Online Program

Barriers and Facilitators to Recommended Nutrition Practices in Early Childhood in Mumbai, India: A qualitative study

Sunday, November 1, 2015

Priyanka Athavale, B.A., School of Public Health, University of California, Berkeley, Berkeley, CA
Kristin Hoeft, MPH, Departments of Epidemiology & Biostatistics and Preventive & Restorative Dental Sciences, University of California, San Francisco, San Francisco, CA
Karen Sokal Gutierrez, MD, MPH, Pub Hlth-JMP, UC Berkeley, Berkeley, CA
Ameya Bondre, MBBS, MPH, Sangath SPRING Project, Rewari
Background:  Childhood malnutrition has been a longstanding crisis in Mumbai, India where despite rigorous governmental initiatives and non-profit efforts, chronic malnutrition (stunting) and underweight rates for children under five are 47% and 36% respectively. To improve interventions, it is crucial to identify cultural, social, and environmental challenges and enablers, which influence the practices of caregivers.

Objective: This study is an in depth qualitative assessment of household barriers and facilitators to implementing recommended nutrition practices in three Mumbai slum sites, within the context of an existing education-based intervention by the Foundation for Mother and Child Health, India.

Methods: The population was purposively sampled to represent varying household demographics. The data were collected through 33 in depth qualitative interviews with mothers (27) or paternal grandmothers (6) of children aged 0-2 years, and 12 ethnographic observations: (6 participant observations in health clinics and 6 in-home observations of child feeding practices). Transcripts were translated and transcribed, and analyzed along with typed field notes using qualitative analysis procedures and software.

Results and Conclusion: A complex interaction of barriers and facilitators produces specific behaviors of mothers, which could better inform existing education-based interventions. Key barriers to implementing recommended nutrition practices included: mother-in-law (paternal grandmother) pressures, poor knowledge of recommended practices, increased availability of snack foods, and nonresponsive feeding. Specific facilitators enabling implementation of recommendations were: maternal desire for a healthy and intelligent child, family and organizational support, positive infant response in complementary feeding, and mother’s self-efficacy in caring for her child’s nutritional requirement and overall health.

Learning Areas:

Advocacy for health and health education
Assessment of individual and community needs for health education
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Social and behavioral sciences

Learning Objectives:
Identify key barriers and enablers in implementing recommended nutrition practices in the household. Explain the importance of secondary caregiver influence on primary caregiver practices. Describe complex behavior clusters of maternal practices emerging from specific interactions of barriers and enablers. Discuss predictability of maternal adherence to recommended practices based on different interacting barriers and facilitators.

Keyword(s): Child Health, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have multiple years of experience working in this community in India, and my research is IRB approved by the University of California, Berkeley and funded by the US Department of State through a Fulbright Research Scholarship. Among my scientific interests has been the multifactorial causes of malnutrition and behaviors and beliefs pertaining to implementation of practices.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.