Assessing Care: Progress towards the Measurement of Selected Childcare and Feeding Practices, and Implications for Programs

The role of care as a critical influence on child nutrition, health, and development has received increasing attention in the last decade. While the role of care has been well elaborated at a conceptual level, we still lack simple, valid, and reliable tools to measure many aspects of care. In this review, experience with the measurement of selected childcare and feeding practices is summarized and implications for programs are discussed. Hygiene practices The use of interviews and recall methods is discouraged for the measurement of hygiene practices because research has shown that responses tend to be biased towards overreporting of “good” practices. Observational methods are therefore the method of choice, but they are subject to problems of reactivity—that is, that people behave differently in the presence of an observer—and normal day-to-day variability. Spot-check observations are an increasingly popular alternative, as they are less time consuming and costly and appear to be less reactive. However, like structured observations, they are subject to problems of day-to-day variability. Approaches to minimize biases and errors due to reactivity and day-to-day variability are discussed. Feeding practices Most feeding practice research has focused on the dietary aspects of feeding, and primarily on breastfeeding and complementary feeding. These practices are usually measured by maternal recall, but little evidence exists to document the reliability and validity of maternal recall of these practices. Recall errors may be particularly problematic when long recall periods are involved and when recall periods vary widely between respondents (e.g., when mothers of all children under 5 years of age are asked to recall early breastfeeding practices). Recall bias also may occur, especially following