Frontline Worker (FLW) Knowledge and Motivation Influence Maternal Exposure to Complementary Feeding Counseling at Home

Abstract

Home‐visit based counseling is a proven intervention to improve complementary feeding (CF) practices. In India, CF counseling is to be delivered by FLWs ‐ Anganwadi Workers (AWWs) and Accredited Social Health Activists (ASHAs) but program experience with CF counseling is limited. We surveyed 588 FLWs and 1183 households in Odisha state to assess the status and determinants of delivery of counseling and other nutrition interventions. Regression analysis was used to study FLW and maternal determinants of maternal exposure to CF counseling. Outcome variable: mother received CF advice at home visit; independent variables (FLW): FLW characteristics, knowledge, sources of motivation, training; independent variables (maternal): demographic characteristics and socio‐economic status. Although most mothers received home visits from FLWs (76% from AWWs and 88% from ASHAs), <30% received CF advice in those visits. FLW motivation to help others (AWW: OR=2.9; CI: 1.61, 5.20; ASHA: OR = 2.2; CI: 1.19, 4.17) and CF knowledge (AWW: OR=2.3; CI: 1.28, 4.39; ASHA: OR = 3.6; CI: 2.12, 6.19) were associated with higher maternal exposure to CF advice. ASHAs' motivation to work for income lowered the odds of exposure to CF advice (OR=0.20; CI: 0.114, 0.371); ASHAs typically receive performance‐based incentives, which could limit their motivation to deliver non‐incentivized interventions. Our study highlights the role of FLW CF knowledge, intrinsic motivation to help others and extrinsic motivation from income as determinants of maternal exposure to CF counseling. Investments in building FLW knowledge and incentivizing or regularizing payment for counseling could improve CF counseling coverage. Funding: Bill & Melinda Gates Foundation, through POSHAN, led by IFPRI