Targeted scripted messages delivered by nurses and radio improved infant and young child feeding in Mexico
Mexico
Objective
Scalable interventions are needed to improve infant and young child feeding (IYCF). We examined effectiveness of a theory-based communication intervention based on short scripted messages to improve IYCF in Mexico.
Design, setting, and participants
Women with children 6-24 months old were selected randomly from vaccination rosters from 6 semi-urban low-income communities in Morelos state (intervention, n=266) and 3 in Puebla state (control, n=201).
Intervention
We used a social marketing approach and theory of planned behavior to guide intervention design. Five scripted messages were delivered by vaccination nurses and radio. The messages focused on breastfeeding, food consistency, flesh-food consumption, vegetable consumption, and offering meat or vegetable that the child had rejected before. Nurses visited participants once at home to deliver all five scripted messages. To reinforce four messages, nurses gave study participants a colorful magnet that depicted four of the messages. Messages also were aired 7 times/day for 21 days on 3 radio stations as 30-second radio spots. Each spot focused on one message and only one message was aired per day.
Outcome measures and analysis
We used a pre-post-test design to evaluate changes in beliefs, attitudes, and intentions via 3-point scales, and in behavior with a 7-day food frequency. Mixed models were used to examine intervention-control differences in pre-post changes accounting for clustering by community.
Results
Nurses delivered scripted messages to 89% of the study participants, and 34% of study participants reported having heard at least one message on the radio. Beliefs, attitudes, and intentions about IYCF were significantly improved in the intervention communities compared to control. Intervention participants had significantly greater breastfeeding frequency (+4 episodes/day), vegetable (+0.5 d/wk) and beef consumption (+0.2 d/wk), and thicker consistency in soups (+0.7 d/wk).
Conclusions and implications
This study provides evidence that a targeted communication intervention significantly improved IYCF. The intervention used a scalable model because the strategy was low-burden and easily integrated with existing vaccination services, with simultaneous delivery via radio.
Collaborating institutions
University of South Carolina’s Department of Health Promotion, Education, and Behavior in Columbia has as its focus using the social and behavioral sciences to understand how policy, environmental, institutional, and individual actions can improve the public’s health in diverse settings across South Carolina, the U.S., and the globe.
Center for Research in Nutrition and Health of the National Institute of Public Health in Cuernavaca, Mexico has as its mission to contribute to social equity and to the complete and healthy development of the Mexican population through the promotion of its nutritional status and health, by generating, publishing, and applying knowledge, and through forming human resources of excellence in the areas of public nutrition and related disciplines.
Principal investigator
Dr. Edward A. Frongillo, Jr., Ph.D., Professor, University of South Carolina