Knowledge, attitudes, beliefs and behaviour of mothers of young children related to healthy eating: comparing rural and urban perspectives in Nepal.

Abstract

Introduction: Mothers’ misconception of a healthy diet is one of the major causes of nutritional problems in preschool-aged children in Nepal and these beliefs and attitudes can result in the inappropriate feeding of young children. There is growing research on this topic in Nepal but very little from a public health perspective. This thesis has been designed to cover gaps in this understanding, especially mothers’ decision-making around feeding their children and is based on a general public health/behavioural change model conceptualised by Marks et al., (2001). Aim: The aim of this thesis was to compare food knowledge, beliefs, attitudes and behaviour related to feeding preschool-aged children in rural and urban Nepalese mothers. Objectives: The objectives were to: i. assess the knowledge, attitudes, and beliefs about nutritious food amongst mothers. ii. identify major barriers that are associated with existing cultures, religions and ethnic divisions; including public opinions for recommending healthy food for preschool-aged children. iii. assess health-seeking behaviour for rural and urban children of low socio-economic status. iv. determine factors that affect the availability of food locally. v. measure the mothers’ knowledge of and attitudes towards health promotion and food security. vi. evaluate the health-seeking behaviours for undernourished children and the reasons why. vii. seek mothers’ suggestions for a better nutritional environment. viii. evaluate the perceptions about healthy diet amongst the stakeholders, such as policy people, health professionals (low level to mid-level), pharmacists and spiritual healers. Methods: This research used a mixed-methods approach in two different locations in Nepal, including a quantitative survey and qualitative focus group discussions. The questionnaire comprised open-ended and structured questions on knowledge, beliefs, and attitudes about nutritious food, child-feeding patterns, food recommendations, major barriers, food insecurity, and health-seeking behaviours. A descriptive data analysis approach was used to analyse the quantitative data by using SPSS version 21.0. The qualitative focus groups aimed to collect in-depth information around attitudes and beliefs and data were thematically analysed. Results: A total of 524 mothers completed the questionnaire. All had children aged 36 – 60 months and were no longer breastfeeding at the time, from rural (n=228) and urban (n=296) localities. In addition, 50 key informants participated in seven focus groups. The findings revealed that 66% of children were being fed by mothers and only 5% by fathers. The major barriers to recommending nutritious foods perceived by mothers included: lack of knowledge (19%); high prices (45%); and cultural influences or beliefs (13%). Almost 12% of mothers never fed colostrum to their children and 34% were unable to identify nutritious food when shopping at grocery stores, whilst 19% lacked food at home. Nearly 57% of children had been taken at least once to a spiritual healer for treatment and 16% more than once. The focus group analysis suggested that important factors associated with knowledge, attitudes, and beliefs about a healthy diet are: poverty, education level, strong cultural beliefs, family size, household income, time, and a growing preference for fast food. Conclusions: Levels of knowledge on what types of food are nutritious were low in both urban and rural mothers and their attitudes and views appear to be poorly-informed. Mothers from both rural and urban communities had great faith in spiritual healers. This study suggests that a public health approach is needed to address nutrition problems associated with behaviour and revealed major barriers to maternal knowledge, which were associated with poverty, resources, mothers’ education level, and climate change. Diversified and conflicting views were also found to be a major barrier preventing mothers from making better decisions. Thus, special attention should be paid at the practitioner and policy-maker level on appropriate interventions and approaches, based on changing these cultural beliefs and behaviours, to help reduce undernutrition in poor communities.