complementary feeding practices also required availability of and access to food and resources. Access to food, especially high-quality foods, is limited in rural Bangladesh, and lack of resources (24) and restricted women's agency have been identified as salient barriers to trying and adopting recommended complementary feeding practices even when caregivers have high self-efficacy for following recommended complementary feeding practices (31). Additional efforts to address factors related to food security and women's agency, therefore, are critical for improving complementary feeding practices.…”

Section: Discussionmentioning

confidence: 99%

Information Diffusion and Social Norms Are Associated with Infant and Young Child Feeding Practices in Bangladesh

Nguyen

Frongillo

Kim

et al. 2019

The Journal of Nutrition

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Background Interaction within mothers’ social networks can theoretically diffuse messages from interventions and campaigns into norms and practices for infant and young child feeding (IYCF). Objectives We hypothesized that mothers’ social networks, diffusion of information, and social norms differed in intensive [intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM)] compared with nonintensive (standard IPC and less-intensive CM and MM) intervention areas, were associated with IYCF practices, and partly explained practice improvement. Methods We conducted household surveys at endline in 2014 and follow-up in 2016 (n = ∼2000 each round). We used multiple regression to test differences and changes in networks, diffusion, and norms within intervention areas. We analyzed paths from intervention exposure to IYCF practices through networks, diffusion, and norms. Results Mothers’ networks were larger in intensive than in nonintensive areas in 2014 and increased in both areas over time [25–38 percentage points (pp)]. The prevalence of receipt of IYCF information was high, with no changes over time in intensive areas but an increase in nonintensive areas (8–16 pp). In both areas, more family members and health workers provided IYCF information over time. Sharing of information increased 17–23 pp in intensive and 11–41 pp in nonintensive areas over time. Perceived descriptive norms improved 8–16 pp in intensive and 17–28 pp in nonintensive areas. Perceived injunctive norms were high in both areas. Breastfeeding practices were associated with networks, diffusion, and norms (OR: 1.6–4.4 times larger comparing highest with lowest quartile). Minimum dietary diversity was associated with larger networks and diffusion (OR: 1.5–2.2) but not with social norms. Indirect paths from intervention exposure to practices explained 34–78% of total effects. Conclusions Diffusion of IYCF information through social networks, reinforced by positive social norms for messages promoted over time, will contribute to positive changes in IYCF practices that may be achieved and sustained through large-scale social and behavior change interventions. This trial was registered at clinicaltrials.gov as NCT0274084.

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The Pathways from a Behavior Change Communication Intervention to Infant and Young Child Feeding in Bangladesh Are Mediated and Potentiated by Maternal Self-Efficacy

Cited by 19 publications

References 45 publications

Program Impact Pathways and Contexts: A Commentary on Theoretical Issues and Research Applications to Support the EsIAN Component of Mexico's Conditional Cash Transfer Program

Program Impact Pathways and Contexts: A Commentary on Theoretical Issues and Research Applications to Support the EsIAN Component of Mexico's Conditional Cash Transfer Program

“If there is no water, we cannot feed our children”: The far‐reaching consequences of water insecurity on infant feeding practices and infant health across 16 low‐ and middle‐income countries

Information Diffusion and Social Norms Are Associated with Infant and Young Child Feeding Practices in Bangladesh

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