Developing and Testing an Integrated Behaviour Change Communication Model for Improving Infant and Young Child Feeding Practices in Northern Nigeria: Theoretical Grounding and Field Evidence

Behaviour change communication interventions targeting infant and young child feeding practices have shown variable effectiveness across Nigerian contexts, partly due to the absence of theoretically grounded, context-specific communication models that account for social norms, religious influences, and community communication dynamics in Northern Nigeria. This study developed and tested an integrated behaviour change communication model for improving infant and young child feeding practices across Kano, Sokoto, and Bauchi States in Northern Nigeria. A theory-driven design process drew on the Theory of Planned Behaviour, Social Cognitive Theory, and Normative Social Influence Models, adapted through formative research comprising ethnographic observation, 25 focus group discussions, and a baseline survey of 400 caregivers. The intervention model integrated mass media messaging through community radio, interpersonal counselling through community health workers, and community mobilisation through religious leader engagement. A cluster-randomised trial with 24 communities allocated to three intervention arms and a control arm evaluated the model's effectiveness over 12 months. Primary outcomes were minimum dietary diversity, minimum meal frequency, and exclusive breastfeeding initiation. Results demonstrated significant improvements in all three primary outcomes in communities receiving the integrated model compared to single-channel and control arms. Religious leader engagement was the most powerful moderator of behaviour change in conservative communities. The study contributes an original integrated behaviour change model and trial evidence specific to Northern Nigerian IYCF promotion. Keywords: behaviour change communication, infant feeding, IYCF, Northern Nigeria, cluster randomised trial