Nutrition Education Intervention in Indonesia

This ppt talk about the application of SCT in Nutrition Education Intervention in developing country setting in Indonesia

1. The Effectiveness of Nutrition Education for Overweight/Obese Mother with Stunted Children (NEO-MOM) in Reducing Double Burden of Malnutrition 1 Randomized Controlled Trial: NEO-MOM

2. Objectives To test the effectiveness of NEO-MOM project to reduce maternal overweight/obesity & child stunting To examine the influence of modifiable factors in the SCT constructs (self-efficacy, outcome expectation and goal setting) on maternal dietary diversity and healthy feeding practices 2

3. Social Cognitive Theory From Albert Bandura (1960s) First called Social Learning Theory Says children and others learn through observation May imitate what they see vicariously (e.g., on television) Empirical evidence: Bobo doll studies, others—generally support basic premise plus additional assumptions, e.g., Rewarded and unpunished violence more likely to be imitated. Punished violence less likely to be imitated.

4. Bobo Doll Studies

5. Bobo Doll Studies—thoughts??

6. Methods A randomized controlled trial ( RCT ) with 2 arms Population: Overweight/obese mother (BMI >25) Stunted under 5 years old child (HAZ<-2) Inclusion criteria: Child received usual care from the government Registered in community health post (“ posyandu ”) Mother is literate Permanent residence of Surabaya City (urban setting) Exclusion criteria: Mother has physical disability Child diagnosed with serious medical problems 7

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8. Methods Statistical Analysis: Performed in IBM SPSS Statistics 22 (Armonk, NY). The statistical significance was set at an alpha level of 0.05. Normally distributed variable: A mixed factorial ANOVA. Non-normally distributed variable Two related-samples Mann Whitney U test with Bonferroni correction (analyzed the data separately for the NEO-MOM group and the PRINT group). Covariate Household food insecurity access scale (HFIAS) score. 9

9. Variables Independent variables: Behavioral based nutrition education (NEO-MOM) Print educational materials Breastfeeding status Socioeconomic status (SES) Maternal characteristics 10 Primary Outcomes: Child’s height* Child’s weight Child HAZ Maternal weight Maternal BMI Secondary Outcomes: Nutrition literacy Outcome expectation Self-efficacy *Sample size calculation based on the power from previous studies ( Imdad , Yakoob , & Bhutta , 2011; Roy et al., 2005)

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11. The NEO-MOM Group 6 sessions of assisted behavioral based nutrition education (3 months span). Each session consisted of 50 minutes nutrition education followed by 50 minutes hands-on activities Biweekly motivational interviewing by trained community health worker through home visit . 12

12. 13 Construct of Social Cognitive Theory Session Intervention components Provide information on health risk of maternal overweight/obesity and child stunting 1 50 minutes nutrition education class on: the double burden of malnutrition, consequences and management of overweight/obesity and child stunting. Outcome expectation 3 50 minutes nutrition education class on: Indonesian balance diet Indonesian version of MyPlate message to improve fruit and vegetable consumption for mother serve more animal protein for the child increase maternal daily steps. Environment (Food Access, peer support) 1-6 Biweekly nutrition education class could provide bonding and peer support. Access of food increased by distribution of grocery voucher.

13. Construct of SCT Session Intervention components Goal setting 1        6 30 minutes hands-on experience on making goal setting to: improve physical activity (as in daily steps), increase fruit and vegetable intake for mother and serving animal protein for their children  50 minutes FGD on how to overcome barriers followed by 30 minutes creation of pledge and strategies to tackle stunted child and overweight/obese mother (SCOWT) from mothers own perspective. Vicarious Experience 5 50 minutes nutrition education class on child feeding practice with emphasize of responsive feeding Verbal Motivation Home visit        6 The motivational interviewing focus on providing verbal motivation for mothers: to achieve their biweekly goal setting to help them with strategies to overcome barriers.  30 minutes role play and jingle/song making related to combating child stunting.

14. Nutrition Education

15. Nutrition Education

16. Mock Healthy Grocery Shopping

17. Physical activity

18. The Comparison Group (PRINT) Received printed educational materials coupled with a supplementary feeding program from Indonesian government Received usual care in the form of monthly growth monitoring of their child nutritional status at the Integrated health post ( posyandu ) 19

19. 1. REGISTRATION 2. CHILD WEIGHING 3. FILL THE GROWTH CHART 4. NUTRITION EDUCATION/COUNSELLING 5. CLINICAL SERVICE INTEGRATED HEALTH POST (POSYANDU) ( Mahmudiono , 2007)