Date of Award

Fall 2024

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Edward A. Frongillo

Abstract

While there have been notable decreases in child undernutrition (i.e., stunting) over the past few decades, it remains a major concern in Nepal, with 25% of children under the age of five experiencing chronic undernourishment. There is considerable scope for improving nutrition-related behaviors to address this ongoing issue. In Nepal, knowledge regarding appropriate child feeding practices is often inadequate, and thus additional sources of accurate information are required. Information through multiple sources (i.e., interpersonal communication, mass media, and mobile SMS) provides opportunity to reach households who inadequately practice childcare. Information improves knowledge and information exchange (i.e., receiving or sharing) usually takes place among the group of people within social networks. Thus social networks play a major role in knowledge sharing and relevant practices among individuals. This study had two specific aims. The first aim was to advance our understanding of how receiving or sharing of nutrition-related information with mothers’ social networks was linked to child feeding practices. The second aim was to identify the major sources of information related to child health and nutrition in the community and how mothers and household heads shared the information with various social network groups including family members, friends, relatives and neighbors. Both the quantitative and qualitative methods were used to achieve the aims using two different datasets collected through the Suaahara-II program: (1) Suaahara-II household level SMS RCT baseline survey dataset (for aim 1), and (2) qualitative data which were collected for the Suaahara-II household level SMS RCT study on the effectiveness of layering SMS messages onto a larger social and behavior change communication intervention (for aim 2). For the first aim, 812 households with a child below 2 years of age were recruited in 2019. Nine items specific to child feeding related information were considered for creating a social network variable. Five items specific to child feeding practices were considered for creating a social norm variable. Outcome of the study was child dietary diversity (continuous). Linear regression models were used to examine the associations between exchange of information (receiving or sharing) with social networks and outcome variable. We conducted focus group discussions (FGDs) for the second aim and altogether 22 FGDs were conducted (range 3–12 participants) with 85 mothers and 65 male or female household heads of 12-23 months old children. Information received about feeding diverse food and providing eggs after 6 months of age had a positive association with child dietary diversity (β= 0.11; p=< 0.01 and β= 0.10; p=0.01 respectively). Furthermore, received information about the effect of eggs on child's brain development had positive relation with child dietary diversity (β= 0.08; p=0.05). Similarly, sharing information regarding introduction of diverse food and the effect of eggs on child’s brain development had positive associations with the child dietary diversity (β= 0.11; p=0.01 and β= 0.15; p=0.02). Sharing information related to the effect of eggs on child’s body and mind development was also associated with child dietary diversity (β=0.20; p=0.03). Both mothers and household heads reported that frequently used sources of information were health workers, female community health volunteers, health mothers’ groups, Suaahara II frontline workers, television, and radio. In general, participants shared information more with women compared to men, both within the family and in the community. They also reported sharing information more with their family members compared to community members. Sharing of information by male household heads with different members of the social networks was less compared to mothers and female household heads. The participants mostly shared information with their own generation including spouses and sisters-in-laws and reported that almost all the information related to child nutrition and feeding practices they received from various sources was comprehensible, applicable, and trustworthy. Participants preferred information through SMS compared to other sources even though they suggested all the information shared through both SMS and other sources was useful. Exchange of information among individuals within the social network should be considered as a form of informational support regarding child feeding practices and this understanding can guide the development of effective communication strategies that may help improving child nutrition and feeding behaviors. Sharing information among members of the social network could ensure information and knowledge transfer regarding age-specific child feeding practices in the community. As SMS via mobile phone can reach remote areas, targeted and tailored use of the information could prompt parents to engage in proper child-feeding behaviors.

Rights

© 2025, Mohammad Masudur Rahman

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