Improving dietary diversity and food security among low-income families during financial crisis using cash transfers and mHealth: experience from two selected districts in Sri Lanka

Abstract

Abstract Background The economic crisis in Sri Lanka worsened food insecurity, with millions facing moderate-to-severe food shortages. This study evaluates the effectiveness of cash transfers combined with mobile health education in enhancing dietary diversity and food security among Sri Lankan households during the crisis. Methods This quasi-experimental single-group pre-post study involved 1040 eligible individuals selected through stratified random sampling from eligible households of Samurdhi beneficiaries and smallholder farmers. The intervention included a cash transfer of LKR 22,500 and weekly nutrition awareness messages via WhatsApp and SMS complemented by a one-time awareness session. Dietary diversity and food security were assessed using standard validated tools such as the Diet Quality Questionnaire and Food Security Questionnaire. Results Food insecurity decreased significantly from 89.3% (n = 681) in the pre-test to 76.9% (n = 533) in the post-test, with a 12.4% reduction (95% CI, 8.57 to 16.24, p < 0.05). The Minimum Dietary Diversity for Women improved from 44.5 to 67.8% [23.3% increase (95% CI, 15.89 to 30.63; p < 0.05)]. The mean NCD-Protect and GDR scores increased significantly, indicating a higher adherence to global dietary recommendations, whereas the NCD-risk scores remained unchanged. Conclusions This study demonstrated that cash transfers combined with mobile phone-based nutritional education significantly improved dietary diversity and food security among low-income families in Sri Lanka during the financial crisis. Clinical trial number Not applicable.

Keywords

• Nutrition
• Dietary diversity
• Food security
• Global dietary recommendations
• Minimum dietary diversity for women
• Noncommunicable diseases