Final Report: Social and Behavior Change (SBC) Formative Research: Trials of Improved Practices (TIPs) for Nutrition and Handwashing

The project focuses on health, nutrition, agriculture, livelihoods, and natural resource management practices, which, when adopted collectively by households and communities, will directly contribute to transformative change. To inform its social and behavior change (SBC) strategy, the project identified the need for formative research to address evidence and knowledge gaps (EKGs) on the barriers and facilitators to adoption of key behaviors. The two behaviors selected for investigation through SBC formative research activities were parents and caregivers of infants aged 6-9 months feeding their child a diverse diet, and household members washing their hands at critical times. The research objectives were to inform refinement of the FIOVANA Theory of Change (ToC) and development of the project's SBC strategy by contributing to behavioral prioritization and identification of key determinants that impact adoption of these behaviors. The dietary diversity study aimed to document food availability and current feeding practices among targeted communities in the Atsimo Atsinanana and Vatovavy-Fitovinany regions. The study also sought to identify feasible and appropriate actions that parents and caregivers of infants 6-9 months can adopt to increase the diversity of foods given to their child, and to document the behavioral determinants that inhibit or facilitate these actions. The handwashing study aimed to document current handwashing practices among targeted communities in the Atsimo Atsinanana and Vatovavy-Fitovinany regions. The study also sought to identify feasible and appropriate actions that households can adopt to increase the practice of handwashing at critical times, and to document the behavioral determinants that inhibit or facilitate these actions. The studies were conducted using an adapted Trials of Improved Practices (TIPs) methodology, a participatory research approach that engages target audiences in trialing new behaviors. The TIPs methodology employs a series of information-gathering sessions with participants to understand current practices, negotiate testing of new practices, and identify barriers and facilitators of these practices. The FIOVANA project adapted the traditional TIPs methodology to include a mix of individual household visits and group visits to facilitate participatory experience sharing amongst participants, inclusion of a supportive family or household member to take part in the trial with each participant, and inclusion of a demonstration activity. Both studies were carried out in two communes within the FIOVANA implementation area: Andemaka and Vohimasina Nord. Each TIPs study was conducted with the primary audience with whom the behavior will be promoted through FIOVANA: mother/primary caregiver of child aged 6-9 months for dietary diversity and mother/primary caregiver of child under 5 for handwashing. Project staff worked with community leaders to randomly select and recruit eligible participants for participation, with a sample size of 25 participants for the dietary diversity TIPs and 24 participants for the handwashing TIPs. The studies aimed to contribute to the refinement of the FIOVANA Theory of Change (ToC) and development of the project's SBC strategy by providing insights into the behavioral determinants that impact adoption of key behaviors. The findings of the studies will inform the development of effective interventions to promote dietary diversity and handwashing practices among targeted communities in the Atsimo Atsinanana and Vatovavy-Fitovinany regions.