Exposure to social and behavior change interventions directly and indirectly improved health and nutrition-related awareness, knowledge, and practices among male household heads and grandmothers in Nepal

BACKGROUND: Adult family members often share household tasks and decision-making, including those related to health and nutrition. Beyond the important role of mothers, grandparents and fathers are instrumental in achieving good maternal and child nutrition and health. OBJECTIVE: This study aimed to investigate whether exposure of male household heads (HHs) and grandmothers to social behavior change communication (SBCC) platforms was associated with ideal nutrition and health practices in their households and the mediating role of awareness and knowledge for this linkage. We also aimed to investigate whether key sociodemographic factors moderated these mediated paths. METHODS: We used data from the endline survey (2022) of Suaahara's quasi-experimental impact evaluation. Our samples were limited to households with a child under 2 that included male HHs (n = 982) and grandmothers (n = 817). Structural equation models, accounting for community-level clustering, were used to examine the mediation paths for male HHs and grandmothers separately. All models were adjusted for household wealth and caste/ethnicity, child age, and respondent (male HHs or grandmothers) age and education. Stratified models examined potential moderating factors: wealth (relatively poorer 40% vs wealthier 60%), caste (upper vs lower), and household structure (nuclear vs joint). RESULTS: Greater exposure to SBCC was associated with greater awareness and in turn, knowledge, and ultimately, maternal and child health and nutrition practices. About 30% and 40% of the total association was mediated through this indirect path among male HHs and grandmothers, respectively. The indirect path through greater awareness and knowledge was stronger among male HHs from lower (versus upper) caste groups and nuclear (versus joint) households, as well as wealthier (versus poorer) grandmothers. CONCLUSIONS: Family member engagement in SBCC interventions is an important mechanism for improving health and nutrition practices.