Table 1.
Summary of the intervention components
| Events/visits | Purpose | Key content |
|---|---|---|
| First community event (3 hours) | Raise awareness of, generate interest in, and elicit commitment to the campaign and the five food hygiene behaviors | Distributed invitation card a day before the event. Program ritual (put-up back-drop banner, nail cutting, hand washing with soap, putting on program badge, etc.) initiated. Program jingle introduced. Campaign objectives described by social leader. Situation contextualized via situational analysis—story, flex with pictures, video clip (disgust motive exploited). Five food hygiene behaviors and their benefits presented. “Ideal mother” introduced as a source of inspiration. Public commitment oath taken, and certificates distributed. Public rally chanting—“safe food, healthy child, we want ideal mother” |
| First households visits (3 hours) | Remind mothers of public commitment; change settings reinforcing the desired behaviors (particularly kitchen cleanliness) | Program jingle installed on mothers' phones. Kitchen compared with “ideal kitchen”—using clean kitchen illustration. Kitchen demarcated with ribbons and flags reminding mothers of the food hygiene behaviors. Danglers placed at eye-level (round illustration of all behaviors, ideal mother board, dhungro—a branded fire blowing instrument). Importance of food hygiene behaviors refreshed via a brief talk using a three-dimensional flip chart. Three-month work plan formulated to ensure each mother meets the public commitment |
| First group event (3 hours) | Reinforce program ritual; establish group norms/habits for all behaviors; and generate interest in having clean kitchens | Program ritual carried out. Mothers' experiences of changes in their kitchens shared. Group norms elicited via cooking demonstration. Benefits of five food hygiene behaviors reiterated via visual aids (3M PetriFilm [3M, St. Paul, MN], Glo Germ lotion [Hygienic Solutions, Lincoln, United Kingdom] before feeding). Bibs with the message “did you wash your hands before feeding me?” distributed as reminder/reward for HWWS. “Clean kitchen” competition announced (putting clean kitchen indicators in the village) |
| Second household visits (2 hours) | Reinforce correct food hygiene behaviors with the view to these becoming habitual | Mothers' preparation of food observed and corrected where necessary. Importance of five food hygiene behaviors reiterated (used 3M PetriFilm, Glo Germs, bib, plastic bucket for handwashing, kettle for boiling water). Mothers reminded about “clean kitchen” competition |
| Second group event (3 hours, 15 minutes) | Increase mothers' confidence; link food hygiene behaviors with affiliation, nurture, and status; generate interest in becoming an “ideal mother” | Program ritual carried out. Obstacles faced by mothers shared and strategies for overcoming these discussed. “Child Life Game” played—the future that mothers want for their children discussed and linked to the five food hygiene behaviors (nurture motive). Puzzle game played to encourage kitchen cues (social respect motive). Folk song composed by mothers conveying key food hygiene messages—affiliation elicited. “Ideal mother” competition announced. Behavior reminder “fan” reflecting five behaviors and ideal mother sticker distributed |
| Third household visits (2 hours) | Establish reheating and boiling as social norms; ensure a conducive family environment exists to practiced behaviors | Mothers' food reheating practices observed and corrected where necessary (noting reheated temperature, motivated to use appropriate vessel to reheat food, and kettle to boil water). Family meeting held to promote food hygiene behaviors (using 3D flip chart). Mothers reminded about “clean kitchen,” and “ideal mother” competitions (visual cues). Unidentical visits performed (by field staff and coordination committee) |
| Third group event (3 hours) | Show that implementing the five food hygiene behaviors will avoid disgust and social exclusion and will increase social prestige and happiness | Program ritual carried out. Mothers participated in disgust exercises (Glo Germs used in food, plate, bowl, glass, spoon) and games (hot potato game using disgusting and safe pictures to demonstrate social inclusion and exclusion). “Safe food hygiene zone” competition announced. “Clean kitchen” competition winner announced and publically commended, thereby conferring = prestige. Participants and guests visited winner's house to encourage and share learning |
| Fourth household visits (2 hours) | Create peer pressure, build confidence, and reduce observer bias in observation of mothers' five behaviors | Peer-review (watch-dog) exercise carried out (element of secrecy entailed) by peer mother. Observer mother reported back practices. Mothers reminded about “ideal mother” and “safe food hygiene zone” competitions. Mothers' three-month work plans reviewed. Unidentical visits performed (by field staffs and coordination committee) |
| Fourth group event (2 hours, 30 minutes) | Reiterate that implementing the five food hygiene behaviors will increase social prestige and status; encourage men to participate | Program ritual carried out. Advice provided by mothers to a fictional mother (Dhukhimaya) experiencing social, environmental, and attitudinal barriers to adopting food hygiene behaviors. A drama (family member role play) showed how to become an ideal mother and tacking social, attitudinal, and physical barrier. “Ideal mother” competition winners announced and publically commended (ideal mother photo placed in the junction of the village), thereby conferring prestige. Men involved in the event and celebration |
| Fifth household visits (1 hour) | Reinforce food hygiene behaviors; mothers self-evaluate their food hygiene behaviors | Mothers' work plans reviewed. Mothers' food hygiene behaviors observed (ongoing progress). Mothers' performance self-evaluated publically. “Safe food hygiene zone” indicators reinforced |
| Second community event (4 hours) | Ensure food hygiene behavior change is sustainable postintervention by further entrenching them as social norms and prestige-conferring practices | Program ritual carried out. Response received from Dhukhimaya linking food hygiene behaviors to child health and social status. Encouraging social norms by reperforming folk song, etc. Mothers volunteer to continually monitor community's food hygiene behaviors. Mothers publically repledge their commitment to sustainable food hygiene behavior change (appreciation certificate distributed). Experiences of stakeholders heard. Remarks from social leaders, guests, representatives link food hygiene as to social respect. “Safe food hygiene zones” declared and bill boards erected at each entry point of the cluster. Group photo session performed. Community rally chanting “we want ideal mother, ideal mother hi-hi, diarrhea bye-bye) and using local music and program song. Intervention formally closed |
| Sixth household visits (1 hour) | Entrench food hygiene behaviors into mothers' daily routines and identify any remaining barriers to these practices; ensure sustainability | Sustainability work plans formulated by mothers. Ease of implementation of food hygiene behaviors analyzed by participants (pile shorting exercise using illustrations) and feedback provided. Sustained behavior change pledged by entire families. Household visits formally end |
For more details about program activities components, follow blog: http://www.shareresearch.org/om-prasad-gautam.