Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
Soc Sci Med. 2012 Nov;75(9):1673-84. doi: 10.1016/j.socscimed.2012.06.025. Epub 2012 Jul 25.
Most nutrition initiatives to date aimed at improving infant and young child feeding (IYCF) have emphasized addressing knowledge gaps through behavior change messaging with less focus on addressing the underlying environmental barriers that may shape these behaviors. This research integrates an analysis of longitudinal dietary data with qualitative data on barriers to improved child feeding to identify the nature and extent of the barriers caregivers face to improving IYCF practices in a farming region of the Bolivian Andes, and to determine the relative influence of these barriers on caregivers' abilities to improve IYCF practices. Sixty-nine caregivers were selected from a sample of 331 households that participated in a longitudinal survey assessing changes in IYCF practices among caregivers with children aged 0-36 months from March 2009 to March 2010. Forty-nine barriers within 12 categories of barriers were identified through semi-structured interviews with the 69 caregivers. The most frequently reported barriers were those related to women's time dedicated to agricultural labor, the limited diversity of household agricultural production, and lack of support for child feeding from spouses and mothers-in-law. In multivariate analyses controlling for several variables that could potentially influence IYCF practices, these barriers were negatively associated with changes to the diversity of child diets, child dietary energy intake, and child meal frequency. While knowledge gaps and individual-level influences affected IYCF practices, physical and social caregiving environments in this region of Bolivia were even more important. Behavior change communication alone will likely not address the social and environmental barriers to improved child feeding that often prevent translation of improved knowledge into action. Particularly in rural regions, agriculture may strongly influence child feeding, not only indirectly through household food security, but also directly by affecting women's caregiving capacity.
迄今为止，大多数旨在改善婴幼儿喂养（IYCF）的营养计划都强调通过行为改变信息传递来解决知识差距，而较少关注可能影响这些行为的基本环境障碍。本研究将纵向饮食数据与改善儿童喂养障碍的定性数据相结合，以确定在玻利维亚安第斯地区的一个农业地区，照顾者在改善 IYCF 实践方面面临的障碍的性质和程度，并确定这些障碍对照顾者改善 IYCF 实践的能力的相对影响。从 2009 年 3 月至 2010 年 3 月期间参与一项纵向调查的 331 户家庭样本中，选择了 69 名照顾者，该调查评估了照顾者在 0-36 个月儿童的 IYCF 实践方面的变化。通过对 69 名照顾者进行半结构式访谈，确定了 12 类障碍中的 49 个障碍。报告最多的障碍与妇女从事农业劳动的时间、家庭农业生产的多样性有限以及配偶和婆婆对儿童喂养缺乏支持有关。在控制可能影响 IYCF 实践的几个变量的多变量分析中，这些障碍与儿童饮食多样性、儿童膳食能量摄入和儿童进餐频率的变化呈负相关。虽然知识差距和个人层面的影响会影响 IYCF 实践，但玻利维亚该地区的身体和社会照顾环境更为重要。仅行为改变交流不太可能解决改善儿童喂养的社会和环境障碍，这些障碍往往会阻止将改善的知识转化为行动。特别是在农村地区，农业可能会强烈影响儿童喂养，不仅通过家庭粮食安全间接影响，而且直接通过影响妇女的照顾能力。
