Trust in targeting: Perceptions of the appropriateness of targeted balanced energy and protein supplementation based on maternal thinness in Bangladesh
4 affiliations
- 1Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA; Corresponding author. 615 N Wolfe Street, Baltimore, MD, USA
- 2Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD, USA
- 3James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- 4JiVitA Bangladesh, Rangpur, Bangladesh
Abstract
Rationale: Targeting balanced energy-protein (BEP) supplements to mothers at greater nutritional risk has been proposed to increase cost effectiveness in resource limited settings. In practice, the success of targeted programs may rely less on targeting metrics and more on community perceptions and trust in program staff. Objective: To examine how pregnant women and their families perceived BEP targeting criteria of low body mass index and inadequate gestational weight gain and how relational dynamics with health workers influenced targeting's appropriateness. Methods: A mixed-methods study was conducted in northwest Bangladesh among participants in a randomized trial evaluating targeted BEP's effect on birth weight. Interviews and focus groups were conducted with 98 women, husbands, mothers-in-law, and community health research workers (CHRWs). Qualitative data were analyzed thematically, and quantitative data were analyzed using Top 3 agreement and Spearman's Rho. Results: Pregnancy was perceived by participants as a vulnerable period, and concerns arose that targeting could deprive non-recipients of benefits. Locally appropriate targeting criteria included experiential signs of deficiency, like weakness, rather than anthropometric categories, like thinness. Women who received additional counseling on weight faltering expressed greater support for weight-based targeting criteria. Women and families cited trusting relationships with CHRWs as reasons for intervention acceptance, although trust in CHRWs did not automatically translate into acceptance of targeting. Conclusions: Targeting is often justified based on cost-effectiveness, but attention to community trust is essential. Programs pursuing targeted supplementation should incorporate frontline counseling that bridges biomedical and emic understandings of vulnerability, while recognizing that such trust is negotiated at the household and community level. Clinicaltrials.gov registration: NCT05576207.
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BibTeX
@article{boer2026trust,
title = {{Trust in targeting: Perceptions of the appropriateness of targeted balanced energy and protein supplementation based on maternal thinness in Bangladesh}},
author = {Mary de Boer and Anna Kalbarczyk and Eleonor Zavala and Pragna Paramita Mondal and Atiya Rahman and Nazrana Khaled and Rezwanul Haque and Hasmot Ali and Towfida Siddiqua and Svea Closser and Kaosar Afsana and Parul Christian and Andrew L. Thorne-Lyman},
journal = {SSM: Qualitative Research in Health},
year = {2026},
month = oct,
doi = {10.1016/j.ssmqr.2026.100885},
url = {https://doi.org/10.1016/j.ssmqr.2026.100885},
note = {CC BY},
}
RIS
TY - JOUR
TI - Trust in targeting: Perceptions of the appropriateness of targeted balanced energy and protein supplementation based on maternal thinness in Bangladesh
AU - Mary de Boer
AU - Anna Kalbarczyk
AU - Eleonor Zavala
AU - Pragna Paramita Mondal
AU - Atiya Rahman
AU - Nazrana Khaled
AU - Rezwanul Haque
AU - Hasmot Ali
AU - Towfida Siddiqua
AU - Svea Closser
AU - Kaosar Afsana
AU - Parul Christian
AU - Andrew L. Thorne-Lyman
PY - 2026
DA - 2026/10/30
JO - SSM: Qualitative Research in Health
DO - 10.1016/j.ssmqr.2026.100885
UR - https://doi.org/10.1016/j.ssmqr.2026.100885
AB - Rationale: Targeting balanced energy-protein (BEP) supplements to mothers at greater nutritional risk has been proposed to increase cost effectiveness in resource limited settings. In practice, the success of targeted programs may rely less on targeting metrics and more on community perceptions and trust in program staff. Objective: To examine how pregnant women and their families perceived BEP targeting criteria of low body mass index and inadequate gestational weight gain and how relational dynamics with health workers influenced targeting's appropriateness. Methods: A mixed-methods study was conducted in northwest Bangladesh among participants in a randomized trial evaluating targeted BEP's effect on birth weight. Interviews and focus groups were conducted with 98 women, husbands, mothers-in-law, and community health research workers (CHRWs). Qualitative data were analyzed thematically, and quantitative data were analyzed using Top 3 agreement and Spearman's Rho. Results: Pregnancy was perceived by participants as a vulnerable period, and concerns arose that targeting could deprive non-recipients of benefits. Locally appropriate targeting criteria included experiential signs of deficiency, like weakness, rather than anthropometric categories, like thinness. Women who received additional counseling on weight faltering expressed greater support for weight-based targeting criteria. Women and families cited trusting relationships with CHRWs as reasons for intervention acceptance, although trust in CHRWs did not automatically translate into acceptance of targeting. Conclusions: Targeting is often justified based on cost-effectiveness, but attention to community trust is essential. Programs pursuing targeted supplementation should incorporate frontline counseling that bridges biomedical and emic understandings of vulnerability, while recognizing that such trust is negotiated at the household and community level. Clinicaltrials.gov registration: NCT05576207.
SN - 2667-3215
ER -