Changing Nutrition Behavior in Bangladesh: Successful Adaptation of New Theories and Anthropological Methods∗

∗This work was done while the first author was on the faculty of the Rollins School of Public Health, Emory University. The second and third authors were students in the MPH program at the time the work was done.

Human subjects and other clearances (also in Methods section): BNEET received Emory University Human Investigations Committee Approval (HIC No. 478-96) in September 1996 and October 1997, as well as USAID Bangladesh Mission clearance (November 1996).

Abstract

Behavior change theories and a positive deviance approach were used to improve child nutrition through home gardening groups in Bangladesh. Groups were assigned randomly to: (T1) individual, stage-based, role-model stories delivered by a literate agent; (T2) role-model stories told by illiterate garden group leaders at meetings; or (T3) no intervention. Four months later, 31% of the T1 mothers demonstrated feeding correct portions of vegetables to young children. Only 15% of T2 and 17% of T3 mothers could do this. Group Leaders did create awareness and spread information; a personal contact was helpful for changing attitudes and portion size.

KEYWORDS:

• health communication
• positive deviance
• vitamin A
• rural development

ACKNOWLEDGMENTS

This project was funded by the United States Agency for International Development (USAID) OMNI Program implemented by the International Life Sciences Institute, and done through Emory University Rollins School of Public Health. It was monitored by P. Trumbo, ILSI and reviewed and evaluated by C. Achterberg and P. Sommers. The project was done in collaboration with many people and organizations. The entire staff of the HKI/Bangladesh program participated in so many ways, but we particularly thank Lynnda Kiess, Tabibul Khan, Aminuzzaman Talukder (Zaman), and Najma Sultana in Dhaka. Their support and hard work made this project possible. In Dinajpur and Birgonj, we particularly thank Shah Jinnah, Alum, Kiron Chandra Rai, Nazrool Islam, and Shaid Hussain of CDA. The field staff most connected to the BNEET effort were Malothi, who was the face-to-face agent for the intervention, Rafel, who served as the “Director” for development of the photonovels, and Rose and Shahaiba, the two gardening agents for the program at the time of the intervention. Malothi, Rose, and Shahaiba also facilitated the group leader trainings. Dillu became a CDA education agent, and served as our pre-tester for the photo-novels. We owe a debt of gratitude to the garden group leaders, the “stars” of our photonovels, and all of the people in the communities of Birgonj who participated in the project

Our qualitative and baseline research team contributed so much to the effort. They are: Sherifa Nazneen, who also participated in the development of the photonovels and appears in some of the pictures, Nasima Shaheen, Taslima Akhter (Meenu), Feroza Akhter (Khuku), and Nasima Begum. The final survey team's contribution is also gratefully acknowledged.

In the U. S., many people also directly helped with this project. In particular, we thank the CDC's Indu Ahluwalia who gave a strong lead to the baseline survey and project development as part of her EIS training program. In addition, Trishna Chhabra served as the baseline field coordinator. Amy Corneli helped with the baseline survey and role model story development and was the photographer for the photonovels. T.A. Gregory, of Emory University, produced the photonovels, and Phillip Beane of the CDC, produced a final version of the photonovels for distribution at the results sharing workshop in December. Linda Block created our training videos for preparing field staff to undertake the baseline survey. And the entire class of RSPH IH/BSHE 520 helped to prepare materials (the infamous Playdough cubes) for use in the surveys.

Notes

∗This work was done while the first author was on the faculty of the Rollins School of Public Health, Emory University. The second and third authors were students in the MPH program at the time the work was done.

Human subjects and other clearances (also in Methods section): BNEET received Emory University Human Investigations Committee Approval (HIC No. 478-96) in September 1996 and October 1997, as well as USAID Bangladesh Mission clearance (November 1996).

¹Ed Maibach, personal communication, 1998.

²More than 147 million people inhabit less than 140,000 sq. kilometers.

³Clive West, p.c. Subsequently confirmed by (Haskell et al., 2004; de Pee et al., 1995).

⁴ http://www.positivedeviance.org.

⁵A third story, Trishna, was only shown to pregnant women in groups 1 and 2.

⁶Mothers were asked, “What does Rachida do to change her mother-in-law's mind?”.

⁷Mothers were asked, “How does Shanaz prepare the vegetables for her daughter?”.

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