Effectiveness of Elements of Social Behavior Change Activities in Nutrition-Sensitive Agriculture Programs: A Systematic Review

Abstract

Background: Limited research exists on the specific approaches and behavior change techniques (BCT) used in nutrition-sensitive agriculture (NSA) programs and their effects on diet diversity. Objectives: We aimed to describe nutrition-related social behavior change (SBC) in the context of NSA and quantify the effectiveness of different SBC components of NSA programs in improving diet diversity. Methods: We searched PubMed, Embase, Web of Science, the International Food Policy and Research Institute repository, and Agricola for articles published between 2000 and 2023. We identified the agricultural activities each project used as a pathway to improved nutrition (ag-nutrition pathways), identified SBC approaches used by each project, and coded BCTs using validated coding protocols. Effectiveness ratios (ERs) were calculated to assess pathways, approaches, and BCTs in relation to dietary diversity outcomes (minimum diet diversity for children, child dietary diversity score, and women’s dietary diversity). Results: Of 65 included NSA interventions, the most used agriculture-to-nutrition pathways included 1) agricultural production for home consumption (n = 61); 2) women’s empowerment (n = 36); and 3) agricultural income (n = 37) pathways. The most used SBC approaches were interpersonal communication (IPC, n = 59) and community-based approaches (n = 53). Frequently used BCTs included “instructions on how to perform the behavior” (n = 65), “social support (unspecified)” (n = 43), and using a “credible source” (n = 43). The increased production for the home consumption pathway, IPC approach, and the BCT “behavioral practice” had high ERs for diet diversity outcomes. Conclusions: Although the agricultural production for home consumption pathway to improved nutrition had the highest ERs for diet diversity, other pathways, such as income generation and reducing wastage, hold promise and require additional investigation. The most commonly applied BCTs focused on information dissemination; however, participatory BCTs related to behavioral demonstration, and behavioral practice had higher ERs. Findings indicate a need to test less frequently utilized SBC components to determine effectiveness.This trial was registered at PROSPERO (=https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179016) as CRD42020179016.

Keywords

• nutrition
• agriculture
• social behavior change
• diet diversity
• project implementation