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. 2023 Mar 30;3(3):e0000401.
doi: 10.1371/journal.pgph.0000401. eCollection 2023.

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review

Daniella Watson  1   2   3 , Patience Mushamiri  4 , Paula Beeri  5 , Toussaint Rouamba  6 , Sarah Jenner  7 , Simone Proebstl  7   8   9 , Sarah H Kehoe  1   7 , Kate A Ward  1   7   10 , Mary Barker  7   10   11   12 , Wendy Lawrence  7   11 ; INPreP Study Group
Affiliations

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review

Daniella Watson et al. PLOS Glob Public Health. .

Abstract

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Behaviour Change Wheel (Michie et al, 2011) [28].
Fig 2
Fig 2. The COM-B model (capability, motivation, opportunity–behaviour) (Michie et al, 2011) [28].
Fig 3
Fig 3. Flowchart of study selection PRISMA diagram.
Fig 4
Fig 4. Framework describing the way in which nutrition-specific and nutrition-sensitive interventions may be underpinned by behavioural concepts to improve maternal and child nutritional and psychosocial outcomes in sub-Saharan Africa.
(Adaption of Lassi et al, 2017 framework [124]).
See this image and copyright information in PMC

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