Simplifying Complementary Feeding Practices: Experimental Evidence from Rural India

Last registered on January 28, 2021
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Pre-Trial

Trial Information

General Information

Title
Simplifying Complementary Feeding Practices: Experimental Evidence from Rural India
RCT ID
AEARCTR-0007021
Initial registration date
January 26, 2021

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
January 27, 2021, 5:10 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
January 28, 2021, 1:34 AM EST

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
India
Region
Madhya Pradesh

Primary Investigator

Name
Shardul Vaidya
Affiliation
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Other Primary Investigator(s)

PI Name
Diksha Radhakrishnan
PI Affiliation
Contact Investigator
PI Name
Pavan Mamidi
PI Affiliation
Contact Investigator
PI Name
Sharon Barnhardt
PI Affiliation
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2020-10-31
End date
2020-12-27
Keywords
Behavior, Health
Additional Keywords
Complementary Feeding, Nutrition
JEL code(s)
I120
Secondary IDs
Abstract
In this randomised controlled trial study, we will evaluate the impact of two communication-based interventions, delivered remotely, on Complementary Feeding practices in rural India. Our interventions aim to simplify information for caregivers, make complementary feeding a social activity, and integrate relevant nutrition heuristics into communication being given to caregivers. We test for these using two experiments; in the first, our treatment is given simplified counselling over the phone, in our second, we assign mothers into moderated groups on WhatsApp. We deploy our experiments in rural Madhya Pradesh, with a sample of 699 mothers.
External Link(s)

Registration Citation

Citation
Barnhardt, Sharon et al. 2021. "Simplifying Complementary Feeding Practices: Experimental Evidence from Rural India." AEA RCT Registry. January 28. https://doi.org/10.1257/rct.7021-1.1
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
We have two interventions that we test in our two separate experiments:

1. Phone Counselling: Mothers are given counselling on complementary feeding practices via a phone call from trained enumerators. The counselling consists of simplified instructions on CF practices, and calls last about 10 minutes in duration. Mothers are also asked to recall the practices to check their understanding of them. The call script also integrates the consequences of poor compliance of complementary feeding, to make the risks associated salient to mothers. In addition to calls, mothers are also sent three SMS messages on three consecutive days, highlighting the CF practices as well as the consequences of not adhering to appropriate CF practices.


2. WhatsApp Mothers Support Group: Mothers who have access to WhatsApp are randomly assigned to online WhatsApp groups of 3-4 mothers, where trained moderators provide information daily on complementary feeding. The group intervention combines simplified instructions on CF practices along with activities designed to encourage discussion and interaction amongst the mothers. We have also incorporated a few behavioral heuristics to make the need for CF salient to the mothers. We are including three mental models in this intervention:
a. Growth Mental Model: In this mental model, our counsellors -- through WhatsApp text posts, say that since the child is at a crucial stage in their life in terms of growth of the body and development of the mind, it is important that they get good nutrition - especially adequate quantity. If enough quantity is not fed, their growth can be impacted.
b. Starvation Mental Model: Here, we emphasise that all the parts of a child’s body are “hungry” - and not just the stomach. Therefore, it is important to feed the child different kinds of food that are made at home to babies now to feed all parts of their bodies.
c. Diet Diversity Mental Model: This model criticizes the similarities in the food that is given to sick adults and healthy children (porridge, rice/lentils) and also stresses that giving all kinds of food will not make the child sick, and in fact, should be encouraged. A healthy baby should be given the same food as a healthy adult.
Discussion in the groups was moderated for 14 days -- the treatment duration for this intervention.
Intervention (Hidden)
Intervention Start Date
2020-12-05
Intervention End Date
2020-12-19

Primary Outcomes

Primary Outcomes (end points)
We are most interested in measuring impact of our interventions on complementary feeding practices, measured using a 24-hour food recall survey. We will estimate treatment effects for 3 key indicator variables as defined by the WHO:
Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Adequate Diet
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Our research design is a straightforward randomised controlled field trial, where mothers with children in the age range 6-23 months are eligible for either the WhatsApp experiment or the Phone Counselling experiment -- depending on whether they have access to WhatsApp and consented to being part of a WhatsApp group.

Our treatments are bookended by a baseline and an endline, where we measure complementary feeding practices, attitudes and intentions, along with standard demographics.
Experimental Design Details
Randomization Method
Randomization was performed using the computational software R.
Randomization Unit
For our phone counselling experiment, the randomisation is on a individual level, stratified by administrative block, age group child, and whether the mother has access to WhatsApp or not.

The WhatsApp Mothers Support Group was stratified by the age group that the child falls under (6-11 months or 12-23 months), and whether the mother uses her own phone number for WhatsApp or has to depend on someone else for WhatsApp access.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
Clustering is applicable for the WhatsApp Support Group experiment. We have 25 WhatsApp Mothers Support Groups, as our treatment, consisting of 103 mothers.
Sample size: planned number of observations
Experiment 1 (Phone Counselling): 494 mothers Experiment 2 (WhatsApp Support Group): 205 mothers
Sample size (or number of clusters) by treatment arms
Experiment 1 (Phone Counselling)
Treatment: 235 mothers
Control: 259 mothers
Experiment 2 (WhatsApp Support Group)
Treatment: 103 mothers
Control: 102 mothers
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials

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IRB

Institutional Review Boards (IRBs)

IRB Name
Ashoka University Institutional Review Board
IRB Approval Date
2020-09-27
IRB Approval Number
22_20_Agarwal
Analysis Plan

Analysis Plan Documents

Complementary Feeding RCT Pre-Analysis Plan

MD5: 4417993f596cb8e773233222b7629529

SHA1: dc9d873fa08e772c74329dd0c7d1ecbf0efa90fe

Uploaded At: January 26, 2021

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
December 19, 2020, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
December 27, 2020, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials