Improving Nutritional Knowledge of Caregivers in Hyderabad, India: A Pilot Study

BACKGROUND: India has the highest prevalence of underweight children under 5 in the world. While lack of access to food is one contributing factor to undernutrition, a caregiver's nutritional knowledge is a more important determinant. Caregivers can improve their nutritional knowledge through nutritional counselling, which is already one of the standard management options for treating children with mild to moderate malnutrition. Therefore, improving nutritional counselling for caregivers can be an effective way to combat undernutrition. OBJECTIVE: The aim of this study was to increase caregiver nutritional knowledge gained after receiving diet counseling at Niloufer Hospital, in Hyderabad, India, by 25% by March 2017 through the use of quality improvement tools. METHODS: Checklists and flipcharts were designed using PDSA cycles and DMAIC, two frequently used quality improvement tools. These interventions were then sequentially implemented in two-week increments over a period of six weeks. Caregivers of children 5 and under were given short surveys both before and after counselling. Change in knowledge scores were calculated from the difference in the pre- and post-counselling survey scores. This was done for three different age groups over each phase of the project: Baseline Phase, Checklist Phase, and Flipchart Phase. This data was then analyzed using a one-way ANOVA, as well as a post-hoc analysis with a student-Newman-Keuls test to confirm the ANOVA. RESULTS: The aim was achieved for all age groups when comparing the change in knowledge scores from the final phase (Flipchart Phase) to the Baseline Phase. For the Under 6 Months age group, the change in knowledge scores were 5.24, 10.17, and 12.20 for the Baseline, Checklist, and Flipchart phases respectively. The percent increase from the Baseline Phase to the Flipchart phase was 132.8%. For the 6 to 35 Months group, the change in knowledge score was 9.25 in the Baseline Phase, 8.14 in the Checklist Phase, and 18.86 in the Flipchart Phase, a 103.9 percent increase from the Baseline Phase. Finally, there was a change of knowledge score of 3.57 in the Baseline Phase, 6.25 in the Checklist Phase, and 29.17 in the Flipchart Phase for the 3-5 Years age group. This age group showed a 717.1 percent increase between the Baseline Phase and the final phase of the study. There were no statistically significant findings in this pilot study. However, there was a positive trend showing the flipcharts were the most effective intervention. CONCLUSION: This pilot study demonstrated that these simple-to-create and low-cost interventions, especially the flipcharts, can improve knowledge gained through counselling in low resource settings. Future studies are needed to determine if these interventions can be improved and expanded for wider use.