Nutrition Behavior Change Research Articles

Penguatan 5 Pilar dalam Upaya Penurunan Stunting di Kelurahan Simokerto Kota Surabaya

The purpose of this study is to find out the five pillars in efforts to reduce stunting in Simokerto Village, Surabaya City. Research data collection using Focus Group Discussion (FGD). The targets of the EMAS Stunting Village Thematic KKN are brides-to-be, pregnant women, postpartum mothers and Baduta and toddlers. The results showed that there were 5 pillars of cultivation carried out by each "Golden Village" group in each village. Pillar 1 in the form of increasing village government commitment and leadership has activities in the form of collecting village commitments related to accelerating stunting reduction through the FGD forum. Pillar 2 related to strengthening and developing systems, data, information, and research has activities to collect and analyze demographic data related to stunting, assistance in stunting surveillance and growth and development, assistance in Rumah DataKu, and assistance in auditing stunting cases. Pillar 3 discusses communication of behavior change and community empowerment in terms of nutrition, healthy behavior, mutual assistance, and independence which has activities including training and education based on nutrition and health behavior change, development of nutrition and health education media. Pillar 4 is on the convergence of specific and sensitive interventions through a quality family village approach with programs implemented in the form of situation analysis related to hygiene and sanitation as well as the availability of clean water, development and development of healthy environments, and clean water surveys. Pillar 5 discusses food security at the individual, family, and community levels through optimizing the use of local food ingredients with activities in the form of local food potential map analysis, food consumption surveys, and market surveys. The implementation of the five pillars is carried out in Simokerto Village well and is adjusted to the needs of the relevant village.

Transfers, nutrition programming, and economic well-being: Experimental evidence from Bangladesh

Many cash transfer programs include complementary nutrition training, with the aim of encouraging households to use transfer resources toward improving child nutrition. Evidence indicates that these bundled programs, if intensive and well-implemented, can be effective in improving child nutritional status. However, little is known about how adding nutrition training to transfer programs affects their economic impacts. In particular, few studies have assessed whether nutrition programming may induce reallocation of transfer resources from physical capital to human capital. Scarce evidence also exists as to whether these tradeoffs depend on the transfer modality. We study a pilot program called the Transfer Modality Research Initiative in Bangladesh (TMRI), designed as a randomized controlled trial. TMRI provided cash or food transfers, with or without intensive group-based nutrition behavior change communication (BCC), to mothers of young children in poor rural households. We find that adding nutrition BCC to cash or food transfers leads to larger impacts on both consumption and assets – potentially surprising, given that the transfer value is unchanged. Analysis of mechanisms suggests that these effects occur through the BCC inducing increases in income generation, through investments in livelihoods. Suggestive evidence indicates that the effects of TMRI’s BCC are plausibly due to the intensive group-based format, which increased social capital for participant women and their household members, as well as improved participant women’s agency and self-confidence, knowledge, and input into household decisions. Results indicate that adding nutrition BCC to cash or food transfer programs do not necessarily induce a tradeoff between investing in human capital versus physical capital, but can rather strengthen impacts on both if appropriately designed.

Exploring the design and utility of an integrated web-based chatbot for young adults to support healthy eating: a qualitative study

BackgroundThere is a lack of understanding of the potential utility of a chatbot integrated into a website to support healthy eating among young adults. Therefore, the aim was to interview key informants regarding potential utility and design of a chatbot to: (1) increase young adults’ return rates and engagement with a purpose-built healthy eating website and, (2) improve young adults’ diet quality.MethodsEighteen qualitative, semi-structured interviews were conducted across three stakeholder groups: (i) experts in dietary behaviour change in young adults (n = 6), (ii) young adult users of a healthy eating website (n = 7), and (iii) experts in chatbot design (n = 5). Interview questions were guided by a behaviour change framework and a template analysis was conducted using NVivo.ResultsInterviewees identified three potential roles of a chatbot for supporting healthy eating in young adults; R1: improving healthy eating knowledge and facilitating discovery, R2: reducing time barriers related to healthy eating, R3: providing support and social engagement. To support R1, the following features were suggested: F1: chatbot generated recommendations and F2: triage to website information or externally (e.g., another website) to address current user needs. For R2, suggested features included F3: nudge or behavioural prompts at critical moments and F4: assist users to navigate healthy eating websites. Finally, to support R3 interviewees recommended the following features: F5: enhance interactivity, F6: offer useful anonymous support, F7: facilitate user connection with content in meaningful ways and F8: outreach adjuncts to website (e.g., emails). Additional ‘general’ chatbot features included authenticity, personalisation and effective and strategic development, while the preferred chatbot style and language included tailoring (e.g., age and gender), with a positive and professional tone. Finally, the preferred chatbot message subjects included training (e.g., would you like to see a video to make this recipe?), enablement (e.g., healthy eating doesn’t need to be expensive, we’ve created a budget meal plan, want to see?) and education or informative approaches (e.g., “Did you know bananas are high in potassium which can aid in reducing blood pressure?”).ConclusionFindings can guide chatbot designers and nutrition behaviour change researchers on potential chatbot roles, features, style and language and messaging in order to support healthy eating knowledge and behaviours in young adults.

Changing maternal, infantand young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive.

Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infantand young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeriaand Vietnam. A&T's SBC approach used interpersonal communication, community mobilizationand mass media to address knowledge gaps, strengthen self-efficacyand shift social norms. The initiative used data for designand evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of childrenand use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large-scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messagesand employing additional channels to reach low media coverage areas. A&T developed and implemented at-scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencersand mass media campaign development, which governments and other implementers can adapt and replicate.

Influence of care group participation on infant and young child feeding, dietary diversity, WASH behaviours and nutrition outcomes in rural Zimbabwe

BackgroundThe care group approach (CGA) is a community-based nutrition behaviour change strategy centred on ‘peer-to-peer learning’ through women support groups.ObjectiveTo assess the impact of the CGA on the adoption of...

The effect of nutrition and health behavior change communication through community-level actors on the nutritional status of pregnant women in the Ambo district, Ethiopia: A randomized controlled trial.

Pregnant women in Ethiopia often had trouble understanding the normal nutrition and health information given by health professionals and found it inconsistent. Undernutrition is still a significant public health problem as a result. Hence, this trial aimed to assess the effect of nutrition and health behavior change communication using the community-level actors on the nutritional status of pregnant women. Cluster-randomized controlled community trial with baseline and endline measurements were used. Endpoint data from 744 pregnant women (372 intervention and 372 control groups) were gathered, respectively. In the intervention group, the community-level actors delivered the behavior change communication main message based on intervention protocol. The control group got nutrition information during their ANC visits but did not receive the behavior change communication intervention. Binary generalized estimating equations regression analyses adjusted for baseline covariates were used to test effects of the intervention on nutritional status. Following the trial's implementation, the prevalence of undernutrition in the intervention arm fell by 10% from the baseline (23.7% vs. 13.7%) and was 13.7% lower than in the control arm (13.7% vs. 27.4%, p = <.001). Pregnant women in the intervention group showed significantly lower risk of undernutrition than the control group (ARR = 0.21; 95% CI 0.14-0.30). This study showed that engaging community actors to communicate about nutrition and health behavior change was successful in enhancing pregnant women's nutritional status. Therefore, nutrition and health behavior change communication through the community-level actors is recommended to improve the nutritional status of pregnant women.

Opportunities and barriers for maternal nutrition behavior change: an in-depth qualitative analysis of pregnant women and their families in Uttar Pradesh, India.

Maternal undernutrition during pregnancy remains a critical public health issue in India. While evidence-based interventions exist, poor program implementation and limited uptake of behavior change interventions make addressing undernutrition complex. To address this challenge, Alive & Thrive implemented interventions to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India. This qualitative study aimed to: (1) examine pregnant women's experiences of key nutrition-related behaviors (ANC attendance, consuming a diverse diet, supplement intake, weight gain monitoring, and breastfeeding intentions); (2) examine the influence of family members on these behaviors; and (3) identify key facilitators and barriers that affect behavioral adoption. We conducted a qualitative study with in-depth interviews with 24 pregnant women, 13 husbands, and 15 mothers-in-law (MIL). We analyzed data through a thematic approach using the Capability-Opportunity-Motivation-Behavior (COM-B) framework. For ANC checkups and maternal weight gain monitoring, key facilitators were frontline worker home visits, convenient transportation, and family support, while the primary barrier was low motivation and lack understanding of the importance of ANC checkups. For dietary diversity, there was high reported capability (knowledge related to the key behavior) and most family members were aware of key recommendations; however, structural opportunity barriers (financial strain, lack of food availability and accessibility) prevented behavioral change. Opportunity ranked high for iron and folic acid supplement (IFA) intake, but was not consistently consumed due to side effects. Conversely, lack of supply was the largest barrier for calcium supplement intake. For breastfeeding, there was low overall capability and several participants described receiving inaccurate counseling messages. Key drivers of maternal nutrition behavior adoption were indicator specific and varied across the capability-opportunity-motivation behavior change spectrum. Findings from this study can help to strengthen future program effectiveness by identifying specific areas of program improvement.

Nutrition education and behaviour change strategies, effectiveness, and implications for promoting healthy eating habits

Nutrition education and behaviour change strategies, effectiveness, and implications for promoting healthy eating habits

Does intervention in African indigenous vegetables value chain improve production and welfare outcomes? Evidence from western Kenya

African Indigenous Vegetables (AIVs) are increasingly recognized as essential for sustainable dietary diversification in the predominantly cereal-based staple diets. The AIVs also provide employment opportunities and generate income for the rural populations. Many initiatives by researchers and development agencies have promoted the AIVs value chains in Kenya. However, little evidence exists on impact of the initiatives on farm households. Several studies have examined impact of agricultural interventions based on observational data. The findings from such studies are likely to be influenced by unobserved attributes, resulting in a biased estimation of causal relationships between interventions and impacts. We conducted a clusterrandomized controlled trial to estimate the unbiased impacts of a multifaceted intervention that focused on production, consumption nutrition behavior change communication, and linking farmers to markets in selected AIV value chains (cowpea, spider plant, amaranth, nightshade, and slender leaf) in western Kenya. Using two waves of household panel data (2018 and 2021), we evaluated the impacts of the intervention on land area allocation to AIVs, total leaf production, AIVs income, and household dietary diversity Score (HDDS). The empirical estimation using descriptive statistics and analysis of covariance revealed that households that were exposed to the intervention significantly increased land area under AIVs by 38% (p &lt; 0.01) and total leaf production by 46% (p &lt; 0.05). At end line, the spider plant had the highest percentage increase (60%) in land area compared to the control group. However, there is no evidence of whether or not the intervention had an impact on AIVs income and HDDS. The study concludes that the hypothesis that the intervention was to have significant impact on AIV production, nutrition security and income had mixed results. We recommend that similar interventions include components to integrate the capacity of households to adapt to risks such as the COVID-19 pandemic and climate change. Further cost-benefit analysis is required for informed resource allocation. Designing and implementing policies that promote household access to input and output markets are likely to improve the performance of the AIV value chains and contribute to income and nutrition.

Physical exercise alleviates oxidative stress in brown adipose tissue and causes changes in body composition and nutritional behavior in rats with polycystic ovary syndrome

AimPolycystic Ovary Syndrome (PCOS) is a very common endocrine disorder in women. We investigate the effect of physical exercise on body composition, nutritional parameters, and oxidative stress in rats with PCOS. MethodsFemale rats were into three groups: Control, PCOS, and PCOS + Exercise. PCOS was induced by letrozole (1 mg/kg via p.o.) for 21 days consecutively. Physical exercise was swimming, for 21 consecutive days, 1 h/day with 5 % load. In all groups, we assessed the nutritional and murinometric parameters, body composition, thermography, and oxidative stress in brown adipose tissue (BAT) and peri-ovarian adipose tissue (POAT). Key findingsIn PCOS we observed an increase (P < 0.05) in body weight vs. the Control group. But, the PCOS + Exercise group prevent this weight gain (P < 0.05). The temperature in BAT, decrease (P < 0.05) in the PCOS group vs. Control group. PCOS + Exercise prevented this reduction (P < 0.05) in BAT temperature vs. PCOS groups. We observed decreases (P < 0.05) in Lee Index and BMI in POS + Exercise vs. PCOS group. In PCOS rats, we observed an increase (P < 0.05) in murinometric (SRWG, EI, and FE) and body composition parameters (TWB, ECF, ICF, and FFM) vs. the Control group. The PCOS + Exercise prevents (P < 0.05) these changes in all groups, compared with PCOS. Regarding the BAT, we observe an increase (P < 0.05) in MPO and MDA levels in the PCOS vs. Control group. PCOS + Exercise prevents (P < 0.05) these increases vs. the PCOS group. SignificancePCOS modifies body composition, and nutritional parameters, and induces changes in oxidative stress in BAT. Physical exercise prevented these alterations.

Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs

BackgroundA healthy lifestyle program that appeals to, and supports, overweight and obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. A pilot program inspired by the successful Football Fans in Training program but delivered via professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, adherence to healthy lifestyle behaviors, and cardiorespiratory fitness in overweight and obese men. A full effectiveness trial is now needed.AimsTo determine the effectiveness and cost effectiveness of Rugby Fans In Training-NZ (RUFIT-NZ) on weight loss, fitness, blood pressure, lifestyle change, and health related quality of life (HRQoL) at 12- and 52-weeks.MethodsWe conducted a pragmatic, two-arm, multi-center, randomized controlled trial in NZ with 378 (target 308) overweight and obese men aged 30–65 years, randomized to an intervention group or wait-list control group. The 12-week RUFIT-NZ program was a gender-sensitised, healthy lifestyle intervention delivered through professional rugby clubs. Each intervention session included: i) a 1-h workshop-based education component focused on nutrition, physical activity, sleep, sedentary behavior, and learning evidence-based behavior change strategies for sustaining a healthier lifestyle; and 2) a 1-h group-based, but individually tailored, exercise training session. The control group were offered RUFIT-NZ after 52-weeks. The primary outcome was change in body weight from baseline to 52-weeks. Secondary outcomes included change in body weight at 12-weeks, waist circumference, blood pressure, fitness (cardiorespiratory and musculoskeletal), lifestyle behaviors (leisure-time physical activity, sleep, smoking status, and alcohol and dietary quality), and health-related quality of life at 12- and 52-weeks.ResultsOur final analysis included 200 participants (intervention n = 103; control n = 97) who were able to complete the RUFIT-NZ intervention prior to COVID-19 restrictions. At 52-weeks, the adjusted mean group difference in weight change (primary outcome) was -2.77 kg (95% CI -4.92 to -0.61), which favored the intervention group. The intervention also resulted in favorable significant differences in weight change and fruit and vegetable consumption at 12-weeks; and waist circumference, fitness outcomes, physical activity levels, and health-related quality of life at both 12 and 52 weeks. No significant intervention effects were observed for blood pressure, or sleep. Incremental cost-effective ratios estimated were $259 per kg lost, or $40,269 per quality adjusted life year (QALY) gained.ConclusionRUFIT-NZ resulted in sustained positive changes in weight, waist circumference, physical fitness, self-reported physical activity, selected dietary outcomes, and health-related quality of life in overweight/obese men. As such, the program should be recommended for sustained delivery beyond this trial, involving other rugby clubs across NZ.Trial registrationAustralia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered 18 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376740 Universal Trial Number, U1111-1245–0645.

Efficacy, feasibility and tolerability of ketogenic diet for the treatment of poor response to bariatric surgery

PurposePoor response to bariatric surgery, namely insufficient weight loss (IWL) or weight regain (WR), is a critical issue in the treatment of obesity. The purpose of our study was to assess the efficacy, feasibility, and tolerability of very low-calorie ketogenic diet (VLCKD) for the management of this condition.MethodsA real-life prospective study was conducted on twenty-two patients who experienced poor response after bariatric surgery and followed a structured VLCKD. Anthropometric parameters, body composition, muscular strength, biochemical analyses, and nutritional behavior questionnaires were evaluated.ResultsA significant weight loss (mean 14.1 ± 4.8%), mostly due to fat mass, was observed during VLCKD with the preservation of muscular strength. The weight loss obtained allowed patients with IWL to reach a body weight significantly lower than that obtained at the post-bariatric surgery nadir and to report the body weight of patients with WR at the nadir observed after surgery. The significantly beneficial changes in nutritional behaviors and metabolic profiles were observed without variations in kidney and liver function, vitamins, and iron status. The nutritional regimen was well tolerated, and no significant side effects were detected.ConclusionOur data demonstrate the efficacy, feasibility, and tolerability of VLCKD in patients with poor response after bariatric surgery.

Dietary interventions using Facebook: a systematic review.

Facebook has been used to change food behaviors. The aim of this review was to synthesize the knowledge about the effect of nutritional interventions delivered through Facebook in dietary intake, food and nutritional knowledge and behavior, and weight management. PubMed, Web of Science, Ovid, Scopus, and Cochrane electronic databases were searched for intervention studies that were published from 2013 to 2019. This systematic review protocol was formulated based on Cochrane Guidelines for Systematic Reviews of Health Promotion and Public Health Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Of the 4824 identified studies, 116 were considered for eligibility and 18 met the inclusion criteria of this review. Of these, 13 were randomized controlled trials, 2 were quasiexperimental studies, 2 were case studies, and 1 was a nonrandomized controlled trial. Interventions had a positive nutritional-related impact in most of the studies (78%). Positive changes in dietary intake, food and nutritional knowledge and behavior, and weight management were observed in studies that used Facebook as a component of intervention. Facebook effectiveness by its own was difficult to evaluate considering that is frequently a component of intervention. The heterogeneity of the outcome variables between studies did not allow concluding about the effectiveness of this tool.

COVID-19 salgını sırasında çocuklarda diyet takviyeleri ve fonksiyonel gıdalar

AIM: Data on the likely interest in dietary support use in children during the COVID-19 pandemic are scarce and not well documented, compared to adults. In this survey study, we aimed to reveal predictors of pandemic-induced changes in nutritional behavior in children and adolescents.&#x0D; MATERIAL AND METHODS: Parents or caregivers of a total of 1327 children aged 6 to 18 years were requested to fill a survey questioning the use of common dietary supplements and/or conventional functional food by children before and during the COVID-19 pandemic. Children were divided into 4 groups according to whether they received dietary supplements before/during the pandemic: those never received dietary supplements (Group 1), those already receiving/continued to receive (Group 2), those started to receive during pandemic (Group 3), those stopped to receive during pandemic (Group 4). &#x0D; RESULTS: A total of 1327 respondents completed the questionnaire. There were 322 (24.3%) children in Group 1, 313 (23.6%) children in Group 2, 679 (51.2%) children in Group 3 and 13 (1.0%) children in Group 4. Number of siblings (p

Engaging Fathers Through Nutrition Behavior Communication Change Does Not Increase Child Dietary Diversity in a Cluster Randomized Control Trial in Rural Ethiopia

BackgroundAdding food vouchers or paternal nutrition behavior change communication (BCC) activities to maternal BCC may improve child diets and household food security but their effect is unknown. ObjectivesWe assessed whether maternal BCC, maternal and paternal BCC, maternal BCC and a food voucher, or maternal and paternal BCC and a food voucher improved nutrition knowledge, child diet diversity scores (CDDS), and household food security. MethodsWe implemented a cluster randomized control trial in 92 Ethiopian villages. Treatments were as follows: maternal (M) BCC only; maternal BCC and paternal BCC (M+P); maternal BCC and food vouchers (M+V); and maternal BCC, food vouchers, and paternal BCC (M+V+P). Effects were assessed using generalized estimating equations. ResultsMaternal BCC and paternal BCC increased the maternal and paternal knowledge of optimal infant and young child feeding practices by 4.2–6.8 percentage points (P < 0.05) and by 8.3–8.4 percentage points (P < 0.01), respectively. Combining maternal BCC with either paternal BCC or the food voucher increased CDDS by 21.0%–23.1% (P < 0.05). The treatments M, M+V, and M+P increased the proportion of children who met minimum acceptable diet standards by 14.5, 12.8, and 20.1 percentage points, respectively (P < 0.01). Adding paternal BCC to the maternal BCC treatment or to the maternal BCC and voucher treatment did not lead to a larger increase in CDDS. ConclusionsIncreased paternal involvement does not necessarily translate into improvements in child feeding outcomes. Understanding the intrahousehold decision-making dynamics that underlie this is an important area for future research.This study was registered at clinicaltrials.gov as NCT 03229629.

Sustainable nutritional behavior change (SNBC) model: How personal nutritional decisions bring about sustainable change in nutritional behavior

BackgroundThe aim of this qualitative study was to identify a practice level model that could explain a sustained change in nutritional behavior. MethodsThe study used three data inputs from four interviewees, one merged input from a married couple, as narrative interviews. The interviews were analyzed using grounded theory. ResultsCoexistence of a certain suffering and a triggering episode lead to the decision to change nutritional life-style by all interviewed. Maintenance of the self-determined newly learned nutritional behavior was supported by subject-related intrinsic motivation, the ability to reflect, and a low expectation of success from the behavioral change. Environment-related factors were identified as support from life-partner and peers. Subjects reported that the sustained nutritional behavior change impacted their holistic health through subject-perceived improved life quality, increase in the number of social contacts, and a change in personal attitudes and perception. The analysis remains limited, and at best hypothesis generating, in that only three data inputs from four interviewees were used. ConclusionIn this hypothesis-generating narrative interview study of four study subjects, volition, personal decision making, and long-term motivation (though not external determination) seemed to sustain a change in newly learned nutritional behavior.

Association between the Health Belief Model, Exercise, and Nutrition Behaviors during the COVID-19 Pandemic.

The COVID-19 pandemic has affected our nation's health further than the infection it causes. Physical activity levels and dietary intake have suffered while individuals grapple with the changes in behavior to reduce viral transmission. With unique nuances regarding the access to physical activity and nutrition during the pandemic, the constructs of Health Belief Model (HBM) may present themselves differently in nutrition and exercise behaviors compared to precautions implemented to reduce viral transmission studied in previous research. The purpose of this study was to investigate the extent of exercise and nutritional behavior change during the COVID-19 pandemic and explain the reason for and extent of this change using HBM constructs (perceived susceptibility, severity, benefit of action, and barriers to action). This study used a cross-sectional design to collect 206 surveys. This survey collected information on self-reported exercise and nutrition changes during the pandemic and self-reported levels of the HBM constructs. Findings showed individuals with medium or high exercise behavior change had greater odds of increased HBM score than individuals with little to no exercise behavior change (OR = 1.117, 95% CI: 1.020-1.223, SE: 0.0464, p = 0.0175). There was no association between nutritional behavior change and HBM score (OR = 1.011, 95% CI: 0.895-1.142, p = 08646). Individuals who reported a more drastic change in either exercise had greater odds of increased feelings of perceived susceptibility and severity related to COVID-19 and decreased perceived benefits and increased barriers to exercise. This relationship was not found regarding nutrition behavior change. These results encourage public health practitioners to understand how an individual's perceived feelings about a threat may affect exercise and nutritional behaviors.

The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh.

Bangladesh struggles with undernutrition in women and young children. Nutrition-sensitive agriculture programmes can help address rural undernutrition. However, questions remain on the costs of multisectoral programmes. This study estimates the economic costs of the Targeting and Re-aligning Agriculture to Improve Nutrition (TRAIN) programme, which integrated nutrition behaviour change and agricultural extension with a credit platform to support women's income generation. We used the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) approach. The approach aligns costs with a multisectoral nutrition typology, identifying inputs and costs along programme impact pathways. We measure and allocate costs for activities and inputs, combining expenditures and micro-costing. Quantitative and qualitative data were collected retrospectively from implementers and beneficiaries. Expenditure data and economic costs were combined to calculate incremental economic costs. The intervention was designed around a randomised control trial. Incremental costs are presented by treatment arm. The total incremental cost was $795,040.34 for a 3.5-year period. The annual incremental costs per household were US$65.37 (Arm 2), USD$114.15 (Arm 3) and $157.11 (Arm 4). Total costs were led by nutrition counselling (37%), agriculture extension (12%), supervision (12%), training (12%), monitoring and evaluation (9%) and community events (5%). Total input costs were led by personnel (68%), travel (12%) and supplies (7%). This study presents the total incremental costs of an agriculture-nutrition intervention implemented through a microcredit platform. Costs per household compare favourably with similar interventions. Our results illustrate the value of a standardised costing approach for comparison with other multisectoral nutrition interventions.

Nutrition and behavior change: a review of recent literature.

The current article will highlight recent trends and novel approaches to behavior change strategies in nutrition. Physicians, nurses, and other healthcare professionals play key roles in counseling patients on lifestyle change, which is critical for patients with chronic conditions. Nutrition science continues to advance, and new approaches to behavior change are needed for successful implementation at the individual and population level. The solutions to obstacles around healthful eating patterns are varied, population-dependent, and require a multipronged approach. One area of focus is the language around behavior change, ensuring it is clear and emphasizes its multifactorial nature. For young adults, the careful use of video games and social media may be essential. For older adults, altering food consistency and ensuring proper nutrient intake are crucial factors. Vulnerable populations remain susceptible to malnutrition and need special attention. Despite significant advances in managing and treating diseases, there are still gaps in nutrition counseling and behavior change efforts. Every age and stage of life needs a focus on healthful foods, and nutrition counseling at each stage has its unique nuances. Careful attention to the language of change and the phrasing used in counseling is vital for educating, connecting with, and empowering patients to change. Changing healthcare operations and provider behavior around nutrition counseling is a part of the solution to the worldwide problem of unhealthy eating patterns and practices.

Ghanaian Female Adolescents Perceived Changes in Nutritional Behaviors and Social Environment After Creating Participatory Videos: A Most Significant Change Evaluation

ABSTRACTBackgroundUnderstanding the influence of participatory video-making on the nutrition-related behavior of video creators may help shape nutrition education interventions.ObjectivesThis study assessed the perceived value and influence of a participatory video intervention among participants and stakeholders.MethodsA 2018–2019 cluster randomized controlled trial (registered at clinicaltrials.gov as NCT03704649) selected 20 schools (10 intervention, n = 181; 10 control, n = 170) in 1 Ghanaian rural district, enrolled adolescent girls aged 13–16 y, and provided a nutrition curriculum. Each intervention school also participated in 2 series of activities designed to help adolescents plan, film, and screen 2 nutrition-related videos. The Most Significant Change method involved intervention participants and local stakeholders to assess the value and influence of the intervention – a secondary outcome of the trial. Project staff collected 116 stories of change from the adolescents. Stories described shifts in 4 domains: participant, peer, and family behavior, and structural changes in the school. The project team used a selection rubric to identify 14 stories that reflected heightened nutrition literacy. Staff conducted interviews with the 14 adolescents whose stories were selected to elaborate on details and perceived resonance. Finally, local stakeholders assessed the stories to identify the 4 most significant changes of the intervention – 1 per domain. A separate thematic analysis identified emerging patterns of motivation and action across the 14 interviews.ResultsThe chosen Most Significant Change stories revealed how adolescents found creative solutions to acquire iron-rich foods, encouraged neighbors to eat iron-rich foods, taught their family new agricultural practices, and promoted change in their school canteen. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes.ConclusionStories of change revealed that the intervention promoted a transformative influence; participants modified their eating habits, lifestyle, and their environment.