Part 3: Identifying and leveraging positive practices for growing healthy children
How can we encourage caregivers to take up practices that may reduce malnutrition?
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Caregivers and pregnant women may not always be aware that some of their practices are associated with healthy child growth. In others, people may need tips or support from their community to try new things. By building on existing positive practices, we hope to understand how new practices associated with severe acute malnutrition (SAM) reduction may be introduced or adapted to the needs of women.
While Community A is only receiving cash, Communities B and C will also receive behavioral interventions we are referring to as “Positive Practices.” The aim of Positive Practices is to identify and amplify existing practices in the community that are associated with growing healthy children.
The Positive Practices component has two parts: 1) identifying existing practices in consultation with the community and 2) amplifying existing practices and introducing new ones. Our approach presumes that some will be more relevant to caregivers than others and that relevant practices will either be related to the use of existing household resources or will be facilitated by the cash transfers.
Start here to get an overview of what we’re designing and why we’re testing three different prototypes.
What are examples of some of the positive practices you might find?
We’ll be working alongside our IRC nutrition colleagues to generate an exhaustive list of practices to look out for. They are likely to be concentrated around feeding practices and food security. We will use the ProPAN (Process for Promotion of Child Feeding) guide published by PAHO and UNICEF as a starting place for positive practices. Based on the recommendation of local nutrition efforts, we will add to and refine these practices.
How will you identify positive practices in the community?
Our approach draws upon the Design by Dialogue methodology laid out by Dicken et al. (1997) for conducting consultative investigations and interventions with caregivers on infant and young child feeding. We will have a couple of months to spend refining our approaches and our tools before the prototype goes live at the start of harvest season in the fall.
During this period, we’ll meet with community leaders and ask for their input. We could take a geographical approach and conduct a few walks in various directions and document what practices we observe or people tell us about. Or we could take a day-in-the-life approach and equip a few women with GoPros that record their activities throughout the day. The latter allows us to observe the household activity at several key times of the day (such as feeding and provisioning) and allows us to observe practices that women may not think to tell us about. Our colleagues have warned us that Niger will be a particularly challenging place to look for positive practices because of food insecurity is common, food diversity is low, and harmful beliefs about food are popular.
Once you’ve found the positive practices, how will you amplify them or introduce new ones?
This is also something we will explore with the help of community leaders. We are likely to use a combination of existing networks, such as mothers or religious groups, as well as door-to-door sessions with our 20 participating women. Since these women will also be receiving cash, these are opportunities to deliver messages along with cash. These messages will be informed by behavioural science and may be associated with aspirational identities, goal-setting, planning, or motivations. We are also eager to include men in these activities, but we’ll take our queue from the community about how to best do this.
What indicators will you use for the take up of positive practices and/or cash? How will you measure them?
Our implementation period isn’t long enough to measure impact indicators, such as the number of children affected by SAM or even changes in their middle-upper arm circumference (MUAC). Instead, we will try to understand whether the combination of the behaviorally promotion of positive practices + cash has led to any changes in household behaviors and if so, whether those behaviors are associated with SAM prevention.
But how do you even determine those?
Since we are actively promoting certain behaviors while distributing cash, we’re unintentionally implying conditionality and hence, there will be a very high likelihood of social desirability bias if we simply ask people what practices they are taking up. Instead, we’ll ask questions about self-efficacy and motivation around certain behaviors — questions like, “How hard is it to do X?” and “How hard is X compared to Y?”
Since this is also self-reported and open to interpretation by respondents*, we ask a handful of caregivers to use body cameras during meal preparation and consumption to better understand who eats what in the household. We will also use games and interactive tools to understand how cash is being spent during the week and track any changes in category allocations.
As baseline and endline measures, we will use 3 surveys noting that the first two are often used to collect population-based data:
- World Health Organization Infant and Young Child Feeding (IYCF) indicators
- Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access
- IRC Cash Use survey
*In Liberia, for example, people commonly joke that “if you haven’t eaten rice today, you haven’t eaten,” emphasizing how challenging it can be to have cross-cultural conversations about food.
This is part of a series detailing a prototype to prevent malnutrition in Niger. We plan to launch in early July and we welcome your feedback in the comments below, or shoot us a note at airbel@rescue.org.
Next up — A Healthy Child Fund Supported by a Communal Warehouse
