The Psychosocial Resources Caregivers Need to Provide Nurturing Care: How Can We Help?

By Neha Jhaveri , Social and Behavior Change Specialist, USAID Advancing Nutrition ; Courtney McLarnon, Monitoring, Evaluation and Learning Advisor, Agency for All Project , Center on Gender Equity and Health at University of California San Diego; Kate Dickin, Associate Professor, Master of Public Health Program, Department of Public & Ecosystem Health, 美国康奈尔大学 ; Stephanie Martin, Assistant Professor, Gillings School of Global Public Health, Department of Nutrition, 美国北卡罗来纳大学教堂山分校

Proper care for a child—including all components of nurturing care—plays an integral role in shaping children’s health, nutrition, and development. But how can programs and services best support nurturing care? Many nutrition programs focus primarily on the caregivers responsible for providing nurturing care to infants and young children by providing them with information and motivational messaging related to care and feeding practices. However, to create lasting change, information and motivation are not enough—caregivers need to be able to draw on a variety of resources and support. These include more obvious resources like food, money, and other material goods to support caregiving, as well as intangible and psychosocial resources such as self-efficacy, mental health, social support, and time sufficiency, which are often overlooked by programs.

These intangible caregiver resources underlie caregivers’ ability to participate in programs and services, and to practice and sustain recommended behaviors to ensure positive child nutrition outcomes. While these resources can help improve the quality of care that caregivers can provide, the sources of the resources may include the family and the broader community. Programs and services are likely to be more effective when their reach goes beyond the caregiver’s actions to consider the wider familial, social, and political structures that surround and support caregiving behaviors. Acknowledging these broader influences on caregiver resources, which in turn impact nutrition and health outcomes, helps take the burden off of caregivers and strengthen enabling environments for care across the levels of the socio-ecological model.

Fostering Caregiving Agency

Understanding agency is an essential component of designing programs that provide and support caregiver resources. If a caregiver does not believe they can change a particular behavior or does not have the power to act towards a desired behavior change, their ability to improve and sustain their provision of nurturing care will be curtailed, potentially severely. Agency is when individuals or groups are aware of their ability to make choices, set individual or collective goals, and take action (and possibly face resistance) to reach those goals. These choices, goals, and actions are influenced by the social norms particular to every community and the internal and external resources that are available to caregivers. Both agency and caregiver resources:

(a) are needed for caregivers to change behaviors,?

(b) reflect similar social and structural factors, and

(c) could and should be addressed by similar program approaches that go beyond information and motivation to support growth and well-being of the caregiver.

Self-efficacy is closely related to agency, and refers to a person’s belief that they can undertake specific actions or succeed at tasks. Without the internal perception that one can provide as a caregiver, one may not make goals to support those around her. Self-efficacy, for example, is essential to intentional action to achieve one’s goals. Caregiver resources encompass both internal attributes (e.g. mental health, time sufficiency, perceived health) and external conditions (e.g. social support, safety and security) that can facilitate or constrain agency to work towards improved provision of nurturing care. As such, designing programs to promote and enable agency—and measuring those changes—is an important aspect of helping us to further understand caregiver resources and their role in nutrition outcomes.

By understanding, measuring, and addressing caregiver resources and agency, programs can enhance efforts to improve child nutrition. Strengthening these resources also serves to improve caregivers’ own well-being, their interpersonal relationships, and quality of life.

Measurement to Support Caregiving

Measuring caregiver resources in health and nutrition programs and services is essential to better understand where these resources fit in the pathways by which programs improve nurturing care. In turn, this will also help staff and partners recognize the valuable roles of caregivers, and develop comprehensive ways to to build caregiver resources and support caregivers’ contributions to child health, nutrition, and development. The Measuring Caregiver Resources Toolkit developed by USAID Advancing Nutrition provides guidance on identifying caregiver resources of interest to build a comprehensive program theory of change or monitoring and evaluation plan. Explore the Caregiver Resources Toolkit measures for ideas on how to measure caregiver resources that your program aims to impact or needs to have in place to make behavior change possible.

Measuring Agency

The USAID -funded Agency for All Project works to improve and sustain health and agency for women, girls, and communities through locally-led, equitable partnerships focused on understanding agency and its role in converting intentions into action within social and behavioral change programs. Agency for All centers the importance of agency across all project facets, and is currently working to address conceptual and measurement gaps in health-related social and behavior change research and practice by developing contextually relevant measures of agency, strengthening evidence on approaches to increase agency for sustained health and well-being, and fostering the agency of local partners to generate and utilize evidence.?

Stay tuned to see how measures of agency fit into broader measures of individual and collective empowerment!