title: Identifying the Sociocultural Barriers and Facilitating Factors to Nutrition-related Behavior Change: Formative Research for a Stunting Prevention Program in Ntchisi, Malawi.
abstract: BACKGROUND
  As the Scaling Up Nutrition (SUN) movement gains momentum globally, more attention and resources are being given to integrated nutrition interventions. In 2013, the Government of Malawi, with support from the World Food Programme and partners, initiated such an intervention in Ntchisi District. Aimed to reduce the prevalence of stunting, the intervention has several components, including the provision of a small-quantity, lipid-based nutrient supplement (SQ-LNS) for children aged 6 to 23 months.
  
  
  OBJECTIVE
  This paper describes formative research findings derived from a Rapid Assessment Procedures (RAP) approach to inform the integrated nutrition intervention.
  
  
  METHODS
  With a three-phase, emergent research design, this study utilized ethnographic methods including in-depth interviews, direct meal observations, and full-day child observations. Free lists and pile sorts were conducted to define food and illness domains through cultural domain analysis. Participants included community leaders, caregivers, health surveillance assistants, and children aged 6 to 23 months.
  
  
  RESULTS
  Community members felt that nutrition-related illnesses were less salient and threatening than other illnesses, and food quality was less important than food quantity. Household food allocation occurred in predictable patterns and varied by type of household member and season. Considered an energy-giving food, the SQ-LNS was accepted, but health education and communications tailored to local understanding of nutrition and health are necessary to ensure its appropriate utilization.
  
  
  CONCLUSIONS
  Tailoring a communications strategy to Ntchisi, Malawi could only be done through formative research to understand the sociocultural factors influencing nutrition-related behaviors. A RAP approach allowed for a comprehensive understanding of this local environment.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA skodish1@jhmi.edu.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kodish
authors.affiliation: United Nations World Food Programme Headquarters, Rome, Italy.
authors.forename: Nancy
authors.initials: N
authors.lastname: Aburto
authors.affiliation: United Nations World Food Programme Malawi Country Office, Lilongwe, Malawi.
authors.forename: Mutinta Nseluke
authors.initials: MN
authors.lastname: Hambayi
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Kennedy
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
mesh_terms: D003469:Culture; D004032:Diet / Q000208:ethnology*; D019587:Dietary Supplements; D005502:Food; D006076:Government; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008295:Malawi; D044342:Malnutrition / Q000150:complications* / Q000178:diet therapy / Q000517:prevention & control; D018673:Nutrition Policy; D066252:Sociological Factors
keywords: Malawi; Scaling Up Nutrition (SUN) movement; ethnographic methods; formative research; lipid-based nutrient supplement (SQ-LNS); prevention of stunting; small-quantity