Abstract
BackgroundAlthough self-efficacy is a potential determinant of feeding and care behaviors, there is limited empirical analysis of the role of maternal self-efficacy in low- and middle-income countries. In the context of behavior change interventions (BCIs) addressing complementary feeding (CF), it is possible that maternal self-efficacy can mediate or enhance intervention impacts. ObjectiveIn the context of a BCI in Bangladesh, we studied the role of maternal self-efficacy for CF (MSE-CF) for 2 CF behaviors with the use of a theoretically grounded empirical model of determinants to illustrate the potential roles of MSE-CF. MethodsWe developed and tested a locally relevant scale for MSE-CF and included it in a survey %(n = 457 mothers of children aged 6–24 mo) conducted as part of a cluster-randomized evaluation. Qualitative research was used to inform the selection of 2 intervention-targeted behaviors: feeding green leafy vegetables in the last 24 h (GLV%) and on-time introduction of egg (EGG) between 6 and 8 mo of age. We then examined direct, mediated, and potentiated paths of MSE-CF in relation to the impacts of the BCI on these behaviors with the use of regression and structural equation modeling. ResultsGLV and EGG were higher in the intensive group than in the nonintensive control group %(16.0 percentage points for GLV; P < 0.001; 11.2 percentage points for EGG; P = 0.037). For GLV, MSE-CF mediated (β = 0.345, P = 0.010) and potentiated (β = 0.390, P = 0.038%) the effect of the intensive group. In contrast, MSE-CF did not mediate or potentiate the effect of the intervention on EGG. ConclusionMSE-CF was a significant mediator and potentiator for GLV but not for EGG. The divergent findings highlight the complex determinants of individual specific infant and young child feeding behaviors. The study shows the value of measuring behavioral determinants, such as MSE-CF, that affect a caregiver's capability to adopt intervention-targeted behaviors.
Highlights
Adequate and appropriate complementary feeding (CF) with nutrient-dense foods such as green leafy vegetables and eggs beginning at 6 mo of age is important for child survival, growth, and development [1, 2]
We sought to clarify the role of self-efficacy in an effective intervention to improve CF behaviors in a low-income setting and chose to examine maternal self-efficacy in the context of 2 distinct behaviors
We found that impacts of the Alive & Thrive (A&T) intervention were mediated through increased maternal self-efficacy for CF (MSE-CF) in the case of feeding green leafy vegetables in the last 24 h
Summary
Adequate and appropriate complementary feeding (CF) with nutrient-dense foods such as green leafy vegetables and eggs beginning at 6 mo of age is important for child survival, growth, and development [1, 2]. Self-efficacy is a potential determinant of feeding and care behaviors, there is limited empirical analysis of the role of maternal self-efficacy in low- and middle-income countries. In the context of behavior change interventions (BCIs) addressing complementary feeding (CF), it is possible that maternal self-efficacy can mediate or enhance intervention impacts. Objective: In the context of a BCI in Bangladesh, we studied the role of maternal self-efficacy for CF (MSE-CF) for 2 CF behaviors with the use of a theoretically grounded empirical model of determinants to illustrate the potential roles of MSE-CF. Qualitative research was used to inform the selection of 2 intervention-targeted behaviors: feeding green leafy vegetables in the last 24 h (GLV) and on-time introduction of egg (EGG) between 6 and 8 mo of age.
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