ENGAGING FATHERS IN IMPROVING INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES TO IMPROVE CHILD DIET
HAN, YAE Eun
An important cause of stunting is limited consumption of complementary foods. To improve complementary feeding practices, behavior change communication (BCC) activities are often used to provide education and counseling. However, most BCC programs commonly target only mothers when fathers have the potential to positively influence complementary feeding practices in settings where gender inequality and the low bargaining power of women are prevalent. The efficacy of paternal BCC program to increase paternal support on improved complementary feeding practices remains unknown. This community-based, clustered randomized controlled trial that included women who had children between 4 and 20 months old, their children, and the partners of participating women who lived in the 92 garees (villages) between April and August 2017; the follow-up ended in March 2018. The trial included 779 women and 509 men who met the eligibility criteria. We randomly assigned the 92 garees into treatment and control groups in a 1:3 (treatment:control) ratio: T1, maternal BCC only (n = 15); T2, maternal BCC and paternal BCC (n = 13); T3, maternal BCC and food voucher (n = 15); T4, maternal BCC and paternal BCC and food voucher (n = 13); and C, control (n = 36). The primary outcomes were the fathers’ knowledge and the children’s dietary diversity scores. Study 1 (Chapter 2) assessed the additional impact of the maternal and paternal BCC programs on complementary feeding practices compared to the maternal BCC program alone (T2 vs. T1). The main findings indicate the paternal BCC additionally increase father’s IYCF knowledge however, we do not see evidence of increased IYCF knowledge translating into improvement in IYCF practices as measured by CDDS and WHO standard IYCF indicators. Study 2 (Chapter 3) assessed the additional impact of the maternal and paternal BCC programs on complementary feeding practices compared to the maternal BCC program alone when affordability constraints are reduced by receiving food voucher (T4 vs. T3). In this study, we compare all four treatment arms for better interpretation of the results. The main findings indicate the group that receive paternal BCC increase fathers’ IYCF knowledge significantly compared to the control group. We also find that CDDS significantly improve among the maternal BCC, maternal and paternal BCC, and maternal BCC and voucher groups, compared to the control group. However, surprisingly, providing the paternal BCC and food voucher together in addition to the maternal BCC leads to a smaller increase in CDDS, and the effect is not statistically significant compared to the control group. We find that this effect is mainly driven by the households in which the husband is more actively involved in food purchases. Study 3 (Chapter 4) assessed beliefs of the mothers and fathers in the BCC and control households by making intra-dyadic comparisons and characterizing the behavioral, normative, and control beliefs. The findings show greater differences in beliefs between the BCC and control mothers. Contrary to expectations, the beliefs of BCC and control fathers are similar overall. As a result, although intra-dyadic concordance between couples in the gender-equal direction is similar between the BCC and control households, more BCC households show discordance between gender-equal mothers and traditional fathers because more BCC mothers have shifted in the gender-equal direction. Finally, a qualitative investigation to explore possible explanations for the unexpected results in the trial show fathers tend to reduce the household budget for food purchases when they receive food vouchers.
Behavior change communication; Father; growth; infant and young child feeding; nutrition; randomized controlled trial
Cassano, Patricia Ann; Pelletier, David Louis; Seguin, Rebecca
Ph. D., Nutrition
Doctor of Philosophy
dissertation or thesis