Nutrition communication has been an integral part of health and nutrition interventions. Though nutrition services have improved the nutritional status of the targeted population, they have either not had the desired effect on dietary habits (Bull et al. 2014) or even if they did, their long term sustainability is not yet established (Black et al. 2017). According to Nutbeam (2000) health programmes that relied primarily on transmission of information without paying attention to the social and economic conditions of the participants failed to bring about sustainable changes in health behaviour. Distinguishing between ‘education’ and ‘literacy’, he considers literacy as a composite term to describe a range of outcomes to health education and communication activities. He identifies three levels of health literacy. Functional literacy that involves transmission of basic health knowledge, with limited goals conforming to prescribed actions. This approach lacks interactive communication and does not support individual autonomy. The next is interactive literacy that enables individuals to derive a meaning from health information and apply it in their daily lives. It supports development of personal skills, self confidence and motivation, leading to behaviour change. The third level is critical literacy that focuses on empowering individuals to question and critique information and practices so as to gain more control over life, events and situations. The latter has subsequently been applied in varied health and nutrition settings.
The integration of critical literacy in school health programmes emerged in Europe and North America in the mid 1980’s. It challenged the traditional top down approach of imparting information. It looked beyond the curriculum and paid attention to other domains such as school environment, school health policies, links with health services and partnership with the local community. This approach shifted health education into a new dynamic and political domain. It strove to improve students’ skills in advocacy and help them achieve a sense of empowerment. The new framework facilitated health literacy at all three levels proposed by Nutbeam and was in place in most European countries by early 1900 (St Leger 2001).
Brown (2015) describes the experience of introducing adult learning principles in a nutrition education programme for Mexican American women offered through adult education centres. The extension educators were challenged with providing a culturally sensitive nutrition education programme for weight loss to the participants. The design included a three-prong approach of programme planning, teaching and learning and research. A pilot study revealed that women wanted more time in the classroom for socialization and developing relationships. They did not like cooking unfamiliar foods and felt the classes offered more information than needed. A second series of classes were planned for 7 weeks at the end of which 15 women who attended 50% of the classes lost 35 cumulative pounds. They were also willing to share their learning with their counterparts in the community.
Students of a community college were involved in an interdisciplinary study of food and agriculture while simultaneously being involved in actual food production for low income members of their community (Adelman and Sandiford 2007). By growing and distributing food, students learnt about the extent of poverty and hunger prevailing in their own communities. They understood that the widespread use of synthetic chemicals by way of fertilizers and pesticides found in the foods that they ate and released into the environment was a threat to humanity. They were convinced that organic agriculture was possible and food security could be addressed at the local grassroots level. They got involved in the national alternate agriculture movement, rooted in local decision making, civic action and freedom from the corporate food industry.
The empowerment model of literacy requires a multidisciplinary approach drawing from the domains of education, development, communication and social sciences. This also raises the question of what pedagogic strategies may be adopted to raise critical thinking especially in resource poor settings with low formal literacy. The Brazilian educator Paulo Freire (1994) used dialogue as a pedagogic tool to raise the ‘critical consciousness’ of people with no formal literacy skills, that led to empowered achievements and outcome. Subsequently others who followed in his footsteps (Wallerstein and Bernstein 1988; Naiditch 2010) have also attributed to sustainable outcomes. A nutritional literacy programme in India modelled on Freire’s principles has reported that besides individual transformation towards healthy eating, participants could expand the scope of nutrition security from beyond food to one of healthy lifestyle such as giving up of tobacco and alcoholism (Narayanan and Rao 2019). Through group exercises, they reflected on the fact that during peak agricultural season they usually skipped meals. They sold the good quality grains and retained the lower quality ones for consumption. This helped them realize that they did not pay much attention to their health and were only filling their stomachs. From gaining access and control over forests to bringing in a variety of foods for cultivation, participants identified ways of improving food security. According to Gavaravarapu (2019) in India, only a small proportion of community nutrition research is devoted to nutrition education. Though there are a few scattered efforts in experimenting with newer communication approaches, there is a dearth of published literature. The paper discusses an action research programme on nutrition literacy using dialogue as a pedagogic tool to raise critical consciousness. It is being implemented by the NGO, MS Swaminathan Research Foundation and funded by the Department of Agriculture and Farmers’ empowerment, Government of Odisha under Rashtriya Krishi Vikas Yojana (RKVY) as part of an agricultural intervention programme in Eastern India. Since the project is ongoing, the paper presents the conceptual basis and methodology of implementation with some early observations from the field.
Definition of nutrition literacy
Krause et al. (2018) observe that, definitions of nutrition literacy were limited to describing the abilities needed to obtain and understand nutrition information. The International Union of Nutrition Sciences (IUNS) and the World Health Policy Forum in a joint initiative stress the need for an interdisciplinary approach and define Nutrition science ‘as the study of food systems, foods and drinks, and their nutrients and other constituents; and of their interactions within and between all relevant biological, social and environmental systems’ (Cannon and Leitzmann 2006). Hence an operational definition of nutrition literacy proposed in this project is ‘the process by which individuals/communities are empowered to critically analyse their nutrition situation and engage with existing social, cultural, biological, political and environmental realities meaningfully to achieve dietary diversity and have access to safe drinking water, sanitation and adequate health services in order to optimize nutrition outcomes’.
Embedding nutrition literacy in agricultural intervention
Nutrition sensitive agriculture is a food based approach to agriculture development that puts nutritionally rich foods, dietary diversity and food fortification at the heart of overcoming malnutrition and micronutrient deficiencies (FAO 2014). This involves addressing existing farming systems to be nutritionally sensitive. Farming System for Nutrition (FSN) is defined as ‘the introduction of agricultural remedies to the nutritional maladies prevailing in an area through mainstreaming nutritional criteria in the selection of the components of a farming system involving crops, farm animals and wherever feasible fish’ (Nagarajan et al. 2014). Embedding a nutritional literacy component in an agricultural intervention involves focusing on the opportunities available and challenges involved in the production and consumption of nutritious foods. Hence with due acknowledgement to the non-food factors involved in determining nutritional outcomes, the nutrition literacy project delimited itself to addressing crop and food related issues within the social, economic, political and environmental context of the participants.
Behaviour change communication (BCC) is a research-based consultative process of addressing knowledge, attitudes and practices of participants using a mix of interpersonal, group and mass-media channels, including participatory methods (UNICEF ROSA 2005). According to Nancy and Dongre (2021) BCC evolved gradually from health education and Information, Education and Communication (IEC). Several theories and models operating at the individual, interpersonal and community levels have been put forward to explain the core constructs of BCC. The approach of BCC is to develop communication strategies to promote appropriate positive behaviour and facilitate a supportive environment for people to initiate and sustain such behaviour. This concept is further expanded to social marketing (i.e.) ‘the application of marketing principles to enable individual and collective ideas and actions in the pursuit of effective, efficient, equitable, fair and sustained social transformation’ (Saunders et al. 2015) wherein the marketer becomes a facilitator and participant of change rather than being a behavior change agent.
The focus of BCC is individual behaviour change and does not take into account the social determinants. Individual behaviour change must be accompanied by social transformation such that power is distributed within various social and political institutions, paving the way for Social Behaviour Change Communication (SBCC) (UNICEF 2005). The ‘S’ in SBCC indicates that individuals and their social relationships are determined by larger structural and environment systems, such as gender norms, power hierarchies that include class and caste, cultural practices, the social, organizational and political atmosphere and local economy (Kumar 2020). SBCC adopts a socio ecological model integrating all the above aspects considered essential to address barriers and opportunities for social and behaviour change and to promote sustainable solutions (McKee et al. 2014). It is a process that is built on three key strategies—communication, behaviour change and social change.
The crux of SBCC’s implementation is dialogue, discussion and negotiations. Paulo Freire, the Brazilian educator, was a pioneer in the use of dialogue in adult literacy. Freire’s pedagogy recognizes that adult learners possess unique knowledge and it should be co-constructed and investigated with all participants; to enable this the classrooms should be democratic and learners must be given an opportunity to speak and break the ‘culture of silence’. They should be engaged in a critical dialogue to raise awareness about their own situation and given hope that they can change it. This process is called ‘conscientization’ where individuals recognize their potential and take action according to their new understanding. Dialogue is a co-operative activity involving respect and is linked with informed action and critical reflection (Freire 2005). The action reflection process enables learners to perceive the social, economic and political contradictions and to act in the context of these realities.
Bonatti et al. (2021) investigated how social learning and Freire’s key concepts were manifest in two case studies of food security in Brazil. The two initiatives were a community seed bank in the northeast of the country and distribution of biodiversity kits in the south. A mixed method approach was used based on semi-structured interviews and literature review. The community seed bank initiative at first maintained stocks of corn and beans that contributed to the conservation of local species and cultivars. A family could borrow a certain quantity of seed and repay it later after harvest plus a small percentage as decided by the community. The seeds network was a partnership between a local NGO and farmer organizations that had accumulated local knowledge. Through meetings farmers identified the seeds to be multiplied and places to do so. Agro ecological management was based on the knowledge of local farmers which included storage and silo making. The farm families promoted knowledge exchange through fairs, experimentation and the ‘Seeds of Passion’ cultural festival. Through these activities they shared the values and cultures of their land and sought dialogue with public policies and legal backing for family agriculture. The second initiative addressed the issue of disappearing landraces. A biodiversity kit consisting of local landraces was created through a participatory process involving local farmers, technicians and scientists. In the implementation phase, small holder farmers met with technicians in formal and informal meetings where they explained their food production process and articulated their demands and needs. They attended courses on agrobiodiversity, identified local farmer families for seed multiplication, made and distributed the kits to other farmers. The authors opine that local initiatives based on the interconnectedness of social learning and Freire’s concepts improved food security through the practice of landrace rescue as a strategy for food security.
According to Nichols (2021) there is a proliferation of nutrition sensitive agricultural endeavors that integrate women’s empowerment and nutrition BCC components. Qualitative data collected from two projects in India implementing nutrition sensitive agriculture was analyzed to find out how women interacted with different behaviour change messages. Women were more drawn to discussions on early marriage and dietary diversity than to those on gender and health, since the latter was more complex and difficult for facilitators to communicate. The study concluded that there is an unmet need for structured spaces for rural Indian women to discuss gendered aspects of health and diet and recommended that nutrition sensitive agricultural programmes should focus on the same. The question that emerges is do agriculture and nutrition interventions, create learning spaces for critical literacy? Do they enable people to question hierarchical relations within families and societies based on caste, class and gender relations that lead to consumption of nutrient deficient diets? A nutrition literacy programme that proposes to raise critical consciousness should therefore involve the key concepts of dialogue, action and reflection, along with the creation of an open space for engaging in these activities. With this understanding of nutritional literacy, behaviour change, critical reflection and use of dialogue as a pedagogic tool, a nutrition literacy component was designed and integrated in the agricultural intervention programme.