Using a barrier analysis to identify determinants of dietary diversity among adult men and women in rural Odisha, India

Abstract Introduction: Dietary diversity, a predictor of micronutrient adequacy, is low in rural Odisha, India. We conducted formative research to understand determinants of dietary diversity and to inform the design of an agriculture-nutrition intervention in rural Odisha. Methods: We conducted a sequential mixed-method study in June-July 2022. First, an abbreviated 24-hour dietary recall was conducted with 429 respondents from 11 villages to capture food consumption patterns. Then, a barrier analysis was conducted among 41 doers, who consumed ≥5 of 10 food groups, and 40 non-doers, who consumed <5 food groups, to identify enablers and barriers to dietary diversity. Closed-ended responses were analyzed using Fishers exact test. Open-ended responses were analyzed using rapid qualitative methods. Results: Participants in the barrier analysis included men and women from indigenous and non-indigenous groups. Most doers (88%) reported consuming 5 food groups in the past 24 hours. Non-doers reported consuming 2-4 food groups with almost half (47.5%) consuming 3 food groups in the past 24 hours. Accessibility to non-governmental policies, programmes or information channels was the only significant determinant of dietary diversity [p=0.016]. Qualitative results indicated that self-efficacy, access and affordability, perceived consequences of a diverse diet, and dietary practices associated with religious and cultural events influenced dietary diversity. Conclusion: These results indicate that individual, market, socio-cultural, and policy level factors were all determinants of dietary diversity in rural Odisha. Findings will be used to design a homestead food production intervention to target determinants for improved nutrition.