Identifying positive and negative deviants and factors associated with healthy dietary practices among young schoolchildren in Nepal: a mixed methods study

Abstract

Abstract Background School-based interventions have been implemented in resource-limited settings to promote healthy dietary habits, but their sustainability remains a challenge. This study identified positive deviants (PDs) and negative deviants (NDs) from the control and treatment groups in a nutrition-sensitive agricultural intervention in Nepal to identify factors associated with healthy dietary practices. Methods This is an explanatory mixed methods study. Quantitative data come from the endline survey of a cluster randomized controlled trial of a school and home garden intervention in Nepal. Data were analyzed from 332 and 317 schoolchildren (grades 4 and 5) in the control and treatment group, respectively. From the control group, PDs were identified as schoolchildren with a minimum dietary diversity score (DDS) ≥ 4 and coming from low wealth index households. From the treatment group, NDs were identified as schoolchildren with a DDS < 4 and coming from high wealth index households. Logistic regression analyses were conducted to identify factors associated with PDs and NDs. Qualitative data were collected through in-depth phone interviews with nine pairs of parents and schoolchildren in each PD and ND group. Qualitative data were analyzed thematically and integrated with quantitative data in the analysis. Results Twenty-three schoolchildren were identified as PDs, and 73 schoolchildren as NDs. Schoolchildren eating more frequently a day (AOR = 2.25; 95% CI:1.07–5.68) and whose parents had a higher agricultural knowledge level (AOR = 1.62; 95% CI:1.11–2.34) were more likely to be PDs. On the other hand, schoolchildren who consumed diverse types of vegetables (AOR = 0.56; 95% CI: 0.38–0.81), whose parents had higher vegetable preference (AOR = 0.72; 95% CI: 0.53–0.97) and bought food more often (AOR = 0.71; 95% CI: 0.56–0.88) were less likely to be NDs. Yet, schoolchildren from households with a grandmother (AOR = 1.98; 95% CI: 1.03–3.81) were more likely to be NDs. Integrated results identified four themes that influenced schoolchildren’s DDS: the availability of diverse food, the involvement of children in meal preparation, parental procedural knowledge, and the grandmother’s presence. Conclusion Healthy dietary habit can be promoted among schoolchildren in Nepal by encouraging parents to involve their children in meal preparation and increasing the awareness of family members.