Participatory evidence generation for nutrition programming

Malnutrition among children under the age of five (U5) remains a critical public health challenge in India, with the National Family Health Survey (NFHS) 2019- 2021 data revealing high prevalence rates of 35.5% stunting, 19.3% wasting, and 32.1% underweight children U5. Complementary feeding alongside continued breastfeeding for children aged 6 to 23 months, is a crucial recommended practice to address this. However, existing social and behaviour change (SBC) interventions to promote the recommended nutrition behaviours and practices are often not based on behaviour science evidence. To address this gap, UNICEF India, along with state Behavioural Insights Units (BIUs) within four state governments in India, conducted participatory, community led, behaviour science research to understand and improve complementary feeding among children and maternal nutrition in India. The research used a Behavioural Insights and Human-Centred Design (BI-HCD) approach for problem diagnosis and participatory co-design of SBC solutions, engaging caregivers, adolescents, frontline workers, and policymakers as stakeholders. Problems were diagnosed in different contexts, revealing behavioural barriers to recommended nutrition behaviours and practices. To address these behavioural barriers, UNICEF co- created culturally resonant SBC solutions with the beneficiaries, ensuring participatory evidence generation and community co-owned solutions. The interventions were evaluated and proven to improve nutrition practices and behaviours among adolescents and women in the states and recommended for scale up with the respective government programmes. This abstract on the initiative aligns with the Summit's call to rethink what is knowledge and emphasises participatory research and creation of SBC solutions for beneficiaries. 

El bajo consumo de frutas y verduras entre adolescentes constituye un reto crítico de salud pública asociado a patrones alimentarios desfavorables, entornos escolares poco facilitadores y barreras sociales y culturales. La Comunicación para el Cambio Social y de Comportamiento (SBC) ofrece estrategias efectivas para abordar estos determinantes mediante narrativas persuasivas, participación comunitaria y reforzamiento social. Este proyecto presenta el diseño y la evaluación preliminar de una intervención educativa Edutainment‐basada, co-creada con estudiantes de preparatoria en Tepatitlán de Morelos, Jalisco, que integra inteligencia artificial, aprendizaje experiencial y modelamiento conductual para promover el consumo de frutas y verduras durante el recreo escolar.
La intervención se implementará mediante un taller participativo de 12 semanas bajo un enfoque PAR/CBPR, en el que los estudiantes producirán 10 videos narrativos (enter-educate) construidos a partir de evidencia nutricional, determinantes psicosociales y análisis del entorno alimentario. El estudio seguirá un diseño mixto con un componente poblacional (n≈285) y un componente intensivo tipo ABA (n=7) con mediciones pre-durante-post. Se emplearán instrumentos validados (ECFVA-19, CFC-FV, PME-3, TS-SF), observación estructurada del entorno y registros conductuales.
Se esperan aumentos significativos o tendencias positivas en el consumo de frutas y verduras durante el recreo, mayor familiaridad y preferencia alimentaria, y una elevada percepción de efectividad de los mensajes narrativos. Los hallazgos anticipados aportan un modelo replicable de SBC escolar basado en participación juvenil, producción audiovisual con IA y principios conductuales culturalmente contextualizados.

Malnutrition is a major health challenge in Nigeria, caused by low consumption of nutrient-rich foods and insufficient dietary diversity.Studies reveal that micronutrient malnutrition is high, with Vitamin A deficiency affecting close to 30% of children under five and 20% of women of reproductive age (GAIN, 2024; Fadare et al., 2019; Aghaji et al., 2019).

The BETA Campaign utilizing a Social and Behaviour Change Communication (SBCC) strategy used an edutainment approach to encourage nutrition learning in communities, using interactive games and participatory cooking demonstrations to introduce biofortified staple crops, like Vitamin A cassava, Vitamin A maize, and Orange Fleshed Sweet Potato (OFSP) supporting reduction in micronutrient malnutrition and encourage nutritious diets in Nigerian communities.

Edutainment approaches were implemented across LGAs in Benue, Kaduna, Nasarawa, and Oyo States. These community engagements, seasoned with interactive games, quizzes, and participatory cooking demonstrations, enabled trained volunteers to reach the target audience of farmers, farm workers, farmers' households, processor employees, retailers, wholesalers, processors, and aggregators.

Exit interviews showed a notable increase in the demand for nutrient-enriched staples. 99.8% of participants were positive about consuming vitamin A-rich foods; many participants felt more confident trying new nutritious recipes they learned. The use of these participatory tools made community engagements captivating and engaging, especially for women and youth. Overall, this approach encouraged participants to be mindful about the nutrient content of meals they prepare, remember key messages, and feel motivated to adopt healthy diet habits.

Exclusive breastfeeding (EBF) for the first six months remains one of the highest impact nutrition and child survival practices. Many women around the world face challenges exclusively breastfeeding their infants, resulting in infants receiving suboptimal feeding. Improving exclusive breastfeeding (EBF) requires an understanding of how and why families choose their current infant feeding strategies so that programs can be tailored to leverage EBF's enablers and overcome barriers.   Using qualitative methods, we explored what influenced breastfeeding practices of mothers of infants in Kasai Centrale province in the Democratic Republic of Congo (DRC). As women's workload had previously been identified as a key determinant in DRC, we specifically explored breastfeeding practices of mothers engaged in income generating activities outside the home, and the role of babysitters in infant feeding decisions and practices. Findings highlighted that women are largely aware of breastfeeding's benefits but lack self-efficacy and support needed to carry out EBF among their many responsibilities.  The findings also revealed the influence of babysitters. There is a need to shift breastfeeding promotion activities in the project area away from promoting the benefits with mothers, and towards offering and facilitating practical solutions for mothers with many responsibilities and their babysitters. Only by addressing women's place in the social context in these communities will higher rates of EBF be within reach. Overall, the study showed that even small samples can yield rich inputs on local behavioral determinants, enabling behavior change strategies to reach the right audiences with locally relevant solutions.