Self‐Reported Barriers to Adapting Contextualized Nutrition Education Messages Targeted At Preventing Iron Deficiency (ID) among Mothers and Their Young Children in Ghana
Authors: Abu Brenda Ariba Zarhari , Louw Vernon L , Raubenhiemer Jacques E , Oldewage‐Theron Wilna , van den Berg Louise Violet 
Published: November 2023

Objective

To assess the barriers of adherence to nutrition education messages on ID among mothers and their young children in an anemia endemic area in Ghana.

Methods

A needs assessment on ID using a multi‐method approach in two randomly selected districts (mothers (N=161) with all their children less than 5 years (N‐175)) in Northern Ghana in April, 2012. The intervention was a 5‐day (90 minutes/day) nutrition education program consisting of ten key messages addressing gaps identified in the needs assessment. The messages were delivered through practical, pictorial and interactive sessions among 73 mothers in the randomly selected intervention district in July, 2013. After which each mother was later visited twice (2 weeks apart) in her households to refresh and integrate the messages to her household situation. Three months after the intervention, a questionnaire, designed by the researcher, was administered via in‐person interviews with mothers to assess recall of messages, adherence and barriers to implementation. Content analysis was used to categorize responses into themes as reported.

Results

Of the mothers (N=71), most were married (98.6%), had no formal education (98.6%), were living in rural households with a median monthly income of 40 cedis ($13.3), mainly from farm produce.

Only 6 (8.8%) mothers could not recall any of the messages, 58 (85.3%) could recall 1–5 messages, 4 (5.9%) could recall 6–9 messages and none of them could recall all ten messages. The highest recall was on messages regarding “Prevent malaria, diarrhea and worms which can increase risk for ID” (69.9%). This may be due to high malaria infestation in the community; thus the mothers could relate to these messages.

About a third (27.4%) of the mothers reported that they now fortified the children's food with fish and 5.5% indicated giving increased portions of soup to children compared to baseline. The highest reported (40.8%) implemented messages was on regular hand washing with soap before cooking/eating.

Financial constraints were the reported reason for not implementing messages on eating iron sources (meat/fish) and improving food choices. Messages which only required change of behavior such as “stop pica practice since it may increase ID risk” were not implemented/relayed to others who practiced pica within their household due to forgetfulness or shyness, majorly due to lack of support or fear of being seen as a “know it all”. Reported barriers to fortifying baby foods with fish/groundnuts were due to babies did not like/refused to eat fortified foods.

Conclusion

Messages for nutrition education, even when contextualized, still had barriers to recall and adherence. The mother's social environment, including other household members, discouraged her from relaying knowledge on pica practices and sanitation. Behavior change models with elements targeted at building the confidence of mothers to act as change agents within their households and community may be more successful.

Support or Funding Information

Source of funding for the entire project was Government of Ghana Education Trust Fund (GetFund), Ghana