Development and Feasibility of a Group, Household Level Intervention To Improve Preconception Nutrition in Nepal

Background: In a setting such as Nepal with malnutrition and persistent poor maternal and infant health outcomes, developing interventions to improve the nutrition of preconception and pregnant women is essential. Aside from factors related to access and knowledge about diverse and adequate diets, inequitable gender norms and women’s low status and autonomy also feed into a lack of emphasis on women’s nutrition.Methods: In this paper we describe the three phases of the design of an intervention for newly married women, their husbands, and mothers-in-law in rural Nepal. We first discuss findings from a mixed methods formative phase, and how that fed into the design of the intervention itself, in close partnership with community members. We the describe the intervention, and findings from a mixed methods feasibility and acceptability pilot among 90 participants.Results: Our formative work highlighted not just lack of awareness about nutrition, but also how factors such as women eating last, and limited mobility, played into poor diets. Low lack of communication and household and community inequitable gender norms were also important factors. Thus we designed Sumadhur, an intervention that brought groups of households (newly married wife, husband, and mother-in-law) together weekly for 4 months to strengthen relationships and gain knowledge through interactive content. We found Sumadhur to be highly feasible and acceptable by all respondents, with most (83%) attending 80% of sessions or more, the majority (73%) of participants reported “no difficulties” in attending sessions, and 99% reporting that they would like it to continue. Pre/post surveys showed a decrease in the proportion of women of women eating last and increase in knowledge about nutrition in preconception and pregnant. Qualitative interviews suggested that respondents felt it made large impacts on their lives, in terms of strengthening relationships and trust, understanding each other, and changing behaviors.Conclusions: We show how a designing an intervention in close partnership with the target recipients and local stakeholders can lead to an intervention that is able to target complicated and culturally held practices and beliefs, positively benefit health and wellbeing, and that is very well received.Trial registration: ClinicalTrials.gov NCT04383847, registered 12/05/2020https://clinicaltrials.gov/ct2/show/results/NCT04383847?view=results