Systematic Review of Social Behavior Change Strategies and Behavior Change Techniques Used in Nutrition Sensitive Agriculture Interventions

OBJECTIVES: While social behavior change (SBC) is an important component of nutrition sensitive agriculture interventions (NSeAI), there is limited research on what specific behavior change techniques (BCT) are effective. This systematic review aims to 1) describe SBC design and implementation in the context of NSeAI 2) examine the BCTs used in NSeAI and 3) quantify associations between BCTs and improvements in diet diversity. METHODS: Literature on NSeAI with nutrition SBC was systematically reviewed. Papers published in 2000–2021, aimed to improve diet quality, and described nutrition SBC activities were selected. Agriculture-nutrition pathways and SBC approaches used by interventions were mapped. BCTs were coded using a validated taxonomy. Effectiveness ratios (ERs) were calculated to assess BCTs in relation to program success. Trials were considered effective if there was significant improvement (P < 0.05) in household, women's, and child diet diversity. RESULTS: Of the 56 interventions included in the study, most were in Sub-Saharan Africa (n = 30) and Asia (n = 21). Thirty-three interventions used formative research to guide SBC design; only six discussed applying a specific behavioral theory. Interventions aimed to increase home production for home consumption (n = 54); increase women's empowerment (n = 30) and increase agricultural income (n = 25) as a pathway to improved nutrition. Fifty-two projects used interpersonal communication, 36 projects used community engagement and 12 used mass media as an approach to behavior change. The most frequently used BCTs included “instructions on how to perform the behavior” (n = 56), “social support (unspecified)” (n = 39), and using a “credible source” for information dissemination (n = 35). On average, projects used 7 BCTs. The BCT “behavioral practice” had the highest effectiveness ratio (ER = 1.0). CONCLUSIONS: Interventions focused predominantly on the home production for home consumption pathway. Women's empowerment and agriculture for income pathways were less frequent. All interventions provided instructions on how to perform the behavior but relatively few provided opportunities for ‘behavioral practice’; however, this BCT had the highest effectiveness ratio with all interventions using this BCT demonstrating significant improvements in diet quality. FUNDING SOURCES: Bill & Melinda Gates Foundation.