Examining how factors from the Capability, Opportunity, Motivation, and Behavior (COM-B) model influence the number of households visited by frontline workers to deliver and counsel on micronutrient powders to children in Bihar, India Open Access
Fadika, Tigidankay (Summer 2020)
Abstract
Abstract
Examining how factors from the Capability, Opportunity, Motivation, and Behavior (COM-B) model influence the number of households visited by frontline workers to deliver and counsel on micronutrient powders to children in Bihar, India
By Tigidankay Kasanti Fadika
Objective: Bihar, India has some of the highest child malnutrition rates in the world in part due to poor infant and young child (IYCF) feeding practices. Home fortification with multiple micronutrient powders (MNP) is a strategy to increase the nutrient content of a child’s food and improve nutritional outcomes. However, there is a lack of knowledge on the effectiveness of MNP programs and what factors influence FLWs to deliver these interventions effectively, especially in resource limited settings like Bihar. This study aims to examine what factors influence FLWs to deliver MNP services to children 6 to18 months in Bihar using the capability, opportunity, motivation, and behavior model as a performance guide.
Methods: An endline frontline worker survey was administered to 280 FLWs in the intervention arm (MNP delivery and IYCF counseling) and 280 FLWs in the non-intervention arm (IYCF counseling only). Data analysis focused on data from the intervention arm. Descriptive analyses (mean, SD, and %) were conducted using Statistical Analysis Software (SAS) 9.4. Poisson bivariate and multivariate adjusted regression was used to model the association between FLW capability, FLW opportunity, and FLW motivation and the delivery of MNP services as measured by the number of households visited in the past month to distribute and counsel on MNPs.
Results: Variables representing FLW capability, FLW opportunity, and FLW motivation were significantly associated with the number of households visited in the past month to distribute and counsel on MNPs. For FLW capability, proper MNP knowledge, receiving training on maternal and/or child health topics, and understanding the training on child feeding were all associated with an increase in the number of households visited (4%, 17%, and 26%, respectively). For FLW opportunity, receiving MNPs on a frequent basis and having a current supply of MNPs were associated with an increased number of households visited (38%, 16%) whereas slow replenishment of MNPs resulted in fewer households visited (-30%). Finally, for FLW motivation, the desire to help people or work with children, and reporting having an improved status in the community due to working in the MNP program were also associated an increase number of households visited (39% and 30%).
Conclusion: All three-behavior change inputs from the COM-B model factor into FLW performance. FLWs with higher reported capability, motivation, and opportunity had enhanced delivery of MNP services in intervention communities.
Table of Contents
Table of Contents
Chapter 1: Introduction ................................................................................................... 9
Child Malnutrition............................................................................................................................9
Child Malnutrition in India and Bihar ............................................................................................ 11
Nutrition Interventions: Home Fortification with Micronutrient Powders ....................................12
The Role of Frontline Workers and their Significance in Delivering Nutrition Interventions ......14
Rationale and Public Health Significance ...................................................................................... 16
Study Purpose.................................................................................................................................18
Chapter 2: Literature Review ........................................................................................ 19
Introduction ....................................................................................................................................19
Malnutrition and its Impact Globally .............................................................................................19
Overview of Child Malnutrition.....................................................................................................20
Child Malnutrition in India.............................................................................................................21
Child Malnutrition in Bihar, India..................................................................................................22
Interventions for Child Malnutrition .............................................................................................. 24
Fortification with Micronutrient Powders (MNPs) – A Child Nutrition Intervention ................... 28
Role/ Significance of Frontline Health Workers in Delivering Nutrition Interventions................33
Frontline Workers (FLWs) in India & Study Context....................................................................36
Significance of Study .....................................................................................................................38
Chapter 3: Methods ........................................................................................................ 41
Study Purpose and Setting..............................................................................................................41
Study Population, Sampling, Training, and Intervention Procedures ............................................42
Study Ethics - Approval, Confidentiality, and Consent .................................................................43
Research Instrument and Data Collection ...................................................................................... 44
Data Analysis..................................................................................................................................45
Limitations & Delimitations...........................................................................................................50
Alternative Approaches for Data Analysis.....................................................................................51
Chapter 4: Results........................................................................................................... 52
Characteristics of FLWs in MNP intervention Health Sub-centers in Bihar, India .......................52
Characteristics of FLW Capability.................................................................................................55
Characteristics of FLW Opportunity ..............................................................................................57
Characteristics of FLW Motivation................................................................................................60
Outcome of Interest ........................................................................................................................ 61
Bivariate Associations between FLW Capability, FLW Opportunity, FLW Motivation and the delivery of MNP Services ..............................................................................................................63
Final Multivariate Associations between FLW Capability, FLW Opportunity, FLW Motivation and the delivery of MNP Services..................................................................................................72
Alternative Approaches: Analysis of Variance (ANOVA) and Correlation Analysis...................76
Chapter 5: Discussion & Conclusion............................................................................. 79
Summary of key findings ...............................................................................................................79
Strengths and Limitations...............................................................................................................89
Future Recommendations...............................................................................................................90
Conclusion ...................................................................................................................................... 92
Appendix A: Tables ........................................................................................................ 94
Analysis of Variance Tables (ANOVA) Reference Tables............................................................94
Correlation Analysis Reference Tables..........................................................................................97
References ........................................................................................................................ 98
About this Master's Thesis
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Primary PDF
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Examining how factors from the Capability, Opportunity, Motivation, and Behavior (COM-B) model influence the number of households visited by frontline workers to deliver and counsel on micronutrient powders to children in Bihar, India () | 2020-08-01 00:01:53 -0400 |
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Supplemental Files
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Frontline Worker Endline Survey (Frontline worker endline survey used to collect data on frontline workers in the study) | 2020-08-01 00:01:57 -0400 |
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Correlation Analysis Scatterplots (Reference scatterplot graphs for correlation analysis) | 2020-08-01 00:02:02 -0400 |
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