Parental Misperceptions on Child Nutrition in India: Implications for Child Feeding Practices and Growth
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 1,542
- 试验地点
- 2
- 主要终点
- Minimum frequency of meals
研究概览
简要总结
The goal of this randomized controlled trial is to examine the role of parental misperceptions and information gaps in contributing to poor child dietary practices and high child undernutrition rates in India. The main research questions it seeks to answer are:
- Do mothers systematically overestimate the nutritional status (height- and weight-for-age percentiles) of their children, relative to global World Health Organization (WHO) standards and other children in their region?,
- Do mothers underestimate the returns to child nutrition on long-term health, education, and labor market outcomes?,
- What mechanisms could explain the formation of such misperceptions? Are mothers with higher exposure to undernourished children more likely to overestimate their children's nutritional status?, and
- Would updating mothers' beliefs about a) their children's true height-for-age and weight-for-age percentiles, and/or b) the returns to child nutrition, improve child feeding practices, utilization of government nutrition services, and child growth outcomes?
The study involves an individual-level randomized controlled trial with 1500 mothers of children aged 7-24 months in Telangana, India, with two information treatment arms and one control arm. The first treatment will update mothers' beliefs on the relative height- and weight-for-age percentiles of their children, and the second will provide information on the impacts of child undernutrition on long-term health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes.
The treatment and control groups will be compared to assess if the information treatments improve outcomes related to child feeding practices, consumption of government-supplied therapeutic food, cognition measures, and child growth.
详细描述
The goal of this randomized controlled trial is to examine the role of parental misperceptions and information gaps in contributing to poor child dietary practices and high rates of child undernutrition in India. This study is guided by two core hypotheses:
- Parents systematically overestimate the nutritional status of their children: If parents form expectations about how healthy their child is by observing other children around them, then parents in areas with high levels of stunting and wasting may be more likely to believe that their own child is relatively healthy and have a skewed perception of "ideal" height and weight levels.
- Parents systematically underestimate the returns to child nutrition on long-term health, education, and labor market outcomes: While there is a large literature documenting the effects of child nutrition on the incidence of infectious and chronic diseases, years of education, test scores, and earnings in adulthood, this information is most likely not common knowledge among parents in India, particularly in rural areas.
These misperceptions, if proven true, may create a suboptimal equilibrium for child nutrition outcomes, trapping families in a cycle of inadequate nutrition.
The main research questions are:
- Do mothers systematically overestimate the nutritional status (height- and weight-for-age percentiles) of their children, relative to global WHO standards and other children in their region?,
- Do mothers underestimate the returns to child nutrition on long-term health, education, and labor market outcomes?,
- What mechanisms could explain the formation of such misperceptions? Are mothers with higher exposure to undernourished children more likely to overestimate their children's nutritional status?, and
- Would updating mothers' beliefs about a) their children's true height-for-age and weight-for-age percentiles, and/or b) the returns to child nutrition, improve child feeding practices, utilization of government nutrition services, and child growth outcomes?
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- None
入排标准
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Biological mothers of sampled children aged 7-24 months
排除标准
- •Any medical/health condition that precludes individuals from understanding the study procedures or communicating with study personnel (eg. deafness, inability to speak, mental health conditions)
结局指标
主要结局
Minimum frequency of meals
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
Binary variable coded "1" if the child consumed the minimum recommended number of meals in the last 24 hours, based on their age, and "0" otherwise
Weight-for-height z-score
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
Weight-for-height z-score at the time of the endline survey
Consumption of Balamrutham
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
Binary variable coded "1" if the child consumed Balamrutham (government-provided therapeutic food) in the last 24 hours, and "0" otherwise
CREDI child cognition scale z-score
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
The Caregiver-Reported Early Development Instruments (CREDI) Short Form is a validated set of 20 population-level measures of early childhood development (ECD) for children from birth to age three (0-36 months). The responses on this 20-point scale (based on age) will be converted to a norm-referenced standardized Z-score for overall development. The z-scores may range from -6 to +6, with larger scores representing better outcomes.
Difference between true and perceived height-for-age percentile relative to WHO standards
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
The difference between the child's true height-for-age percentile relative to the WHO reference population and the mother's perceived percentile rank. Values may range from 0 to 100.
Height-for-age z-score
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
Height-for-age z-score at the time of the endline survey
Average willingness-to-pay for protein-rich food bundle
时间窗: Baseline
All mothers who participate in the survey will be entered into a lottery to win a bundle of protein-rich food items for their child or, alternatively, a randomly chosen cash prize (amount may range from Rs. 100 to Rs. 2000). 25 lottery "winners" will be chosen randomly at the end of the baseline survey. Mothers will be asked to state their preferences between the food bundle and several potential cash prize amounts, using a multiple-price-list elicitation method. One cash prize amount will be randomly chosen for each mother, and their choice for that amount will be implemented in case they win the lottery. WTP will be measured by the mid-point of the interval of two cash amounts at which a mother switches from preferring to receive cash to preferring to receive food. Possible values range from 0 to 2000. Average willingness-to-pay will be compared between mothers in the treatment groups and the control group.
Knowledge score on returns to child nutrition (Binary)
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
Binary variable coded "1" if at least half the prompts (3 out of 6) about the returns to child nutrition are answered correctly, and "0" otherwise. This is a binary indicator constructed based on the knowledge score scale that may range from 0 to 6, with higher scores representing better knowledge.
Difference between true and perceived weight-for-age percentile relative to WHO standards
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
The difference between the child's true weight-for-age percentile relative to the WHO reference population and the mother's perceived percentile rank. Values may range from 0 to 100.
Minimum dietary diversity
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
Binary variable coded "1" if the child consumed food from at least 5 of the 8 specified food groups in the last 24 hours, and "0" otherwise. This is a binary indicator constructed based on the World Health Organization "Minimum Dietary Diversity - Infant and Young Child Feeding" (MDD-IYCF) scale. Scores may range from 0 to 8, with higher scores representing better outcomes.
Weight-for-age z-score
时间窗: During endline survey, an average of 4 months (or 17 weeks) from baseline
Weight-for-age z-score at the time of the endline survey
次要结局
- Change from baseline in weight-for-height z-score(During endline survey, an average of 4 months (or 17 weeks) from baseline)
- Household food expenditure in last calendar month(During endline survey, an average of 4 months (or 17 weeks) from baseline)
- Change from baseline in height-for-age z-score(During endline survey, an average of 4 months (or 17 weeks) from baseline)
- Change from baseline in weight-for-age z-score(During endline survey, an average of 4 months (or 17 weeks) from baseline)
- Change from baseline in weight(During endline survey, an average of 4 months (or 17 weeks) from baseline)
- Episodes of illness in last 14 days (binary)(During endline survey, an average of 4 months (or 17 weeks) from baseline)
- Change from baseline in height(During endline survey, an average of 4 months (or 17 weeks) from baseline)
研究者
Jeffrey Broadman Weaver
Assistant Professor
University of Southern California