ANN JIMERSON, BEHAVIOR CHANGE SPECIALIST, ALIVE & THRIVE, FHI 360
I wasn’t joking when I told Mary Penny and Hilary Creed-Kanashiro that the Skype call we had recently fulfilled a fantasy for me. For some time, I’ve been fascinated with a study they and their Peruvian colleagues were part of about 10 years ago. And now I’d been granted my wish to ask my questions.
In the early 2000s, the Peru group tested a streamlined interpersonal communication intervention to improve complementary feeding. Using formative research, the program designers arrived at three key messages. In intervention health centers, staff were encouraged to repeat the three messages to all mothers of babies over 6 months old. The mothers’ feeding practices improved. And to their surprise, the researchers discovered that by 18 months, the babies they had followed who were born at the beginning of the program and lived near the intervention health centers had grown taller than babies in the same town who went to other health centers.
Children who grow to their full height become healthier, smarter, and even more economically productive adults. Nutritionists have been clear about which behaviors will improve children’s growth and development. But the kind of success seen in the Peru study is rare.
What’s so special about delivering three simple messages?
The first two messages are standard admonitions to feed nutritious thick foods rather than thin broths; and to add animal source foods like chicken liver, egg, or fish to the baby’s daily diet.
But the third message has intrigued me: Teach your child to eat with love, patience, and good humor.
In a streamlined message set, why “waste” one of only three messages on this seemingly vague plea that doesn’t really lay out a measurable “small doable action”? I’d met several others who were involved with the study, and asked them about that third message. Each smiled before gushing over this one. Is it possible that this message is what set the study apart from others that were less successful? But no one could tell me where this message came from.
Imagine my excitement to take my questions to two women who might have the answer. They too smiled when I asked about that third message. Yes, they said, it did play an important role. They didn’t have the data to tease out the role of each message. But they had observed clinic visits where this message changed everything.
“Even with trained staff, there often was a mismatch between the concerns a mother expressed and the nurse’s response,” Hilary Creed told me the other day. “The mother would say, ‘I’m worried that my child isn’t eating,’ and the nurse would say, ‘Feed more liver.’ It just didn’t connect. Finally the nurse would deliver that third message, and it softened the counseling atmosphere. The mother smiled, and the nurse smiled. The message helps you past an impasse, it’s the bridge. It makes it feel possible to solve the problem.”
The message has persisted. A decade later, parents can repeat it, even in regions far from the study area. Mary Penny explained, “It’s gone viral, really. And surprisingly, it really appeals to men. I was speaking recently with a community group about feeding in the first two years of life. A man stood up and said, ‘But you haven’t even mentioned that you must teach your child to eat with…’ [yes, you guessed it] ‘…love, patience, and good humor.’”
So the others were right. There really was something magical about this particular message. I had to know: “How did you come up with it?”
Hilary filled me in. “We hit it lucky, really. It was a creative anthropologist who came up with it, thinking about the findings from formative studies. Then we tested it in a few TIPs-type studies, where you explore with mothers and then look at the impact and the feasibility of the behavior. This message was a winner, right from the beginning.”
An intriguing message, yes, almost magical. But still it had emerged from solid formative research and passed the test with mothers. Only then did this message become part of a winning trio. Maybe further study will someday explain why this message. Meantime, Peruvian mothers and fathers take it to heart, and their feeding practices improve.
Yes, we’re all for “less guess” – using research to shape messages and then testing them like crazy. But it’s good to be reminded that often it’s the informed creative leap that makes the difference.
 The stunting rate in the intervention group was three times better (lower) than in the control group (5% vs 15%).