Undernutrition contributes to up to 45% child deaths in African countries. At the same time, childhood obesity rates have doubled between 2006 and 2016. Over 40% women of childbearing age are anemic. And 13.7% of infants have low birth weight. Stunting in the African region is 30.7% – above the global average of 22%.
In 2020, more than a fifth of the African population faced hunger; 346.4 million people experience severe food insecurity; and 452 million experienced moderate food insecurity.
Nutrition programs have supported families in Africa for decades. But many of these programs have inconclusive results.
As health psychologists and behavioral scientists, we think it’s because the programs don’t focus on adjusting to family life. It would also make nutrition interventions sustainable. Understanding the behaviors of people targeted by nutrition programs could improve their nutritional status.
OUR recent search reviewed the results of studies that had incorporated behavior change into programs aimed at improving maternal and child nutrition in sub-Saharan Africa. Our results show that nutrition programs that focus on family and community behavior change have better health outcomes for mothers and children.
The World Health Organization has stressed the importance of Changing behaviour to support maternal and child health and help overcome barriers in current nutrition programs. Our study goes further to show how to use behavior change models to design better nutrition programs.
Health psychologists and behavioral scientists developed the COM-B model. This suggests that a person’s Ability, Opportunity and Motivation can change their Behavior. Our study showed that this model can be used to consider what happens in people’s lives at conception. nutritional interventions including barriers there may be to eating healthy foods.
“Capability” in the COM-B model refers to a person’s physical capability, such as skill, and psychological capability, such as knowledge of a behavior. If a person doesn’t know what foods to eat to be healthy or doesn’t think they have the skills to cook healthy foods, they can’t change their behavior. Programs should help people learn about healthy local foods and how to cook these foods, possibly through community-led cooking demonstrations. Our results show that educating people is not enough. Making the lessons interactive and practical in people’s daily lives increases the likelihood of behavior change.
“Opportunity” in the COM-B model refers to a person’s physical opportunities in their environment and their social opportunities such as their family and wider community. For example, if communities do not have apples and bananas growing in their environment or for sale, they simply will not have access to these foods. Programs should therefore support foods that are already available for purchase in people’s environment. If possible, they should also help the wider community grow food. The people around us influence what we do and what we eat. Programs should try to encourage key figures in the community and family to support nutrition practices.
“Motivation” in the COM-B model refers to a person’s habits and the things they do without realizing it (automatic motivation). One of the habits or norms in many communities is to give priority to men, then children, to eat first. Women often receive leftovers, even when pregnant. This means pregnant women are not getting the nutrients they need. Programs should work with women, men and wider communities to motivate them to prioritize women’s nutrition, while respecting culture and tradition. This would encourage reflective motivation where people can consciously make decisions about food within social structures.
Build nutrition programs
When designing nutrition programs, the best way to find out what motivates people is to ask them directly about the problems they face and the solutions they want. Once you know their problems and potential solutions, you can use behavioral science models such as the COM-B model to classify problems and solutions, and begin designing programs to fill those gaps.
Going further, the same behavioral scientists also developed the behavior change wheel, which helps us think about different methods.
Our study shows that applying the behavior change wheel to nutrition programs can also increase their impact. The wheel offers:
give incentives to participants
use persuasive communication
modeling healthy diets
educate about nutrition, interactively
provide resources such as tools and seedlings (enablement)
train communities in cooking or agricultural methods.
Using simple behavioral science models can help programs understand people’s lives and design nutrition interventions that directly benefit them, even when funding ends.