Table 1.

Behaviour change interventions description and impact

Author/date/location	Study design	Formative research	Platform/facilitator	Communication strategy/messages	Impact
Aboud et al./2008/Bangladesh	Randomised efficacy study 202 children, 12–24 months 6 sessions 5 months follow‐up	Pilot, discussion groups and observations informed strategy and messages	Community‐based/Peer educators ∘  Added to usual 12‐week programme	Self‐feeding and responsive feeding Wash your child's hands, and then let the child pick up food and eat Read your child's signals and then respond positively When your child refuses, pause and question why; don't force feed or threaten Offer variety of foods.	Physical growth Weight (+) Weight gain (+) Behaviour change Self‐fed mouthfuls (+) Mouthfuls eaten (+) Mother's responsiveness (ns) Non‐responsive encouragement (+) Forceful feeding (ns)
Aboud et al./2009/Bangladesh	Randomised efficacy study 203 children, 8–20 months 6 sessions 5 months follow‐up	Pilot, discussion groups, observations, and previous research informed strategy and messages	Community‐based/Peer educators ∘  Added to usual 12‐week programme	Self‐feeding and responsive feeding Wash your child's hands; let the child pick up food and eat Read your child's signals and then respond positively When your child refuses, pause and question why; don't force feed or threaten Offer variety of foods.	Physical growth Weight gain (ns) Behaviour change Self‐fed mouthfuls (+) Mother's responsiveness (+) Mouthfuls eaten (ns) Mother washed child's hands (+)
Aboud et al./2011/Bangladesh	● Randomised efficacy study ● 302 children, 8–20 months ● 6 sessions ● 5 months follow‐up ● 3 groups:   Intervention only (INV)   Intervention + Sprinkles (INV+MNP)   Control	Pilot, discussion groups, observations, and previous research informed strategy and messages	Community‐based/Peer educators ∘  Added to usual 12‐week programme ∘  Provided Sprinkles for one group	Self‐feeding and responsive feeding Wash your child's hands, and then let the child pick up food and eat Read your child's signals and then respond positively When your child refuses, pause and question why; don't force feed or threaten Responsive stimulation during play Offer variety of foods	Physical growth Weight (+) Weight/age (ns) Length/age (ns) Behaviour change Self‐fed mouthfuls (+) Mother's verbal responsiveness (ns) Mouthfuls eaten (+) Mother washed child's hands (+) Language skills (+)
Bhandari et al./2001/India	● Randomised effectiveness study ● 418 infants, 4 months old ● 2×/week + 1 hour/month ● 4 groups:   INV + Cereal   INV   Visitation group   Nothing ● Pre‐post 8‐month programme	No description	Community‐based Nutritionist ∘  Provided milk‐based cereal	Negotiated decision‐making process	Physical growth Weight (vs visitation group)   INV + Cereal (+)   INV (ns) Length (ns) Behaviour change BF (INV + Cereal) (−)
Bhandari et al./2004/India	Randomised effectiveness study 1025 newborns Various dosages: (1/month × 12 months) + (at 15 and 18 months) = 14 total + vaccination and sick child visits Pre‐post 18‐month programme	Stated that qualitative and quantitative research informed target behaviours, message and channels, but gave no detail	Community‐based/Health care workers, village workers and auxiliary nurses	CF at 6 months Specific foods Frequency and quantity + BF Methods to encourage children to eat more Hand washing before meals Feeding during illness	Physical growth Length gain (+) Weight gain (ns) Behaviour change Responsive feeding (+) Encouraged actively (+) Fed with love and affection (+) Hand washing (+) Other: Energy intake (+) Morbidity (ns)
Bonvecchio et al./2007/Mexico	Randomised efficacy study 374 families with infants 6–23 months Various dosages Pre‐post 5‐month programme	Qualitative and quantitative research informed target behaviours, message and channels	Community‐based/Community volunteers and health care workers during routine visits Provided papilla	Prepare papilla with 4 tbsp of powder and 3 tsp of water Give papilla every day Give papilla between meals, Give papilla only to target children.	Behaviour change Prevalence for three of four behaviours (+)
de Romana et al./2000/Peru	Randomised effectiveness study 500 children 6–36 months Various dosages Pre‐post 1‐year programme	Qualitative research and acceptability trials informed product formulation and distribution	Community‐based/Community volunteers Provided CF (Alli Alimentu)	Increase awareness of Alli Alimentu Increase awareness of the nutrition project BF promotion Instructions on food preparation	Physical growth Height (ns) Weight (ns) Other Consumption of nutrients (+) Micronutrient status (+) Anaemia (+)
Guldan et al./2000/China	Quasi‐experimental efficacy study 495 children, 4–12 months Monthly growth monitoring and counselling Pre‐post 1‐year programme	Quantitative needs assessment informed target behaviours	Community‐based/Village nutrition educators	Breast milk is best for first 4–6 months Post‐birth BF Bottle feeding may be dangerous and BF is free BF on demand Appropriate foods	Physical growth Weight (+) Height (+) Other Anaemia: (+) BF rates: (+) Knowledge: (+)
Guyon et al./2009/Madagascar	Cross‐sectional effectiveness study 1200 children under 2 at baseline; 1760 at end line Various dosages Pre‐post 5‐year programme	No description	Community and health centre‐based media/Various health care and community facilitators	● ‘The right ENA message, at the right time, to the right target group’ ● Small ‘doable actions’ with age‐specific recommendations ● Specific messages:   Age‐appropriate CF   Continued BF   Food frequency, diversity and quantity ● Feasible home food enrichment	Behaviour change Food frequency (+) Fed during illness (ns) Vitamin A (+) Food quantity (+) Other BF rates (+) % dewormed (+) Food diversity (ns)
Hotz & Gibson/2004/Malawi	Quasi‐experimental efficacy study 105 children, 9–23 months 4 weekly groups + home visit 4‐week follow‐up	No description	Community‐based/Community volunteers	Increase the energy density of porridges Methods to increase intake of iron and zinc Enrichment of phalas with energy and nutrient dense foods Encourage children to eat	Behaviour change Adoption rates (+) Other Quantity of CF food (+) Micronutrient intake (+) Animal intake (+)
Inayati et al./2012/Indonesia	●  Randomised, efficacy study ●  215 children, 6–60 months ●  Various dosages ●  4 groups   Intensive nutrition education   Intensive education + MNP   Non‐intensive education   Non‐intensive education + MNP ●  Pre‐post discharge	Qualitative research informed target behaviour	Community‐based/ Health and nutrition officers and community volunteers Provision of MNP	Importance of: Healthy family meals Food safety Feeding infants and young children Feeding sick children Prevention and treatment of malnutrition	Physical growth Weight gain (+) Other Length of stay (+) Hb value (+)
Kapur et al./2003/India	Randomised efficacy study 451 children, 9–36 months 8 weekly sessions 8 weeks follow‐up 4 groups:   Nutrition education   Weekly iron   Nutrition education + weekly iron   Placebo control	Surveys informed strategy message and channels	Community‐based/Anganwadi workers Provision of iron	Exclusive BF for 6 months CF by 6 months Appropriate foods (consistency, quality and quantity) Small, frequent meals Family food by 1 year More solids, less milk Hygiene Knowledge of anaemia Iron‐rich and Vitamin C foods	Other Iron intake (+) Serum ferritin levels (+) Prevention of declines in iron status (+) Maternal knowledge (+)
Kilaru et al./2005/India	Effectiveness study (not randomised) 242 infants, 5–11 months 12 monthly monitoring and counselling 1‐year follow‐up	Used data from Bhandari studies	Community‐based/ Educated workers	Use and preparation of appropriate local foods Feeding frequency Increase food diversity CF then BF Avoid bottles	Physical Growth Weight: Girls (+) Boys (ns) Behaviour Change 4 of 6 behaviours, Girls (+); Boys (ns) Solids 4×/day (+) 5 food groups (+)
Li et al./2007/Dai minority in China	Cross‐sectional effectiveness study 352 newborns Various dosages, with growth monitoring bimonthly Pre‐post 2‐year programme	Community partners contributed to strategy, message and channels	Community‐based/Health workers, community, village representatives	Support for early initiation and continued BF Quality/quantity of CF Instructions on child feeding Preparation of foods Overcoming food taboos (egg, liver, fish)	Physical growth Weight change (+) Behaviour change Earlier BF (+) Earlier initiation of indicated foods and later of rice (+) Consumption of taboo foods (+)
Lutter et al./2008/Ecuador	Quasi‐experimental, non‐randomly chosen control 634 children, 9–14 months Various dosages including weekly monitoring Pre‐post 11‐month programme	No description	Community‐based/Health and community workers, parent committees Provision of MNP CF (papilla)	Awareness of good nutrition during childhood Inform families and communities about the programme, and encourage enrolment	Physical growth Less likely to be underweight (+) Growth (ns) Behaviour change CF quantity and quality (+) BF practices (ns) Other Haemoglobin (+) Anaemia (+)
Mackintosh et al./2002/Vietnam	Cross‐sectional programme evaluation 142 younger siblings of children in 1st study Daily, 2 weeks/month, Growth, monitoring, and promotion 3‐ and 4‐year follow‐up	Positive Deviance method informed intervention content	Community‐based/Villagers Part of Poverty Alleviation and Nutrition Program (PANP)	Basic UNICEF ‘Facts for Life’ messages	Physical Growth Younger siblings (+) Weight/age (+) Weight/height (+) Height/age (ns) Behaviour change Food frequency (+) Washed hands (+)
Pachón et al./2002/Vietnam	Randomised effectiveness trial 238 children, 5–25 months Daily, 2 weeks/month, Growth, monitoring and promotion	Positive Deviance method informed intervention content	Community‐based/ Villagers	Feed children PD ‘good foods’ Increase food quantity Feed 5–6 times/day Continue breastfeeding Other health‐seeking and caring behaviours	Behaviour change PD foods eaten (+) Frequency and quantity (+) Consumed more energy (+) BF frequency or prevalance (ns)
Penny et al./2005/Peru	Randomised effectiveness study 377 infants, at birth Growth, monitoring and promotion Various dosages Pre‐post 18‐month programme	Structured observations and cross‐sectional survey informed strategy, messaging and medium	Health centre‐based/Health care providers	A thick puree satisfies and nourishes your baby, equal to three portions of soup Add a special food to your baby's serving (chicken, liver, egg or fish) everyday Teach your child to eat with love, patience and good humour	Physical growth Stunting (+) Weight (+) Weight/age (+) Height (+) Height/age (+) Behaviour change: Care practices (+) BF rates (ns) Preventive healthcare (+) Animal sources (+)
Rivera et al./2004/Mexico	Randomised effectiveness study 650 children, 4–23 months 1 education session + regular monitoring 1‐year follow‐up	No description	Community‐based/Unspecified facilitators Part of incentive‐based welfare programme Provided fortified food supplements	General nutrition and health	Physical growth Height (+) (highest for infants < 6 months and the poorest infants) Other: Haemoglobin at 18 months (+) Haemoglobin at Y2 (ns) Anaemia (+)
Roy et al./2005/Bangladesh	Randomised effectiveness 282 children, 6–24 months 2×/week, 3 months 6‐month follow‐up 3 groups:   Intensive nutrition education (INE)   Intensive nutrition education +supplemental food (INE + SF)   Non‐intensive nutrition education	No description	Community‐based/Health assistants Food ration supplement	Importance of BF (UNICEF nutrition triangle) Importance of food security, caring practices, personal hygiene and disease control Nutritional properties of food ingredients Risks of malnutrition and how to achieve good nutrition	Physical growth Weight/age (+) Behaviour change Separate pots (+) Feeding frequency (+) Cooking CF (+) Other Nutritional status (+) No significant difference in nutritional status between INE and INE+SF groups vs. control
Roy, et al./2007/Bangladesh	Randomised effectiveness study 605 children, 6–9 months Weekly for 3 months + 2× week for 3 months 6‐month follow‐up	Qualitative groups of study mothers informed strategy, message and materials	Community‐based/Community health workers	(UNICEF nutrition triangle) Importance of food security, caring practices, personal hygiene and disease control Use separate feeding pots Prevention and control of diarrhoea and acute RTI Promotion of khichuri (a local CF) as energy‐ and protein‐rich Responsive feeding	Physical growth Weight gain (+) Weight/age (+) Length/age (+) Behaviour change Frequency (+) Separate pots (+) Cost Malnutrition prevention Range through districts of US$37 to US$21.34
Salehi et al./2004/Iran	Quasi‐experimental efficacy study 811 children, 0–59 months Various dosages 12‐month programme 3 months follow‐up	Used Hubley's (1993) BC model to guide quantitative and qualitative research, inform behaviours, and develop strategy and messages	Community‐based/Literate daughters and influential people + health care workers	18 messages including: Clean drinking water Vaccination Child growth and illness monitoring Food pyramid Hygiene Age‐appropriate CF	Physical growth Weight (+) Height (+) Weight/age (+) Height/age Z (+) Weight/height (+) Behaviour change % protein from animal sources (+) Food variety (+)
Santos et al./2001/Brazil	Randomised efficacy study 424 children, <18 months 20 hours training for doctors Various dosages for children 6‐month follow‐up	In‐depth interviews with 30 mothers and household trials informed behaviours, strategy and messages	Health centre‐based/ Doctors	IMCI guide for physicians to use in counselling: Increase frequency of BF and CF Give animal protein and micronutrient‐rich foods Add oil to food Increase energy and nutrient food density	Physical growth Weight/age (+) Weight/height (+) Weight gain (+) Height (ns) Behaviour change Dr.'s nutrition assessment and counselling skills (+) Quantity and density (ns)
Schroder et al./2002/Vietnam	Randomised effectiveness study 238 children, 5–25 months Daily, 2 weeks/month Pre‐post 1‐year	Positive Deviance method with four families informed intervention content	Community‐based/Community members	Feeding children ‘good foods’ (i.e. PD foods) Educating mothers in good caretaking practices based on UNICEF's Facts for Life	Physical growth Growth (ns) Younger (</15 months) and more malnourished (<–2 Z) deteriorated significantly less Other Dietary intake (+) Morbidity (+)
Suchdev et al./2012/Kenya	Randomised effectiveness study 1063 baseline; 862 post children, 6–35 months Variable dosage Pre‐post 1‐year programme	Quantitative survey and 14 focus groups with caregivers, vendors, consumers informed strategy	Social Marketing/ Sold Sprinkles through community‐based distribution system	‘Happy child; happy family’ Rationale, benefits and appropriate use of product	Behaviour change Purchase intention (+) Purchases (+) Average weekly intake/child (+) Other Haemoglobin (+) Iron (+) Vitamin A (+)
Sun et al./2011/China	Randomised effectiveness study 226 baseline; 221 post, 6–24 months Variable dosage Pre‐post after 8‐month programme	Used quantitative research on Theory of Planned Behaviour and Health Belief Model to inform six‐P strategy	Social marketing/ Social marketing of Ying Yang Bao (YYB) MNP through health system, public‐ private partnership, mass media	Appropriate CF and use of YYB Project background, sale locations, price, usage instructions	Behaviour change Intention to buy (+) Ever purchased (+) Ever used (+) Other Anaemia in general population (ns) For purchasers, odds ratio for risk of anaemia (+)
Tomedi et al./2012/Kenya	Non‐randomised efficacy study 276 children, 6–20 months 7 monthly sessions Pre‐post 7‐month programme	No description	Community‐based/Community health workers Monthly food rations	From WHO ‘Guiding Principles for CF of the BF Child’ Hand washing Hygienic food preparation Offer diversity of local foods	Physical growth Weight gain (+) Weight/height (+) Height/age: (ns) Wasting (+) Other Micronutrient intake (+)
Zaman et al./2008/Pakistan	Randomised efficacy study 375 children, 6–24 months Various dosages 5 ½ days training for LHV Pre‐post 6‐month programme	Replicated Brazil (Santos et al. 2001 study) No further description	Health centre‐based/Lady Health Visitors (LHV) using IMCI training	IMCI messages	Physical growth: Weight gain (+) Weight/age (+) Height/age (ns) Behaviour change: LHV skills (+) Animal source food (+)
Zhang et al./2012/China	Randomised effectiveness study 599 children, 2–4 months Daily, 2 weeks/month, Growth monitoring and promotion 18‐month follow‐up	Literature review and qualitative research with health care providers informed strategic messages	Community‐based/Health care providers	Food selection, preparation and hygiene (especially animal‐source protein) Childhood nutrition and growth Responsive feeding	Physical growth Weight for age (+) Weight for height (+) Behaviour change Diversity (+) Frequency (+) Animal sources (+) Other Hand washing (+) Cook separately (+) BF frequency (+)

BC, behavior change; BF, breast feeding; CF, complementary feeding; ENA, Essential Nutrition Actions; INE, intensive nutrition education; IMCI, Integrated Management of Childhood Illness; MNP, Micronutrient powder; PD, Positive Deviance; RTI, Respiratory tract infection; SF, supplemental food.