Program Guidance on Engaging Family Members

"Interventions that go beyond simply providing information and engage family members in discussing and reconsidering traditional roles and practices related to child feeding and care can lead to more positive effects..."

Created by the United States Agency for International Development (USAID)'s flagship multi-sectoral nutrition project USAID Advancing Nutrition, this guidance translates research findings into practical recommendations for interventions that engage family members - not just mothers - in care and feeding of children. Designed for programme planners and implementers who seek to improve maternal, infant, and young child nutrition, it is intended to inform the design of social and behaviour change (SBC) strategy, plans for a new or improved activity, or the adaptive management phase of a nutrition programme.

As indicated in the guide, evidence suggests that engaging family members leads to greater awareness of recommended maternal and child nutrition practices and often results in increased supportive attitudes and behaviours. Mothers who report support from family members have longer duration of exclusive breastfeeding and improved complementary feeding practices. Interventions promoting family engagement in maternal and child nutrition also provide an opportunity to negotiate the gender-based division of labour and responsibilities in households and communities.

Informed by lessons from programmes and research, steps in the programme cycle detailed in the guide include:

1. Formative research - This involves exploring the context and behaviours leading to maternal and child nutrition outcomes and factors that prevent or support the behaviours by, for example, speaking with mothers and family members separately (if possible) and/or using group interview methods and focus group discussions to explore social norms and general beliefs.
2. Gender analysis - Practitioners should ask: How will the different roles and status of male and female family members affect the results of your intervention? How will the anticipated outcomes of the intervention differ for male and female family members (e.g., how will mothers' workload, time, and power be influenced by family support?)? Promoting gender equity through community sensitisation and gender-transformative practices can help to increase family members' support for mothers.
3. Strategy design and implementation - Design should reflect a logical pathway that connects the desired behaviour to the factors that prevent or enable the behaviour, the person who will take the supporting action, and the intervention activities. Covered here are discussions of: participant groups, types of support, intervention examples, and activities to engage family members (e.g., counseling and other facility-based interventions, community-based interventions, community mobilisation, mass media, digital approaches, and/or school- and workplace-based interventions). Building on social and gender norms, with content and methods tailored to family members' preferences, increases the likelihood of participation and engagement.
4. Measurement - This section covers: selecting indicators, dealing with unintended consequences, research design and evaluation, and documentation and learning.

Concluding recommendations for engaging family members:

• Conduct targeted formative research to understand family roles and dynamics.
• Ensure individuals are willing and able to adopt the recommended behaviours.
• Engage first-time expectant parents - both mothers and fathers.
• Build on existing values, norms, and roles.
• Counter harmful norms, roles, and power imbalances.
• Consider negative consequences and be alert to potential risks.
• Ensure that delivery approaches are acceptable and appropriate for family members.