Systematic Review of Behavioral Interventions to Increase Family Support for Maternal and Child Nutrition in Low- and Middle-Income Countries

Abstract

Abstract Objectives To examine the scope and impact of behavioral interventions to increase family support for maternal, infant, and young child nutrition (MIYCN) practices in low- and middle-income countries (LMICs). Despite the recognized influence of fathers, grandmothers, and other family members, we lack a comprehensive review of how interventions engage them and how engagement impacts MIYCN. Methods We first conducted a scoping review to identify family-focused interventions and then a mixed methods review to assess impacts. We systematically searched PubMed, Scopus, Web of Science, Global Health, and CINAHL for peer-reviewed studies of behavioral interventions to increase family support for MIYCN. We screened 5733 abstracts and evaluated 142 full-text articles. Quantitative and qualitative results were examined independently. (PROSPERO ID# CRD42018090273) Results The scoping review of intervention approaches included 48 studies; the mixed methods systematic review assessing impact included 16 comparative quantitative studies and 13 qualitative studies. A wide range of approaches were used to engage family members to support MIYCN, including multi-channel strategies with community outreach. Most comparative research relied on direct counseling and focused on breastfeeding in first 6 months, primarily engaging fathers (9) or, less often, grandmothers (2) or both (2). Most (10/13) found positive impacts on exclusive breastfeeding rates and some associated practices and on family members’ awareness and support to mothers. The 3 studies on maternal nutrition, complementary feeding, or multiple MIYCN indicators also suggested benefits of engaging family members. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Conclusions Interventions engaging family members in LMICs can increase awareness, build support for MIYCN, and improve practices. While many positive outcomes were reported, more rigorous study designs testing causal relationships, and implementation research to elucidate pathways and identify factors shaping effectiveness, are needed. Important gaps include research on interventions that support maternal nutrition and complementary feeding, include nutrition-sensitive activities, and utilize gender transformative approaches. Funding Sources USAID.