title: And young child feeding practices in different country settings.
abstract: BACKGROUND
  Alive & Thrive aims to increase exclusive breastfeeding and complementary feeding practices in Bangladesh, Ethiopia, and Vietnam.
  
  
  OBJECTIVE
  To develop and execute comprehensive communication strategies adapted to each context.
  
  
  METHODS
  We documented how three countries followed an established iterative planning process, with research steps followed by key decisions, to develop a communication strategy in each country. Secondary analysis and formative research identified the priority practices to focus on, and locally specific constraints to proper infant and young child feeding (IYCF). Communication strategies were then developed based on the social, cultural, economic, epidemiological, media use, and programmatic contexts of each country.
  
  
  RESULTS
  There were widespread gaps between recommended and actual feeding practices, and these varied by country. Gaps were identified in household, community, and institutional levels of awareness and skills. Strategies were designed that would enable mothers in each specific setting to adopt practices. To improve priority behaviors, messaging and media strategies addressed the most salient behavioral determinants through face-to-face communication, social mobilization, and mass media. Trials of improved practices (TIPs), concept testing, and pretesting of materials proved useful to verify the relevance and likely effectiveness of communication messages and materials tailored for different audiences in each setting. Coordination and collaboration with multiple stakeholders from the start was important to harmonize messages and approaches, expand geographic coverage to national scale, and sustain the interventions.
  
  
  CONCLUSIONS
  Our experience with designing large-scale communication strategies for behavior change confirms that systematic analysis and local planning cannot be omitted from the critical process of strategic design tailored to each context. Multiple communication channels matched to media habits in each setting can reach a substantial proportion of mothers and others who influence their IYCF practices. Preliminary data suggest that exposure to mass media plays a critical role in rapidly reaching mothers, household members, community influentials, and health workers on a large scale. Combining face-to-face interventions for mothers with social mobilization and mass media was effective in improving IYCF practices.
authors.affiliation: FHI 360, Dhaka, Bangladesh. tsanghvi@fhi360.org
authors.forename: Tina
authors.initials: T
authors.lastname: Sanghvi
authors.forename: Ann
authors.initials: A
authors.lastname: Jimerson
authors.forename: Nemat
authors.initials: N
authors.lastname: Hajeebhoy
authors.forename: Medhanit
authors.initials: M
authors.lastname: Zewale
authors.forename: Giang Huong
authors.initials: GH
authors.lastname: Nguyen
mesh_terms: D001459:Bangladesh; D001942:Breast Feeding; D002662:Child Health Services / Q000379:methods* / Q000592:standards; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003142:Communication; D003906:Developing Countries; D005002:Ethiopia; D006266:Health Education / Q000379:methods* / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009035:Mothers; D009752:Nutritional Status; D014744:Vietnam