Maternal knowledge after nutrition behavior change communication is conditional on both health workers knowledge and knowledge-sharing efficacy in Rural Haiti

In the context of a food assistance program in rural Haiti, we developed measures of the effectiveness of community health worker (CHW)-delivered behavior change communication (BCC). We administered knowledge tests to 954mothers and 38 CHWs to define 4 measures: CHW knowledge, maternal knowledge, knowledge-sharing efficacy(proportion of CHW knowledge shared), and shared correct knowledge between the CHWs and the mothers with whomthey interacted. On the basis of the tests, CHWs had high knowledge (93% correct), mothers scored 72% on maternalknowledge, the proportion of CHW knowledge shared was 75%, and shared correct knowledge between CHWs andmothers was 70%. Factors affecting maternal knowledge included CHW characteristics (unmarried: β = -0.070, P < 0.05), long duration (19-45 mo) of program participation (β = 0.034, P < 0.05), and having multiple sources of health and nutrition information (β = 0.072, P < 0.01). Shared correct knowledge and CHW knowledge-sharing efficacy were positively associated with CHW (age, education) and program participation characteristics. We parsed the relative contributions ofCHW characteristics to total and proportion of shared CHW knowledge. We observed a positive association betweenCHWeducation and shared correct knowledge between the CHWs and mothers (β = 0.328, P < 0.01), not because ofmoreknowledge (β = -0.012, P > 0.05) but rather because of greater knowledge-sharing efficacy (β = 0.340, P < 0.01). Thesemeasures provide a means of examining features of program delivery and interpreting impact evaluation results. They showthat BCC outcomes are conditional on both frontline workers knowledge and knowledge-sharing efficacy. Whereas mostprograms focus on content training to improve CHWs knowledge, it is also important to strengthen process training andsupport to foster knowledge-sharing efficacy. © 2013 American Society for Nutrition.