Material and Methods

Design and setting

To investigate the effects of targeted nutritional education, a mixed-methods pre–post intervention study was conducted in three Government schools of Karnataka, one each in Bagalkot, Belagavi and Raichur districts. All students in grades six and seven in the three schools were invited to participate in the study. Written informed consent was obtained from the students’ parents and assent from the students. Pre and post - intervention tests were used to measure changes in adolescents’ awareness due to the intervention, and qualitative interviews were used to capture reactions and facilitators or barriers to the implementation of the intervention.

Nutrition education intervention

A multimodal learning approach was used as a basis to develop the intervention. The education intervention was delivered through teachers and divided into seven sessions containing lectures, role play and practical demonstrations. Teachers were chosen as educators to ensure sustainability of the intervention and students of grades six and seven were chosen, considering the higher attrition among older students. The content and modes of delivery were co-developed through multiple deliberations and discussions with community leaders, local school teachers and nutrition experts. The resource materials were adapted from the resources available for the Anemia Mukt Bharat programme and the National Institute of Nutrition. The final intervention materials included illustrative, pictorial, and colourful books, cards, wall charts, handbooks for teachers and food samples (legumes, grains, dry fruits, vegetables etc.). Emphasis was put on ensuring that materials developed were appealing to children and easy to understand. All materials were translated into the local language (Kannada) with photos of local foods added, and messages modified as appropriate for the Kannada language. The sessions covered: (i) Balanced diet; (ii) Anaemia and its importance; (iii) Anaemia in pregnancy; (iv) Diet and anaemia – iron-rich foods; (v) IFA supplementation; (vi) Myths and facts about IFA, do’s / don’ts of IFA consumption; (vii) Good habits to be adopted; (viii) Summary and mantras for adolescent health. The intervention was delivered in Kannada in sessions of approximately half an hour once every week for seven weeks.
A total of 11 teachers (one male and 10 female) from the three schools were initially provided a one-day in-person training on the materials and approach before the start of the intervention. Regular online weekly refresher training was conducted during the intervention to reinforce the material and resolve any challenges.