97. Percentage of individuals practicing recommended healthy diet behaviour

97. Percentage of individuals practicing recommended healthy diet behaviour

VERSION

V3.0 - 2026.03 — Existing

INDICATOR CODE

97

TECHNICAL OWNER

PRG-S Nutrition

INDICATOR TYPE

Country Level Outcome Indicator

INDICATOR CLASSIFICATION

Complementary

INDICATOR SCOPE

Programme specific

APPLICABILITY

The selection of this indicator is recommended against the following sub-activities in CSPs logframes. Selection of the below sub-activities will NOT trigger in COMET the mandatory selection of this indicator:

1. Prevention of micronutrient deficiencies (PMD)

2. Prevention of acute malnutrition (PREV)

3. Prevention of stunting (STUN)

4. Management of moderate acute malnutrition/undernutrition (MAM)

5. Treatment of severe acute malnutrition (SAM)

6. General Distribution (GD)

7. School Meals Programme On Site (SF_ONS)

8. School Meals Programme Take Home Incentives (SF_THI)

This indicator is also recommended to be used under Nutrition-Sensitive activities therefore the Nutrition Sensitive Marker should be selected at sub-activity level where relevant.

UNIT OF MEASUREMENT & ANALYSIS

Percentage of individuals

DEFINITION

The indicator measures the percentage of individuals receiving Social Behaviour Change (SBC) for healthy diets practicing recommended healthy diet behaviours promoted through programmes implemented by WFP or by partners with WFP support.

Healthy diets are of optimal quantity, adequate quality, diverse, and safe to prevent malnutrition in all its forms, ensure optimal growth and development and protect against diet-related illnesses and mortality¹. Healthy diets are crucial to reducing malnutrition risk, promoting healthy growth and development, and preventing obesity and non-communicable diseases (NCDs) throughout life.²

Improving dietary practices supports the availability, accessibility, and consumption of healthy diets and the uptake of essential complementary health and nutrition services.

Below are key terms important for this indicator:

Social Behaviour Change (SBC) is a collection of approaches, activities, tools, and communication methods to influence behaviours positively. It is an evidence-based process to shift norms, improve enabling environments, and change behaviours to improve health and nutrition.

Promotion refers to activities that support or encourages action to be taken or implemented toward healthy diets. Examples of activities include:

• Promoting programme participant awareness and knowledge of a healthy diet

• Support the development of school policies and programmes that encourage children to adopt and maintain a healthy diet

• Providing nutrition and dietary counseling at nutrition/health facilities to individuals and groups.

Practice is the acceptance or repeated application of an activity supporting healthy diets. It entails doing something different from the previous norms and practices.

Behaviour: Actions promoted by the programme aimed towards enhancing healthy diets.

• Examples of recommended behaviours include:

• Eating enough at appropriate frequencies

• Eating a variety of safe, diverse, nutrient-rich foods

• Feed children 6–23 months old a variety of age-appropriate safe, diverse nutrient-rich foods.

• Appropriate handwashing practices before food consumption and while handling food

• Reduce intake of foods high in fat, sugar, and salt.

• Appropriate storage of food

• Washing foods with clean water before consumption

Targeted audience: individuals participating in behaviour change activities under a WFP programme promoting healthy diets.

Note: Recognizing that there are direct and indirect behaviours that contribute to healthy diets, this indicator only intends to measure behaviours related to the quality, quantity, and safety of diets. If a Country Office wants to measure additional behaviours that fall outside these three identified areas, this should be done with complementary country-specific indicators. Examples of additional behaviours not considered under this indicator include sanitation, breastfeeding, and health-seeking behaviours.

RATIONALE

SBC may contribute to addressing socio-cultural drivers of healthy diets by promoting modification of existing behaviours and practicing new behaviours.

SBC is implemented under both nutrition-specific and nutrition-sensitive programming, for example, prevention of malnutrition, malnutrition treatment, and nutrition-sensitive programming such as general food distribution, cash-based transfer, school feeding, and livelihood activities aimed at improving the diets of the target population.

The indicator measures the success of a behaviour change intervention by demonstrating the level of uptake of a recommended behaviour among the target audience.

This indicator applies to WFP programmes implementing SBC components for healthy diets. It measures practice among direct beneficiaries (Tier 1) targeted by SBC programmes.

DATA COLLECTION TOOL

For data collection, a beneficiary will be considered to have practiced a healthy diet behaviour if they either self-report practicing the behaviour promoted by the SBC programme or if the behaviour can be directly observed. Reporting is a positive response to recommended actions for healthy diets, e.g., a pregnant mother consuming iron-rich foods in recommended frequencies.

Please see the link here for a sample data collection tool.

SAMPLING REQUIREMENTS

A significant representative sample needs to be used for each behaviour. The following guidance can be used for each behaviour included in this indicator:

• Population size is the number of direct beneficiaries (Tier 1) of the SBC program at the survey time targeted for the specific behaviour

• Expected prevalence of each behaviour: use previous prevalence if available, and if unknown, 50% can be used.

• Non -response: 10%

• Design effect: if cluster sampling is done, the design effect needs to be considered. This can be based on previous results and set at 1,5 if no information is available. Take note of guidance on design effect for situations where the design effect needs to be increased or decreased due to the homogeneity of the surveyed population.

• Confidence interval highly recommended being 95%. After the sample size is calculated for each behaviour; the highest sample size is selected. If more than one target group is included; this needs to occur for each target group.

INDICATOR CALCULATION FOR REPORTING

Based on the programme design and SBC strategy, a country office should prioritise one to a maximum of seven key behaviours⁴ to be identified for comparison every year throughout the CSP reporting period. These same behaviours should be monitored and reported on throughout the CSP.

As part of the methodology, any behaviour that supports healthy diets can be incorporated into the key prioritised behaviours. Country offices have complete autonomy to choose the specific healthy diet behaviour that aligns with their Social and Behaviour Change (SBC) program objectives.

The following steps should be taken to calculate the indicator:

For example, Country X has prioritised the following behaviours:

• Non-breastfed children 6-23 months consume four feedings of solid, semi-solid, or soft foods or milk feed

• Reducing the consumption of sugary beverages, sweets, processed snacks, and packaged foods

• Increasing handwashing with soap and water in rural areas

• Reduction of cooking oil usage

• Increasing consumption of healthy breakfasts among school-aged children

• Increasing consumption of high-iron foods for pregnant and breastfeeding women, and children 2-5 years old

• Reducing sugar consumption among school-aged children

Please note that the aforementioned prioritised behaviours serve as mere examples and do not constitute an exhaustive list of healthy diet behaviours. Country offices should select healthy diet behaviours, considering formative research findings and the objectives of the Social and Behaviour Change (SBC) program. Refer to this link for more information: SBCC Guidance Manual for WFP Nutrition | WFPgo.

DATA ENTRY AND DISAGGREGATION IN CORPORATE SYSTEMS

Values are recorded in the logframe. Each value has a reporting combination which is created based on:

• Sub-activity

• Location

• Target Group

Follow-up values are reported as one overall number.

Recommended disaggregation:

• Sex

BASELINE

Baselines are set only once, at one of the following points:

1. At the beginning of the CSP, or

2. When the indicator is selected for reporting after the commencement of the CSP, or

3. When a change in target, location and/or modality triggers a new reporting combination (target, location and modality) for an existing indicator.

Baselines remain fixed for the entire CSP period and are not recalculated annually, unless applicable above.

TARGET SETTING

Annual targets:

The percentage of individuals practicing recommended healthy diet behaviour(s) has increased compared to the previous year’s value. See the end of the CSP target section below for further guidance on determinants of increases.

The percentage of individuals practicing recommended healthy diet behaviours has increased compared to the baseline.

Only general guidance can be provided for setting targets for SBC in nutrition programming, as it is impossible to recommend universal targets.

The percentage of increase should thus be determined based on local context; baseline value; type of intervention implemented and its theory of change or impact pathway; scientific evidence on the impact of this type of intervention, if available, and timeframe.

Note that ongoing interventions in the same area and/or events may affect the desired outcome.

FREQUENCY OF DATA COLLECTION

Twice per year.

INTERPRETATION

A higher percentage of individuals practicing recommended healthy diet behaviour indicates improved uptake of promoted behaviours.  The context, programme approaches, and delivery mechanisms should be reviewed if there is no change or a decrease.

When interpreting results, it is essential to review contextual and other contributing factors that may have affected behaviour change, in addition to examining the intervention itself.

REPORTING EXAMPLE(S)

Survey results from the SBC programme in Bangladesh indicate an improvement in the proportion of individuals practicing recommended healthy diet behaviours between the baseline in 2021 and the last follow-up in December 2022. A 10% improvement was registered between the two periods reflecting the effectiveness of the SBC programme approaches in changing the dietary practices of the target population.

INDICATORS COLLECTED & ANALYSED AT THE SAME TIME

The following indicators may be reported along with this indicator:

Outcome indicators:

• 2. Food Consumption Score-Nutrition (FCS-N)

• 10. Proportion of children aged 6-23 months who receive a minimum acceptable diet (MAD)

• 11. Minimum diet diversity for women and girls of reproductive age (MDD-W)

Output indicators:

• T.1 Number of people (Tier 1) receiving direct food/cash-based/commodity vouchers/individual capacity strengthening transfers (disaggregated by sex, age group, residence status, modality and activity)

• T.2 Number of people indirectly benefiting (Tier 2) from an asset, knowledge and capacity, commodities or services delivered through WFP programmes

Intermediate behaviours and change the text as below:

It is recommended that programmes include intermediate indicators in their monitoring frameworks alongside the measurement of this indicator. The intermediate indicators should measure key behavioural drivers in terms of capability, opportunity, and motivation as outlined in the SBC programme.

These could include:

• Percentage of caregivers who are confident they can prepare iron-rich foods for their children

• Percentage of caregivers who find it easy to feed their children diverse foods daily

COMPLEMENTARY QUALITATIVE RESEARCH

Using qualitative methods to triangulate and gain a deeper understanding of quantitative findings is encouraged. These include focus group discussions, key informant interviews, and observations.

DECISIONS DATA CAN INFORM

This indicator assesses the progress of WFP's SBC programmes aimed at promoting healthy diets. The data collected on the indicator establishes the success of the SBC programmes and informs decisions about the continuation of approaches or strategic modifications required to achieve intended outcomes. Further, the indicator informs strategic decisions on resource allocation and approaches needed to make intended changes – for example, if there is no change in the percentage of individuals practicing recommended healthy diet behaviour, it may signal a need for increased investment in nutrition education, behaviour change communication, or other interventions to improve dietary practices. SBC programmes can use this indicator to review existing targets or set realistic targets and goals for future programs and initiatives.

VISUALIZATION

Example:

Figure: Percentage of individuals practicing recommended healthy diet behaviour

LIMITATIONS

Ideally, SBC indicators are incorporated into a programme theory of change to allow for the attribution of SBC approaches in achieving programmatic and behavioural objectives. However, it is not always a linear process and, therefore, challenging to attest attribution of an SBC intervention to behavioural outcomes as many factors could influence behaviour change.

A further consideration that may limit measurement is the variability of change in practice over periods- that is, changes in practice may not be stable over long periods depending on circumstances.

The timeframe in which an individual has adopted or practiced a behaviour will vary based on the recommended behaviour. The individual should have satisfied a specific criterion for that behaviour. Therefore, the data collection plan should take these aspects into consideration.

Another issue is the bias that may be created due to self-recall measurement questions that behaviour measurement surveys lean towards. Responses can be influenced by the respondent's judgment, cooperation, and memory (as well as by the surveyor’s skills). Gaps may exist between what is said and what is done. This should be accounted for to the extent possible during the analysis and interpretation of survey findings.

FURTHER INFORMATION

Social and Behaviour Change (SBC) | WFPgo