Behavioural drivers of child feeding during and after illness in the Democratic Republic of the Congo: results from a qualitative study through the lens of behavioural science.

OBJECTIVE: For young children experiencing an illness, adequate nutrition is critical for recovery and to prevent malnutrition, yet many children do not receive the recommended quantities of food during illness and recuperation. Our research applied a behavioural science lens to identify drivers of feeding behaviours, including barriers inhibiting caregivers from following the feeding guidelines. DESIGN: In 2021, we conducted qualitative research informed by the behavioural design process. Data from in-depth interviews and observations were analysed for themes. SETTING: Research was conducted in South Kivu, Democratic Republic of the Congo. PARTICIPANTS: Research participants included caregivers of young children, other family members, health workers and other community members. RESULTS: Five key findings about behavioural drivers emerged: (1) poverty and scarcity impose practical constraints and a cognitive and emotional burden on caregivers; (2) health providers are distracted and discouraged from counselling on feeding during sick visits; (3) a focus on quality and hesitations about quantity obscure benefits of feeding greater amounts of available foods; (4) perceptions of inappropriate foods limit caregivers' choices; and (5) deference to a child's limited appetite leads to missed opportunities to encourage them to eat. CONCLUSIONS: Each of these behavioural drivers is triggered by one or more addressable features in caregivers' and health workers' environment, suggesting concrete opportunities for programmes to support caregivers and health workers to improve feeding of young children during illness and recovery. In other settings where these features of the environment are similar, the insights and programming implications are likely to translate.

Harnessing the Power of Behavioral Science: An Implementation Pilot to Improve the Quality of Maternity Care in Rural Madagascar.

BACKGROUND: Postpartum hemorrhage (PPH) is the leading direct cause of maternal deaths worldwide, and women in low-income countries are at particularly high risk of dying from PPH-related consequences. Most deaths can be avoided through consistent provider adherence to prevention protocols and timely, appropriate management, yet providers do not consistently adhere to these best practices. USING BEHAVIORAL DESIGN TO DEVELOP SOLUTIONS TO IMPROVE PROVIDER CARE: We applied the behavioral design methodology to identify behavioral drivers, develop solutions, and build a program theory of change. Implementation research was conducted to understand the adoption, desirability, feasibility, and appropriateness of the solutions and explore suggestive findings related to impact. Data were collected through observation and in-depth interviews. Solutions developed included: (1) a timer to remind providers of the 1-minute window to administer oxytocin; (2) a glow-in-the-dark poster illustrating a simplified algorithm for PPH management; (3) badges to assign family members tasks to support providers during labor and delivery; and (4) a risk visualization exercise. Clinical mentors introduced the solutions during facility visits, and providers received orientation using videos. Solutions were piloted in 10 rural facilities in southeastern Madagascar during November-December 2020. RESULTS: Providers reported high adoption of the timers and task badges during routine deliveries. They remarked on the desirability and appropriateness of the timer, task badges, and algorithm poster, as well as the value of the cocreation process. Adoption of the timer solution shows promise in having a potential positive impact on increasing the awareness of and adherence to timely oxytocin administration. CONCLUSION: This work highlights the promise of applying behavioral science to identify underlying drivers of gaps in clinical practice and to develop innovative and desirable solutions to address them.

Behavioural barriers and perceived trade-offs to care-seeking for tuberculosis in the Philippines.

Effective tuberculosis (TB) treatment has existed for more than 50 years, but TB remains a leading cause of death worldwide and in the Philippines, in part because symptomatic individuals delay or avoid seeking care. Through qualitative interviews in Pampanga, Philippines, we investigated barriers to care-seeking using a behavioural science lens. We found barriers to TB care-seeking to be shaped by: (1) ambiguous symptoms; (2) association of TB risk with lifestyle and habits; (3) expectations of stigma, discrimination, and isolation; (4) short-term costs and long-term financial burden of TB; and (5) visibility of care in public sector facilities. Findings suggest that these barriers are deeply intertwined and that, typically, it is a combination of barriers that holds back a particular symptomatic individual from seeking care, as the barriers influence implicit trade-offs related to health, social, and financial consequences of having TB or another serious illness and of seeking care or not seeking care. The findings suggest avenues for more effectively reaching those with symptoms and their family members to encourage care-seeking by elevating the perceived benefits and putting perceived costs in proper perspective.