Impact of Behaviour Change Communication Intervention on Responsive Feeding Practices of Caregivers of Infants and Young Children, 6-23 months in Ghana

Background Optimal infant and young child feeding is critical to healthy growth and cognitive development during the first two years of life. The World Health Organization’s Complementary Feeding (CF) guidelines emphasize not only what to feed but also how , with Responsive Feeding (RF) being a key psychosocial component that encourages sensitive, non-coercive interactions that respond to children's hunger and satiety cues. This study examined the factors associated with RF and Feeding During Illness and Recovery (FDIR) practices, and evaluated the effect of a Nutrition Behaviour Change Communication (NBCC) intervention, aligned with WHO CF guidelines, on these practices among caregivers of children aged 6–23 months in the Bosomtwe District of Ghana. Method A total of 525 mother-infant pairs were recruited at baseline: 322 (61.3%) received the NBCC intervention while 203 (38.7%) served as controls. The six-month intervention included structured education, personalized counselling, and practical demonstrations on appropriate CF and RF. Data on RF and FDIR practices were collected pre- and post-intervention and analysed using Mann-Whitney U tests, paired t-tests, and logistic regression. At baseline, only 6.3% of caregivers demonstrated good RF practices, and a mere 3.0% practiced appropriate FDIR. Results No significant associations were observed between caregivers' socio-demographic characteristics and feeding practices. Importantly, caregivers with poor RF had markedly lower odds of practicing good FDIR (OR = 0.03, p < 0.001). Pre-intervention RF practices were similarly poor across intervention (94.4%) and control groups (92.6%, p = 0.408). However, post-intervention, the proportion of caregivers practicing poor RF reduced by over 50% in the NBCC group (to 40.2%) compared to only a marginal reduction in controls (86.8%, p < 0.001). Improvements in FDIR mirrored these trends. Post-intervention, NBCC participation was strongly associated with reduced odds of poor RF (OR = 0.1, 95% CI p < 0.001 ), a reversal from baseline trends. Conclusion These findings underscore the transformative potential of well-designed, context-sensitive behaviour change communication grounded in global best practices. Scaling up NBCC interventions aligned with WHO guidelines can substantially improve caregiver feeding behaviours, particularly in low-resource settings, thereby enhancing child health outcomes during this critical developmental window.