Identifying positive and negative deviants and factors associated with healthy dietary practices among young schoolchildren in Nepal: a mixed methods study

Prasant Vikram Shahi; Rachana Manandhar Shrestha; Pepijn Schreinemachers; Akira Shibanuma; Junko Kiriya; Ken Ing Cherng Ong; Masamine Jimba

doi:10.1186/s40795-023-00700-5

Identifying positive and negative deviants and factors associated with healthy dietary practices among young schoolchildren in Nepal: a mixed methods study

BMC Nutr. 2023 Mar 8;9(1):42. doi: 10.1186/s40795-023-00700-5.

Authors

Prasant Vikram Shahi¹, Rachana Manandhar Shrestha¹, Pepijn Schreinemachers², Akira Shibanuma¹, Junko Kiriya¹, Ken Ing Cherng Ong³, Masamine Jimba¹

Affiliations

¹ Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
² World Vegetable Center, Bangkok, Thailand.
³ Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. kenicong@m.u-tokyo.ac.jp.

Abstract

Background: School-based interventions have been implemented in resource-limited settings to promote healthy dietary habits, but their sustainability remains a challenge. This study identified positive deviants (PDs) and negative deviants (NDs) from the control and treatment groups in a nutrition-sensitive agricultural intervention in Nepal to identify factors associated with healthy dietary practices.

Methods: This is an explanatory mixed methods study. Quantitative data come from the endline survey of a cluster randomized controlled trial of a school and home garden intervention in Nepal. Data were analyzed from 332 and 317 schoolchildren (grades 4 and 5) in the control and treatment group, respectively. From the control group, PDs were identified as schoolchildren with a minimum dietary diversity score (DDS) ≥ 4 and coming from low wealth index households. From the treatment group, NDs were identified as schoolchildren with a DDS < 4 and coming from high wealth index households. Logistic regression analyses were conducted to identify factors associated with PDs and NDs. Qualitative data were collected through in-depth phone interviews with nine pairs of parents and schoolchildren in each PD and ND group. Qualitative data were analyzed thematically and integrated with quantitative data in the analysis.

Results: Twenty-three schoolchildren were identified as PDs, and 73 schoolchildren as NDs. Schoolchildren eating more frequently a day (AOR = 2.25; 95% CI:1.07-5.68) and whose parents had a higher agricultural knowledge level (AOR = 1.62; 95% CI:1.11-2.34) were more likely to be PDs. On the other hand, schoolchildren who consumed diverse types of vegetables (AOR = 0.56; 95% CI: 0.38-0.81), whose parents had higher vegetable preference (AOR = 0.72; 95% CI: 0.53-0.97) and bought food more often (AOR = 0.71; 95% CI: 0.56-0.88) were less likely to be NDs. Yet, schoolchildren from households with a grandmother (AOR = 1.98; 95% CI: 1.03-3.81) were more likely to be NDs. Integrated results identified four themes that influenced schoolchildren's DDS: the availability of diverse food, the involvement of children in meal preparation, parental procedural knowledge, and the grandmother's presence.

Conclusion: Healthy dietary habit can be promoted among schoolchildren in Nepal by encouraging parents to involve their children in meal preparation and increasing the awareness of family members.

Keywords: Dietary diversity score; Nepal; Nutrition; Qualitative; Quantitative; School and home garden.