Understanding Why Behavioral Interventions Pose Challenges - Using Cultural Domain Analysis to Compare Malnutrition Risk Perception in 6 Global Contexts

Objectives Within formative research to inform behavioral interventions since 2013, we have sought to understand community risk perceptions toward nutrition-related illnesses. This analysis compares findings from 6 countries to 1) describe the extent to which nutrition-related illnesses are salient to community members, and 2) to compare malnutrition risk perception across cultural contexts. Methods We conducted formative research in 6 countries between 2013–2018 to inform preventative nutrition interventions where behavior change was a focus. In both rural and urban sites of each country context, we used two ethnographic methods for cultural domain analysis. Free listing of ‘childhood illnesses’ was conducted in Malawi (n = 64), Mozambique (n = 115), Nigeria (n = 81), Marshall Islands (n = 86), Solomon Islands (n = 89), and Kiribati (n = 84). Smith's statistic (S) was used to assess illness term salience. The most salient terms in each setting were then pile sorted by participants who were asked to sort illness terms by perceived severity/seriousness for young child health. Data were analyzed using ANTHROPAC. Semi-structured interview data contextualized and triangulated findings. Results Across 6 global contexts, community members perceived nutrition-related illnesses to be less serious/severe than other childhood illnesses. Consistently, the most salient child illness terms identified were malaria/fever, flu/cough, and stomachache/diarrhea. Terms referring to malnutrition were mentioned in just half of the country contexts, with iron deficiency anemia (‘loss of blood’) and wasting-related terms the most salient. Local terms referring to the biomedical equivalent of stunting did not exist in most contexts. Most participants categorized nutrition-related illness terms into ‘least serious/severe’ or ‘moderately serious/severe’ rather than ‘most serious/severe’ where other more salient childhood illnesses were placed. Interview data corroborated these findings, revealing an important discrepancy between the priorities of global nutrition practitioners and the communities with whom they work, regardless of cultural or geographic context. Conclusions This study provides insight into why nutrition interventions where behavior change is needed may face challenges achieving desired effectiveness. Funding Sources Not applicable.