Understanding How Participating in a Food-Assistance Program In Rural Guatemala Alters Household Dietary Choices
There is growing concern that food-assistance programs may contribute to overweight and obesity, but the factors that determine households' decisions regarding food quality and quantity in the context of food aid are not well understood. We studied these decisions using the community randomized design for Programa Comunitario de Diversificación Alimentaria (PROCOMIDA) in Guatemala, part of Preventing Malnutrition in Children Under Two Years of Age Approach. PROCOMIDA provides food rations (rice, beans, oil, and corn-soy blend), behavior-change communication, and health-sector strengthening. We conducted semi-structured interviews and six focus groups with 63 households in six villages participating and not participating in the program. A 24-hour dietary recall and a food frequency questionnaire with the use of food cards were included in the interviews as quantitative measures of assessing dietary choices. Qualitative analysis was done using thematic coding based on a priori and emergent codes. Two-level mixed modeling and Chi-square testing were used to assess differences in household food choices between the two groups. PROCOMIDA households scored higher on the composite food-frequency score that was developed to assess changes in dietary choices. They reported a higher consumption of foods provided by the program and of foods indicative of dietary quality (local plants, vegetables and eggs), and were more likely to have consumed foods from the "Legumes and nuts" and the "Dairy products" food group, in the 24-hour diet recall. The qualitative interview data were crucial for understanding these differences. We developed a model in which we display that the combined influence of aspects related to program components affect the factors influencing food choice, and these factors subsequently affect the household food choices that are made. PROCOMIDA altered household dietary choices and resulted in an improvement in the quality of the diet of its program participants.
Medicine and Health Sciences, Public Health, Public Health Education and Promotion, food aid programs, food assistance programs, Guatemala, health, indigenous, nutrition
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