AUTHOR=Gizaw Abraham Tamirat , Sopory Pradeep , Sudhakar Morankar 

TITLE=Effectiveness of a positive deviance approach to improve mother’s nutritional knowledge, attitude, self-efficacy, and child’s nutritional status in Maji District, West Omo Zone, South West region, Ethiopia: a cluster randomized control trial

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1277471

DOI=10.3389/fpubh.2023.1277471

ISSN=2296-2565

ABSTRACT=<sec id="sec1"><title>Background</title><p>Achieving appropriate feeding for infants and young children continues to be a struggle. These impediments are not only due to limited food availability but also inadequate knowledge, unfavorable attitudes, and low self-efficacy. A positive deviant approach (PDA) addressing positive and possible solutions inherent in a community focusing on problems is applied in Africa and particularly to Ethiopia. Therefore, this trial is aimed at evaluating the effectiveness of PDA in improving mothers’ nutritional knowledge, attitudes, self-efficacy, and children’s nutritional status.</p></sec><sec id="sec2"><title>Method</title><p>This was a cluster randomized control trial in which 516 mothers were randomly assigned to either an intervention or control group after collecting baseline data. The trial participants in the intervention cluster received a positive deviant intervention for 6 months, whereas those in the control group received only the usual care. Trained positive deviant mothers (PDM) delivered the intervention. A pretested, structured, interviewer-administered questionnaire was used for data collection. Generalized estimating equation regression analysis adjusted for baseline covariates and clustering was used to test the intervention effect.</p></sec><sec id="sec3"><title>Result</title><p>The results showed that PDA improved breastfeeding outcomes in the intervention groups compared to their counterparts. A mean difference (MD) of breastfeeding (BF) knowledge (MD = 6.47; 95% CI: 6.45–6.49), BF attitude (MD = 12.68; 95% CI: 11.96–13.40), and BF self-efficacy (MD = 3.13; 95% CI: 3.05–3.21) was observed favoring the intervention. The intervention group showed better improvement in complementary feeding (<italic>CF</italic>) knowledge, attitude, and self-efficacy among mothers compared to the control group. A mean difference in <italic>CF</italic> knowledge (MD = 4.53, 95% CI: 4.31–4.75), <italic>CF</italic> attitude (MD = 9.14, 95% CI: 8.52–9.75), and <italic>CF</italic> self-efficacy (MD = 11.64, 95% CI: 11.16–12.12) were observed favoring the intervention. At the end of the 6-month follow-up, children in the intervention group showed a lower prevalence of underweight (18.23%) (95% CI: 4.55, 22.54%; <italic>p</italic> = 0.004) compared with the control group.</p></sec><sec id="sec4"><title>Conclusion</title><p>PDA was effective in improving mothers’ nutritional knowledge, attitude, and self-efficacy and reducing children’s underweight in the intervention area.</p><p><bold>Clinical trial registration:</bold><ext-link xlink:href="http://ClinicalTrials.gov" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, identifier PACTR202108880303760.</p></sec>