Measuring Persuasive Communication in two nutrition education delivery methods in rural Mozambique

Background: Nutrition education programmes are frequently implemented in developing countries with the aim of improving dietary practices. Few studies have, to date, examined the various steps in such an education process in a developing country setting. This study, uses McGuire's "Communication/Persuasion" model to assess the impact among poor rural women in Mozambique of two nutrition education delivery methods: group classes only versus group classes plus individual classes. Methods: Study participants were randomly selected from the total population of RCT taking place in rural Mozambique: the Towards Sustainable Nutrition Improvement project. Participants were female, had a child under 5 years of age and had been randomised to receive the nutrition education program. McGuire's output steps (exposure, attention, understanding, memorisation/recall, skills acquisition, and attitude change) were assessed for both nutrition education delivery methods using a range of tools developed by the investigator, ranging from direct observations to questionnaires. The sample size varied for each output step depending on pre-defined criteria. Results: The methods devised in the current study for the assessment of McGuire's output steps were able to detect a good degree of variability in response. Mothers receiving both the group and individual classes (intervention II) scored higher in most output steps than those receiving only the group classes (intervention I), even after adjusting for possible confounding influences. For example, those mothers in intervention II had significantly higher skills acquisition scores than those mothers in intervention I (difference of means 1.03, independent t-test, p<0.001). Within the sample of intervention II mothers, the scores from measurements taken in individual classes were significantly higher than those taken in the group classes. For example, while there was no difference in observed attention scores between intervention II and intervention I mothers when assessed at group classes, observed attention scores at individual classes were Significantly higher (for intervention II mothers) than those of intervention I mothers at group classes (Independent t-test, p=0.031). Further analysis appeared to suggest that this advantage was due to the added benefit of receiving individual classes in addition to group classes; although this cannot be confirmed in the current study given the lack of a study 'arm providing only individual classes. 2 Conclusions: This study has for the first time used McGuire's model to systematically investigate and compare the communication process in two nutrition education delivery methods in a developing country and attempted to develop tools to measure McGuire's output steps in such a setting. McGuire's model emerged as a good conceptual framework to use for this purpose as it is practical, and. allowed for the breakdown of the process into _, discrete steps that permitted comparisons to be made between two delivery methods. The analysis suggested that there was an advantage in providing individual classes in addition to group classes, although this clearly has important resource implications.