Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany; Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany; Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany.
Int J Hyg Environ Health. 2024 Jan;255:114291. doi: 10.1016/j.ijheh.2023.114291. Epub 2023 Nov 18.
Behavioural interventions could improve caregivers' food hygiene practices in low-resource settings. So far, evidence is limited to small-scale and short-term studies, and few have evaluated the long-term maintenance of promoted behaviours. We evaluated the effect of a relatively large-scale behaviour change intervention on medium and long-term maintenance of household food hygiene practices in Bangladesh.
We analyse a secondary outcome of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomised trial and its sub-study Food Hygiene to reduce Environmental Enteric Dysfunction (FHEED), conducted in Habiganj district, Sylhet division, Bangladesh. The FAARM trial used a 1:1 parallel arm design and included 2705 women in 96 settlements: 48 intervention and 48 control. Women in the intervention settlements received training in homestead gardening, poultry rearing and nutrition over three years (2015-2018), complemented by an eight-month (mid-2017 to early-2018) behaviour change component on food hygiene using motivational drivers. Nested within the FAARM trial, the FHEED sub-study evaluated several outcomes along the hygiene pathway. For this article, we evaluated household food hygiene behaviours by analysing structured observation data collected in two cross-sectional surveys, four and 16 months after the food hygiene promotion ended, from two independent subsamples of FAARM women with children aged 6-18 months. We assessed intervention effects on food hygiene practices using mixed-effects logistic regression, accounting for clustering. In exploratory analyses, we further assessed behaviour patterns - how often critical food hygiene behaviours were performed individually, in combination and consistently across events.
Based on the analysis of 524 complementary feeding and 800 food preparation events in households from 571 participant women, we found that intervention households practised better food hygiene than controls four months post-intervention, with somewhat smaller differences after 16 months. Overall, the intervention positively affected food hygiene, particularly around child feeding: using soap for handwashing (odds ratio 5·8, 95% CI 2·2-15·2), cleaning feeding utensils (3·8, 1·9-7·7), and cooking fresh/reheating food (1·8, 1·1-2·8). However, the simultaneous practice of several behaviours was rare, occurring in only 10% of feeding events (intervention: 15%; control: 4%), and the practice of safe food hygiene behaviours was inconsistent between events.
Our findings suggest that a motivational behaviour change intervention encouraged caregivers to maintain certain safe food hygiene practices in a rural setting. However, substantial physical changes in the household environment are likely needed to make these behaviours habitual.
NCT02505711.
行为干预可以改善资源匮乏环境下照顾者的食品卫生习惯。但迄今为止，证据仅限于小规模和短期研究，很少有研究评估所推广行为的长期维持情况。我们评估了一项相对大规模的行为改变干预措施对孟加拉国家庭食品卫生习惯的中长期维持效果。
我们分析了食品和农业方法减少营养不良（FAARM）集群随机试验及其子研究食品卫生以减少环境肠道功能障碍（FHEED）的次要结果，该试验在孟加拉国锡尔赫特分部的哈比甘杰区进行。FAARM 试验采用 1:1 平行臂设计，包括 96 个定居点的 2705 名妇女：48 个干预组和 48 个对照组。干预定居点的妇女在三年内接受了家庭园艺、家禽饲养和营养方面的培训（2015-2018 年），并在 2017 年年中至 2018 年初的八个月内通过使用动机驱动因素进行食品卫生方面的行为改变组成部分进行补充。作为 FAARM 试验的一部分，FHEED 子研究沿着卫生途径评估了几个结果。本文通过分析来自 FAARM 妇女的两个独立子样本的两次横断面调查（干预结束后四个月和 16 个月）中收集的结构化观察数据，评估了家庭食品卫生行为，这些妇女的孩子年龄在 6-18 个月之间。我们使用混合效应逻辑回归分析，考虑到聚类，评估了干预对食品卫生实践的影响。在探索性分析中，我们进一步评估了行为模式 - 个别、组合和一致地执行关键食品卫生行为的频率。
基于对来自 571 名参与者妇女的 524 个补充喂养和 800 个食品制备事件的分析，我们发现干预组在干预后四个月的食品卫生实践优于对照组，16 个月后差异较小。总体而言，干预对食品卫生产生了积极影响，特别是在儿童喂养方面：用肥皂洗手（优势比 5.8，95%CI 2.2-15.2）、清洁喂养用具（3.8，1.9-7.7）和烹饪新鲜/加热食物（1.8，1.1-2.8）。然而，同时进行多种行为的情况很少见，仅在 10%的喂养事件中发生（干预组：15%；对照组：4%），并且安全食品卫生行为在事件之间并不一致。
我们的研究结果表明，激励行为改变的干预措施鼓励照顾者在农村地区保持某些安全的食品卫生习惯。但是，可能需要对家庭环境进行实质性的物理改变，以使这些行为成为习惯。
NCT02505711。
