What Worked for Improving Balanced Maternal Dietary Intake in Rural Bangladesh? Implications for New Programs

Abstract Objectives To assess the strategies that worked to motivate the women and families to adhere to a nutrition behavior change intervention trial that aimed to promote balanced diet in pregnancy in rural Bangladesh. Methods We designed this process evaluation as part of a cluster randomized controlled trial. We conducted in-depth interviews with pregnant women, recently-delivered women, and husbands; focus groups with mothers and mothers-in-law; and key-informant interviews with Shasthya Kormis (community health workers) who provided the balanced plate nutrition intervention. Results The novel finding in the study was that the balanced plate nutrition education helped women through practical demonstration to learn about a balanced meal considering appropriate portion sizes and diversity of foods. We also found that pregnant women needed active involvement of community health workers in mobilizing social support to create an enabling environment essential to bring changes in dietary behavior with self-motivation. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in own or neighbors’ kitchen were the most commonly mentioned reasons of acceptance of the intervention to the women and families. We identified six key areas within the intervention strategy that played crucial role in achieving desired adherence. These include: practical demonstration of portion sizes engaging the end-users; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women's social networks; and harnessing community health workers’ social role. Conclusions Programs to improve maternal nutritious food consumption should focus on promoting diet through practical demonstration of portion sizes through active engagement of the women and family instead of replicating the conventional information-based counseling. Funding Sources The University of Sydney Faculty of Medicine and Health.

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How Can We Improve the Consumption of a Nutritionally-Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the ‘Balanced Plate’ Intervention

10.20944/preprints202007.0197.v1 ◽

2020 ◽

Author(s):

Ashraful Alam ◽

Morseda Chowdhury ◽

Michael John Dibley ◽

Camille Raynes-Greenow

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Controlled Trial ◽

Maternal Diet ◽

Intervention Strategy ◽

Rural Bangladesh ◽

Portion Sizes ◽

The Impact ◽

Practical Demonstration

Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observation of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Programs to promote a nutritious maternal diet should focus on encouraging the use of healthy foods through practical demonstration of portion sizes and engagement of the women and family instead of replicating the traditional information-based counselling.

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How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176289 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6289

Author(s):

Ashraful Alam ◽

Morseda Chowdhury ◽

Michael J. Dibley ◽

Camille Raynes-Greenow

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Controlled Trial ◽

Intervention Strategy ◽

Local Context ◽

Rural Bangladesh ◽

Portion Sizes ◽

The Impact ◽

Practical Demonstration

Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observations of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Future implementation of the intervention should tailor the strategies to the local context to ensure optimal adherence to the intervention.

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How the Women and the Community Responded to an Antenatal Balanced Plate Nutrition Education Intervention? A Qualitative Process Assessment in Rural Bangladesh (P04-002-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-002-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Ashraful Alam ◽

Morseda Chowdhury ◽

Camille Raynes-Greenow ◽

Michael Dibley

Keyword(s):

Community Health ◽

Nutrition Education ◽

Community Health Workers ◽

Dietary Habits ◽

Health Workers ◽

Education Intervention ◽

Community Based ◽

Rural Bangladesh ◽

Portion Sizes ◽

Practical Demonstration

Abstract Objectives Acceptability to the beneficiaries is crucial for effectiveness of a community-based nutrition intervention. We conducted a process evaluation to explore the response of the women and the community to an antenatal balanced plate nutrition education intervention in rural Bangladesh. Methods We conducted in-depth interviews (IDI) to collect data from recently delivered women, their husbands, and older women ((mothers and mothers-in-law of the women) who received the intervention. Key informant interviews (KII) were conducted with BRAC Shasthya Kormis (community health workers) who provided balanced plate demonstration. Results We found that the balanced plate nutrition education helped women through practical demonstration to learn about a balanced meal considering appropriate portion sizes and diversity of foods. The family decision makers, such as husbands and mothers-in-law, considered adopting a healthier diet as a tactic to protect the newborn and the mother from health complications that might safeguard a healthier baby. We also found that rural Bangladeshi pregnant women needed the active involvement of CHWs in mobilizing social support to create an enabling environment essential to bring change in dietary habits with self-motivation. Conclusions A community-based balanced plate nutrition education aiming to increase birth weight was widely accepted by the beneficiaries. Practical demonstration of balanced plate with appropriate portion sizes involving the community health workers and family members enhanced the acceptance. Funding Sources Faculty of Medicine and Health, University of Sydney, Australia.

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Making a balanced plate for pregnant women to improve birthweight of infants: a study protocol for a cluster randomised controlled trial in rural Bangladesh

BMJ Open ◽

10.1136/bmjopen-2016-015393 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015393 ◽

Cited By ~ 5

Author(s):

Morseda Chowdhury ◽

Camille Raynes-Greenow ◽

Ashraful Alam ◽

Michael J Dibley

Keyword(s):

Public Health ◽

Pregnant Women ◽

Nutrition Education ◽

Low Birthweight ◽

Health Workers ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Cluster Randomised ◽

Randomised Controlled ◽

Practical Demonstration

ObjectivesLow birthweight significantly contributes to neonatal mortality, morbidities and psychosocial debilities throughout the course of life. A large proportion of infants (36–55%) in Bangladesh is born with low birthweight. Nutritional status of women during pregnancy is critical for optimal growth and development of the fetus. Nutrition education has been found to improve maternal nutritional status. Our study aims to determine whether nutrition education with a practical demonstration during pregnancy is an effective intervention for improving the birthweight of infants compared with standard nutrition education only.Methods and analysisWe will conduct a community-based cluster randomised controlled trial in one rural district of Bangladesh. Treatments will be allocated evenly between the study clusters (n=36). Participants in the intervention clusters receive ‘balanced plate nutrition education’ with a practical demonstration from community health workers 4–7 times throughout their entire pregnancy, starting from the first trimester. The control clusters will receive standard nutrition education delivered by public and other healthcare providers as per ongoing antenatal care protocol. Our sample size would be 900 pregnant women to determine 100 g differences in mean birthweight, considering 5% type 1 error, 80% power and an intra-cluster correlation coefficient of 0.03. The primary outcome of the trial is birthweight of the infants and the secondary outcomes include daily caloric intake and dietary diversity score among the pregnant women. Outcomes will be measured at enrolment, third to ninth month of gestation (monthly) and at delivery. Community health workers blinded to the study hypothesis will collect all data.Ethics and disseminationThe study was approved by the James P Grant School of Public Health, BRAC University Ethical Review Committee, Dhaka, Bangladesh. We will communicate the final results to relevant research and public health groups and publish research papers in peer-reviewed journals.Trial registration numberACTRN12616000080426.

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