Effectiveness of participatory trainings in improving nutrition knowledge and dietary diversity in rural Bangladesh

Abstract Background Despite improvements in recent decades, Bangladesh continues to face malnutrition rates that are among the highest in the world. Consuming a nutrient-rich diverse diet can mitigate the risk of malnutrition-induced health problems. However, consumers often lack knowledge about what constitutes a healthy diet, and often knowledge improvements do not necessarily translate to behavior change due to social norms and access constraints. Objectives This study evaluates the effectiveness of participatory nutrition education in improving nutrition knowledge and dietary diversity among rural men and women in Bangladesh, investigates whether increased nutrition knowledge leads to changes in dietary behavior, and explores the factors limiting behavior change to aid in the development and implementation of nutrition-sensitive interventions. Design Three-arm randomized control study. We randomize participants into two participatory workshop interventions or the control group of no training. The first intervention consisted of workshop activities related to selecting a balanced diet. The second intervention included the activities of the first intervention as well as activities related to gender and intrahousehold food allocation. Participants 358 adult men and women in two districts of Bangladesh. Results Using pre- and post-intervention survey data and lagged dependent variable regression analyses, we find an 8–11% increase ( p = 0.010) in the comprehensive nutrition knowledge score among workshop attendees, compared to the control. We find larger effects, up to a 30% increase ( p = 0.002), on targeted scores measuring knowledge around food groups and nutrients. Despite increases in knowledge, we find little to no evidence that the workshops impact dietary diversity or that nutrition knowledge translates to behavior change. Our survey responses reveal economic factors such as income and food access limit participants from putting their improved nutrition knowledge into action. Conclusions Habits, social norms and economic factors such as income and access constraints can prevent participants from putting improved nutrition knowledge into action. Short-term, low-cost participatory workshops may be more effective when coupled with economic incentives, gifts-in-kind, or nutrition-sensitive agriculture.