Abstract
BackgroundChild stunting, an indicator of chronic malnutrition, is a global public health problem. Malnutrition during pregnancy and the first 2 years of life undermines the survival, growth, and development of children. Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. The aim of this study was to describe a systematic, theoretically informed approach (that drew from the Starr and Fornoff approach to the Theory of Change development and the Behavior Change Wheel approach) to design a multi-component and integrated social and behavior change intervention to improve WASH and nutrition-related behaviors in western Kenya.MethodsThis intervention was developed to be integrated into an existing project that utilized the care group model and aimed to create a culture of care and support for HIV/AIDS-affected children under two and their caregivers and was executed by local partners. We tested the newly created intervention packages in user-testing trials using an adapted Trials of Improved Practices approach to pilot acceptability and feasibility.ResultsUsing authentic stakeholder engagement and relevant theories, we conducted an 8-step process: (1) conduct mixed methods formative research, (2) prioritize target behaviors, (3) use causal analysis to create problem trees, (4) develop solution trees and articulate assumptions and rationales for change, (5) link solution trees to intervention functions, (6) develop the intervention plan, (7) create the intervention packages, and (8) test and refine the intervention packages.ConclusionsThis study highlights the need to take a multi-sectorial, integrated approach that integrates contextually relevant behavior change theories with the experiential knowledge gleaned from stakeholders into the design of interventions that seek to reduce child stunting. This process resulted in the creation of intervention packages that grouped behaviors thematically to be most relevant and responsive to the population context. This work has the potential to make important contributions towards achievement of the United Nations’ sustainable development goals.
Highlights
Child stunting, an indicator of chronic malnutrition, is a global public health problem
Findings from the desk review informed the protocols and guiding questions for a second round of ethnographic research that aimed to provide greater contextual detail, clarify key barriers and facilitators of behavior change to infant and young child feeding and WASH-related behaviors, identify messages that resonated with caregivers, explore in more depth the opinions and experiences of caregivers, and determine potential sources of information [52]
We developed intervention tables to show the connection between the positive health goal statement from our solution trees with COM-B domains, the theoretical domain framework (TDF), intervention functions, and behavior change techniques
Summary
Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. An indicator of chronic malnutrition, is a global public health problem. The etiology of early childhood malnutrition is complex, involving interactions between parental feeding practices, dietary intakes, and nutrient absorptive capabilities. Gastrointestinal and other infectious diseases, determined by a household and community’s access to adequate water, sanitation, hygiene, and health services, increase nutritional needs and can further exacerbate malnutrition [3,4,5]. Chronic malnutrition in early childhood predisposes individuals to cardiovascular disease in adulthood [3,4,5]. Known as nutrition-sensitive approaches, these include nutritionsensitive agriculture [10, 11], poverty reduction [9], girls’ education [10, 12], birth spacing [13], and women’s empowerment [14]
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