Table 1 Overview of key changes in adapting the Nepali food hygiene promotion model to the FAARM context in Bangladesh
| Â | Nepal | Bangladesh | Key changes and rationale |
|---|---|---|---|
Objective | Developing an innovative food hygiene intervention using a behavior-centered design approach in Nepal | Adapting and integrating the Nepali innovative food hygiene package within a large-scale nutrition-sensitive intervention in Bangladesh | FAARM combined food hygiene with ongoing agricultural and nutrition support to address the critical pathway from food contamination via infection to undernutrition |
Contents and focus | |||
Targeted food hygiene behaviors | 5 food hygiene behaviors | 6 optimal feeding and food hygiene behaviors | Two optimal feeding/eating related behaviors for children and mothers were added to reinforce ongoing nutrition messages of FAARM. The microbial contamination of tube well water (which is the primary drinking water source in rural Bangladesh) is relatively low at source; and the risk of contamination increases during household water storage and handling [29, 30]. Boiling would also be a huge effort. Therefore, the message on boiling water and milk was taken out and emphasis was put on safe storage of drinking water at the household level. |
|  | • Handwashing with soap • Cleanliness of serving utensils • Safe storage of cooked food • Thorough reheating • Boiling of milk and water | • Exclusive breastfeeding • Dietary diversity for women and children • Handwashing with soap • Cleanliness of serving utensils • Safe storage of cooked food and drinking water • Cooking fresh or thorough reheating | |
Motivational drivers | Nurture | i ‘Nurture’ or boosting caregivers’ desire for their children’s optimal health and wellbeing ii ‘Disgust’, i.e., triggering strong negative feelings toward activities or habits that are associated with the risk of infections and diseases by highlighting the links between poor hygiene practices and transmission of germs iii ‘Affiliation and pride’, i.e., creating a feeling of social togetherness and achievement derived from making healthier choices and being an inspiring figure for others | FAARM developed a promotional strategy that was built around a similar set of emotional drivers; however, the triggers of these drivers were adapted culturally. |
Disgust | |||
Affiliation | |||
Social respect/status | |||
Central theme | Ideal mother - safe food, healthy child. This theme portrayed a central ‘ideal mother’ character, who practiced safe hygiene to be respected in the community | Safe and nutritious food: ideal family. This theme communicated the idea that giving a child a nutritious and diverse diet and handling foods safely will help the family to enjoy a healthy and happy life and earn a sense of pride in the community | The focus was shifted from mother to family, recognizing the fact that family members play a powerful role in influencing each other’s behaviors and that a mother’s ability to adopt a healthy behavior strongly depends on family support in our context. |
Scale and intensity | |||
Setting | 4 intervention settlements with 30 households per settlement | 48 intervention settlements of the FAARM trial with 10 to 65 eligible women per settlement | In FAARM, the intervention was delivered at a more than 10 times larger scale. To maintain feasibility and balance considering other FAARM activities, it was designed to be implemented over a longer time frame at a lower intensity. While the Nepali intervention was only targeted to women with young children, FAARM targeted all women in the intervention arm of the trial. |
Study participants | Primary target group: Mothers with a child aged 6–59 months Secondary target groups: Grandmothers, community people and school students Total targeted: 120 women and their household members | Primary target group: Married women less than 30 years old at enrollment Secondary target groups: Husbands, mothers-in-law, other family members Total targeted: 1275 women and their household members | |
Duration | 3 months | 8 months | |
Frequency of contract | Every 15 days; a joint community/group event was followed by a door-to-door household visit | Once every month; a group event was usually followed by a household visit | |
Dissemination channels | 12 structured sessions conducted by 15 food hygiene motivators • 2 community events • 4 group events • 6 household visits Other touch point: Half-day school sessions with students and teachers in four government schools Ideal mother’s photos put-up in the junction of the village for social respect and pride | 8 structured sessions conducted by 8 food hygiene promoters (FHPs) • 4 group events • 4 household visits | Community touch points were removed from the implementation design to reduce spillover to FAARM control settlements. |