Changes in family knowledge, practices, and perceived competencies after a family-centered home-visiting program for chronic child malnutrition prevention in rural Ecuador: an uncontrolled pre-post study

Introduction Chronic child malnutrition (CCM) remains a major public health challenge, particularly in socially vulnerable settings, given its association with adverse developmental outcomes. Preventing CCM requires integrated approaches that combine nutritional support, healthcare, and the strengthening of family caregiving capacities. Objective To describe pre-to-post changes over 6 months in parental knowledge (primary outcome) and in practices and perceived competencies (secondary outcomes) related to the prevention and management of CCM among 208 pregnant women or mothers of children under 3 years of age participating in a family-support process guided by the principles of Family-Centered Practices (FCP) in a rural community in Santa Elena, Ecuador. Methods An uncontrolled longitudinal pre-post study with an embedded exploratory qualitative component was conducted within a community program involving biweekly home visits and monthly food kits. No concurrent comparison group was used. A 34-item, study-specific scale assessing knowledge, practices, and perceived competencies related to CCM prevention and management was administered before and after the intervention. In addition, 25 purposively selected mothers provided written responses to open-ended questions, which were analyzed deductively using four a priori categories. Results The total scale score increased significantly from pre- to post-assessment (mean difference = 8.03, 95% CI [4.53, 11.53], p < 0.001, d z = 0.31). The largest and only statistically significant domain-level change was observed in Knowledge ( d z = 0.66), whereas changes in Practices ( p = 0.425) and Competencies ( p = 0.080) were smaller and not statistically significant. Sixteen of 34 item-level comparisons remained significant after Holm-Bonferroni correction. Differences according to baseline nutritional status were descriptive and were not confirmed by the group-by-time interaction test. Qualitative responses illustrated perceived learning related to safe water, dietary practices, and greater confidence in food-related decision-making. Conclusion Participation in an integrated home-visiting and food-support program was associated with higher self-reported knowledge related to CCM prevention and management, whereas aggregate changes in practices and perceived competencies were not statistically significant. Given the uncontrolled design, concurrent food support, and use of a study-specific outcome measure, the findings should be considered preliminary. Controlled studies using validated measures and objective nutritional outcomes are needed to evaluate the contribution of family-centered support to CCM prevention.