Designing integrated interventions to improve nutrition and WASH behaviors in Kenya

• Authors: Kimberly Jacob Arriola, Emory University; Anna Ellis, Emory University; Amy Girard, Emory University; Emily Awino Ogutu, Emory University; Emilie McClintic, Emory University; Bethany Caruso, Emory University; Matthew Freeman, Emory University
• Journal Title: Pilot and Feasibility Studies
• Volume: Volume 6, Number 1
• Publisher: BMC | 2020-02-03, Pages 10-10
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s40814-020-0555-x
• Subjects: Agriculture, Animal Culture and Nutrition; Psychology, Behavioral; Health Sciences, Public Health
• Keywords: Behavior change intervention; Behavioral theory; Child stunting; Malnutrition; Maternal and child health; Water, sanitation, and hygiene

Abstract

Background: Child stunting, an indicator of chronic malnutrition, is a global public health problem. Malnutrition during pregnancy and the first 2 years of life undermines the survival, growth, and development of children. Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. The aim of this study was to describe a systematic, theoretically informed approach (that drew from the Starr and Fornoff approach to the Theory of Change development and the Behavior Change Wheel approach) to design a multi-component and integrated social and behavior change intervention to improve WASH and nutrition-related behaviors in western Kenya. Methods: This intervention was developed to be integrated into an existing project that utilized the care group model and aimed to create a culture of care and support for HIV/AIDS-affected children under two and their caregivers and was executed by local partners. We tested the newly created intervention packages in user-testing trials using an adapted Trials of Improved Practices approach to pilot acceptability and feasibility. Results: Using authentic stakeholder engagement and relevant theories, we conducted an 8-step process: (1) conduct mixed methods formative research, (2) prioritize target behaviors, (3) use causal analysis to create problem trees, (4) develop solution trees and articulate assumptions and rationales for change, (5) link solution trees to intervention functions, (6) develop the intervention plan, (7) create the intervention packages, and (8) test and refine the intervention packages. Conclusions: This study highlights the need to take a multi-sectorial, integrated approach that integrates contextually relevant behavior change theories with the experiential knowledge gleaned from stakeholders into the design of interventions that seek to reduce child stunting. This process resulted in the creation of intervention packages that grouped behaviors thematically to be most relevant and responsive to the population context. This work has the potential to make important contributions towards achievement of the United Nations' sustainable development goals.