Impact pathways of a homestead food production program on women's dietary diversity: mediation analysis of a cluster-randomized trial in Bangladesh

Homestead food production (HFP) can improve nutrition through multiple pathways. Understanding their relative importance can optimize intervention design and impact. Using panel data on 2611 women (8600 observations) from a 1:1 cluster-randomized trial of 96 settlements in rural Bangladesh, we conduct multiple mediation analysis to investigate the impact pathways of a three-year HFP intervention on women’s dietary diversity. The pathways analyzed jointly accounted for 90% of the intervention’s total effect on dietary diversity, amounting to an increase in 0.38 (0.28-0.48) food groups. Garden production alone accounted for 77% of the increase (β=0.32 [0.23-0.41]), thus emerging as the key component to improving women's dietary diversity. Poultry production, nutrition knowledge, and market activity made much smaller contributions. These findings can guide the design of future HFP interventions, but similar analyses are needed across a range of interventions, outcomes, and settings to build a robust evidence base for improved nutrition.