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How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention

1
School of Public Health, The University of Sydney, Sydney 2006, Australia
2
Health, Nutrition and Population Programme, Bangladesh Rural Advancement Committee (BRAC), Dhaka 1212, Bangladesh
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2020, 17(17), 6289; https://doi.org/10.3390/ijerph17176289
Received: 8 July 2020 / Revised: 20 August 2020 / Accepted: 26 August 2020 / Published: 28 August 2020
(This article belongs to the Section Global Health)
Social, cultural, environmental and economic factors closely regulate the selection, allocation and consumption of maternal diets. We developed a nutrition behaviour change intervention to promote a balanced diet in pregnancy through practical demonstration in rural Bangladesh and tested the impact with a cluster randomised controlled trial. This paper presents the findings of the process evaluation and describes the strategies that worked for intervention compliance. We conducted in-depth interviews with pregnant women, women who birthed recently, and their husbands; focus groups with mothers and mothers-in-law; key-informant interviews with community health workers, and observations of home visits. We identified six key areas within the intervention strategy that played a crucial role in achieving the desired adherence. These included practical demonstration of portion sizes; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women’s social networks; and harnessing community health workers’ social role. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in their kitchen or neighbours’ kitchen were the most commonly mentioned reasons for acceptance of the intervention by the women and their families. The balanced plate intervention helped women through practical demonstration to learn about a balanced meal by highlighting appropriate portion sizes and food diversity. The women needed active involvement of community health workers in mobilising social support to create an enabling environment essential to bring changes in dietary behaviours. Future implementation of the intervention should tailor the strategies to the local context to ensure optimal adherence to the intervention. View Full-Text
Keywords: maternal diet; dietary behaviour change intervention; nutrition education; balanced plate; process evaluation; qualitative methods; Bangladesh maternal diet; dietary behaviour change intervention; nutrition education; balanced plate; process evaluation; qualitative methods; Bangladesh
MDPI and ACS Style

Alam, A.; Chowdhury, M.; Dibley, M.J.; Raynes-Greenow, C. How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention. Int. J. Environ. Res. Public Health 2020, 17, 6289. https://doi.org/10.3390/ijerph17176289

AMA Style

Alam A, Chowdhury M, Dibley MJ, Raynes-Greenow C. How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention. International Journal of Environmental Research and Public Health. 2020; 17(17):6289. https://doi.org/10.3390/ijerph17176289

Chicago/Turabian Style

Alam, Ashraful, Morseda Chowdhury, Michael J. Dibley, and Camille Raynes-Greenow. 2020. "How Can We Improve the Consumption of a Nutritionally Balanced Maternal Diet in Rural Bangladesh? The Key Elements of the “Balanced Plate” Intervention" International Journal of Environmental Research and Public Health 17, no. 17: 6289. https://doi.org/10.3390/ijerph17176289

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