Engaging men in maternal, infant and young child nutrition in rural Tanzania: Outcomes from a cluster randomized control trial and qualitative study

• Published in: Maternal and child nutrition Vol. 19; no. 2; pp. e13460 - n/a
• Main Authors: Rothstein, Jessica D., Klemm, Rolf D. W., Kang, Yunhee, Niyeha, Debora, Smith, Erin, Nordhagen, Stella
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-04-2023; John Wiley and Sons Inc; Wiley
• Subjects: Behavior change; Behavior modification; behaviour; Breastfeeding & lactation; Catchment areas; Cellular telephones; Child; Children; Children & youth; Childrens health; Clinical trials; Communication; Community support; Data collection; Empowerment; Enrollments; Evaluation; Families & family life; Female; Focus Groups; Gender; Gender Identity; Gender roles; Groups; health promotion; Households; Human nutrition; Humans; Individual differences; Infant; infant and child nutrition; Infants; International Child Health Nutrition; Interpersonal communication; Intervention; Knowledge; low‐income countries; Male; Males; Maternal and infant welfare; Men; Mothers; Nutrition; Original; Population number; Prioritizing; Public health; qualitative methods; Qualitative Research; Questionnaires; Rural communities; Tanzania; Text messaging; Women; Tanzania; International Child Health Nutrition; low-income countries; behaviour; health promotion; infant and child nutrition; qualitative methods
• ISSN: 1740-8695; 1740-8709
• DOI: 10.1111/mcn.13460

There is growing recognition that engaging men in maternal, infant and young child nutrition (MIYCN) interventions can benefit child health and disrupt harmful gender norms. We conducted a cluster‐randomized controlled trial in Tanzania, which engaged men and women in behaviour change via mobile messaging (short message service [SMS]) and traditional interpersonal communication (IPC), separately and in combination. Here, we evaluate intervention effects on individual‐level men's MIYCN knowledge and discuss barriers to male engagement. Eligible clusters were dispensary catchment areas with >3000 residents. Forty clusters were stratified by population size and randomly allocated to the four study arms, with 10 clusters per arm. Data on knowledge and intervention exposure were collected from 1394 men through baseline and endline surveys (March–April 2018 and July–September 2019). A process evaluation conducted partway through the 15–18‐month intervention period included focus group discussions and interviews. Data were analysed for key trends and themes using Stata and ATLAS.ti software. Male participants in the short message service + interpersonal communication (SMS + IPC) group reported higher exposure to IPC discussions than IPC‐only men (43.8% and 21.9%, respectively). Knowledge scores increased significantly across all three intervention groups, with the greatest impact in the SMS + IPC group. Qualitative findings indicated that the main barriers to male participation were a lack of interest in health/nutrition and perceptions that these topics were a woman's responsibility. Other challenges included meeting logistics, prioritizing income‐earning activities and insufficient efforts to engage men. The use of a combined approach fusing IPC with SMS is promising, yet countering gender norms and encouraging stronger male engagement may require additional strategies.
We conducted a cluster‐randomized controlled trial in rural Tanzania with four study arms, which received the following maternal, infant and young child nutrition (MIYCN) behaviour change interventions: a short message service text messaging intervention, traditional interpersonal communication, a combination of both interventions and a control arm; both men and women were recruited. Baseline and endline surveys demonstrated that male participants had moderate exposure to the interventions and that men's MIYCN knowledge increased significantly across all three arms, with the greatest impact in the combined intervention group. Qualitative data collected during a mid‐point process evaluation revealed that the main barriers to male participation were a lack of interest in health/nutrition, perceptions that such topics were a woman's responsibility and prioritization of income‐earning activities.
Key messages
Men's nutrition knowledge improved significantly more among those enrolled in a combined intervention strategy leveraging both traditional interpersonal communication (IPC) and a short message service text‐messaging intervention, as compared with those receiving either strategy alone.
Concurrent enrollment in a low‐intensity intervention leveraging technology may heighten men's motivation to engage in activities surrounding maternal and child nutrition.
The greatest barriers to male participation in IPC activities were perceptions that health and nutrition topics were a woman's responsibility and men's prioritization of income‐generating work over attending group discussions.
Gender‐transformative approaches that actively seek to shift social norms may enable greater male engagement in targeted nutrition interventions.