Adherence to micronutrient powder for home fortification of foods among infants and toddlers in rural China: a structural equation modeling approach

BMC Public Health

Research

Chang Sun¹  Ping Yuan¹  Huan Zhou²  Ruixue Ye²  Sarah-Eve Dill³  Muizz Akhtar³  Scott Rozelle³ 

[1] Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 610041, Chengdu, Sichuan, China;Department of Health Behavior and Social Medicine, West China School of Public Health, West China Fourth Hospital, Sichuan University, 610041, Chengdu, Sichuan, China;Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA, USA;

关键词: China;    Micronutrient Powder;    Ying Yang Bao;    Infants and toddlers;    Integrated behavioral model;    Structural equation modeling;    Adherence;   

DOI  :  10.1186/s12889-022-14731-3

 received in 2021-11-21, accepted in 2022-11-25,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework.MethodsCross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework.ResultsMean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (β = 0.440, P < 0.001), intention (β = 0.374, P < 0.001), knowledge and skills (β = 0.214, P < 0.001), personal agency (st. effect = 0.172, P < 0.001), environmental constraints (β=-0.142, P < 0.001), and caregiver generation (β = 0.119, P < 0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen’s f2 = 0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P < 0.001), and behavioral inputs were consistent among both parent and grandparent caregivers.ConclusionThere is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence.

【 授权许可】

CC BY   
© The Author(s) 2022

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