Effect of Nutrition Education Intervention Based on Health Belief Model on Dietary Diversity Practices of Pregnant Women in Rural Western Ethiopia: A Cluster Randomized Controlled Trial, 2026
Abstract:
Inadequate dietary diversity during pregnancy is a major public health concern in Ethiopia, contributing to maternal undernutrition and adverse pregnancy outcomes. Theory-based nutrition education interventions have shown promise but have not been rigorously evaluated in remote, low-resource settings using cluster-randomized designs. This study aimed to assess the effect of a nutrition education intervention based on the Health Belief Model (HBM) on dietary diversity practices of pregnant women in rural western Ethiopia. A community-based pretest-posttest cluster-randomized controlled trial was conducted among 328 pregnant women (164 per arm) selected from 22 kebeles in Nuer Zone, Gambella Region, from March to June 2026. A 24-hour dietary recall was used to assess dietary diversity. Generalized Estimating Equations (GEE) fitted with a negative binomial distribution and Difference-in-Differences (DiD) were used to assess the intervention effect. At baseline, both groups exhibited comparable proportions of inadequate dietary diversity (intervention 75.3%, control 73.0%). At endline, the proportion of pregnant women with adequate dietary diversity rose from 24.7% to 73.5% in the intervention group but declined from 27.0% to 6.9% in the control group. In the adjusted GEE model, the intervention led to 42.5% greater relative increase in Dietary Diversity Score (IRR = 1.425, 95% CI: 1.322–1.535, p < 0.001), indicating robust improvement in dietary diversity and protection against seasonal dietary decline. An HBM-based nutrition education intervention significantly improved dietary diversity among pregnant women in rural western Ethiopia. Integrating behaviorally informed nutrition education into routine antenatal care services is recommended to improve dietary diversity of pregnant women in resource-limited settings.References:
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