Caregivers' responses to an intervention to improve young child feeding behaviors in rural Bangladesh: A mixed method study of the facilitators and barriers to change

Behavior change communications regarding child feeding have met with mixed success. The present study analyzes responses of 34 Bangladeshi caregivers seven months after they received a responsive feeding intervention. The intervention communicated and demonstrated five feeding interactions: hand-washing, self-feeding, verbal responsivity, managing refusals non-forcefully, and dietary diversity. Seventeen caregivers who adopted key behaviors addressed by the intervention and 17 who did not were compared in terms of socio-demographic variables, but more importantly in terms of their recall of the messages, their reported practice, and reported facilitators and barriers. Both those who changed and those who did not reported similar facilitators and barriers to practicing the new behaviors; there was also no difference in recall or in socio-demographic variables. Key themes identified through a constant comparative analysis helped to focus on common features of the lives of caregivers that made it easy or difficult to perform the practices. Some of these were household constraints such as poverty, shortage of time in which to complete chores, and avoiding waste and messiness; others related to the child's demands. Many caregivers misinterpreted instructions about talking to one's child in response to signals, as opposed to more common forms of supervision. Facilitators such as the child's evident pleasure and the caregiver's satisfaction did not always outweigh the barriers. Recommendations for improving interventions include helping caregivers solve problems tied to barriers and including more family members in the intervention. ► Adopters and non-adopters who participated in a responsive feeding intervention for Bangladeshi mothers were equally likely to recall messages and identify barriers to practices. ► Poverty, work demands, gender roles, and gender based social constraints were significant barriers for responsive feeding. ► There are cultural beliefs that practicing responsive feeding might lead to sickness and death of the child. ► Interventions need to be expanded to include husbands and older women in both the family and community.