Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, United Kingdom.
Department of Environmental Health and WASHTED Centre, Polytechnic, University of Malawi, Blantyre, Malawi.
Am J Trop Med Hyg. 2020 May;102(5):1104-1115. doi: 10.4269/ajtmh.19-0528.
The study evaluated the effectiveness of an intervention to improve complementary food hygiene behaviors among child caregivers in rural Malawi. Formative research and intervention development was grounded in the risk, attitude, norms, ability, and self-regulation (RANAS) model and targeted washing hands and kitchen utensils with soap, safe utensil storage, reheating of leftover food, and feeding of children by caregivers. Longitudinal research was applied at baseline and follow-up surveys among 320 caregivers. Determinants of selected behaviors were found, and interventions were developed based on the behavior change techniques aligned with these determinants in the RANAS model. The intervention was delivered over 9 months through group (cluster) meetings and household visits and included demonstrations, games, rewards, and songs. We randomly assigned villages to the control or intervention group. Follow-up results indicated a significant increase in three targeted behaviors (washing kitchen utensils with soap, safe utensil storage, and handwashing with soap) among intervention recipients. Several psychosocial factors differed significantly between the intervention and control groups. Mediation results showed that the intervention had a significant effect on these three targeted behaviors. For handwashing, feelings, others' behavior in the household, and remembering; for washing kitchen utensils, others' behavior in the household and difficulty to get enough soap; for safe utensils storage, others' behavior in the village and remembering mediated the effect of the intervention on the targeted behaviors. The study demonstrated that targeting food hygiene behaviors with a theory-driven behavior change approach using psychosocial factors can improve the behavior of child caregivers in rural Malawi.
本研究评估了一项干预措施在改善马拉维农村地区儿童照顾者补充食品卫生行为方面的效果。形成性研究和干预措施的制定以风险、态度、规范、能力和自我调节（RANAS）模型为基础，针对用肥皂洗手和清洗厨具、安全储存厨具、重新加热剩余食物以及由照顾者喂养儿童等行为。在基线和随访调查中，对 320 名照顾者进行了纵向研究。确定了选定行为的决定因素，并根据 RANAS 模型中与这些决定因素一致的行为改变技术制定了干预措施。该干预措施通过小组（集群）会议和家访在 9 个月内进行，包括演示、游戏、奖励和歌曲。我们随机将村庄分配到对照组或干预组。随访结果表明，干预组在三种目标行为（用肥皂清洗厨具、安全储存厨具和用肥皂洗手）方面有显著增加。干预组和对照组之间的几个社会心理因素存在显著差异。中介结果表明，干预对这三种目标行为有显著影响。对手部卫生，家庭中他人的行为和家庭中的记忆；对于清洗厨具，家庭中他人的行为和难以获得足够的肥皂；对于安全储存厨具，村庄中他人的行为和记忆中介了干预对目标行为的影响。该研究表明，通过针对社会心理因素的理论驱动行为改变方法来针对食品卫生行为，可以改善马拉维农村地区儿童照顾者的行为。
