Health belief model constructs and sociodemographic factors associated with minimum meal frequency among children aged 6 to 23 months in Harar City, Eastern Ethiopia

Abstract Background Optimal nutrition in the first 24 months of life is vital for child development. While socioeconomic factors associated with feeding practices are well-documented, evidence regarding the psychosocial correlates of minimum meal frequency (MMF) in Eastern Ethiopia remains scarce. Objective To assess the magnitude of minimum meal frequency and identify Health Belief Model (HBM) constructs and sociodemographic factors associated with minimum meal frequency among children aged 6–23 months in Harar City, Eastern Ethiopia. Methods A facility-based analytical cross-sectional study was conducted from December 2023 to January 2024 among 514 mothers/caregivers of children aged 6–23 months attending three randomly selected public health centers in Harar City. Participants were selected using systematic random sampling. Minimum meal frequency was defined according to WHO guidelines: ≥2 meals (breastfed, 6–8 months); ≥3 meals (breastfed, 9–23 months); ≥4 feeds (non-breastfed, 6–23 months). The Health Belief Model (HBM) was applied to assess psychosocial factors, including perceived susceptibility, severity, benefits, barriers, and self-efficacy. Data were collected using a structured questionnaire administered via KoboToolbox. Bivariable and multivariable logistic regression analyses were performed, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to identify factors associated with MMF. Results The prevalence of MMF was 61.5% (95% CI: 57.3–65.7). Achieving MMF was significantly associated with being breastfed (AOR = 3.20; 95% CI: 1.80–5.68), child age 6–8 months (AOR = 1.85; 95% CI: 1.10–3.12), and maternal primary education (AOR = 2.40; 95% CI: 1.05–5.45). Other significant correlates included high maternal knowledge (AOR = 3.40; 95% CI: 1.40–8.10), household food security (AOR = 3.10; 95% CI: 1.40–6.70), and postnatal care (PNC) attendance (AOR = 3.10; 95% CI: 1.70–5.50), and higher household wealth. HBM constructs were also independently associated with MMF: high maternal self-efficacy (AOR = 2.05; 95% CI: 1.30–3.25) and high perceived susceptibility (AOR = 1.45; 95% CI: 1.05–2.20) were associated with higher odds of meeting MMF requirements. Conclusions A substantial proportion of children did not meet recommended feeding frequency. Maternal psychosocial factors, particularly self-efficacy and perceived susceptibility, were significantly associated with feeding practices, alongside key sociodemographic and health service-related factors. Interventions should move beyond food security toward building caregiver confidence and utilizing PNC as a key touchpoint for behavioural change.