Theorizing child nutrition interventions: a scoping review of the behavior change wheel

Background: Child malnutrition undermines holistic development and contributes to premature death and developmental disability. Although preventable, child malnutrition persists due to suboptimal nutrition interventions. Mounting evidence has demonstrated that nutrition interventions informed by sound theoretical frameworks are effective in improving child nutrition outcomes. This scoping review aimed to map the coverage of the behavior change wheel (BCW) underlying the design, implementation, and evaluation of child nutrition interventions. Methods: In accordance with the Preferred Reporting for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, seven electronic databases were searched via the Population, Concept, and Context (PCC) framework. Peer-reviewed English-language articles published from January 2016 to June 2024 that applied BCW in nutrition interventions for children (aged <18 years) were identified. Data were extracted from eligible articles and analyzed viathematic content analysis. Results: The initial search yielded 2,460 articles. After deduplication and application of the inclusion criteria, 22 articles were included in the final review. The findingsshow that (i) BCW interventionfunctions are more commonly used than policy categories are; (ii) most articles explicitly use the COM-B model, but the behavior to change is not explicit; and (iii) all interventions are implemented in stable, high-income contexts, with one exception reported in one low-/middle-income country. Most articles converge toward using the BCW as the most comprehensive framework. Conclusion: This review consolidates evidence on the use of the BCW in child nutrition interventions, with little illumination of the differential contributions of each model component. It highlights a predominant focus on contexts in high-income countries and on outcomes such as overall nutritional improvement and obesity prevention, whereasinterventions addressing stunting, wasting, and micronutrient deficiencies remain scarce. Future research should investigate the limited use of BCW in low- and middle-income countries and in emergency and humanitarian contexts.