Association between micronutrient powder information dissemination and caregivers' knowledge, health beliefs, and adherence in rural western China: a propensity score-matched analysis

Association between micronutrient powder information dissemination and caregivers' knowledge, health beliefs, and adherence in rural western China: a propensity score-matched analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between micronutrient powder information dissemination and caregivers' knowledge, health beliefs, and adherence in rural western China: a propensity score-matched analysis Xiannan Xian, Xiuchun Yao, Linhua Li, Jieyuan Feng, Yuju Wu, Huan Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6436855/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background In remote rural China, a micronutrient home fortification program has been implemented to prevent childhood anemia by providing free micronutrient powders (MNP) to caregivers. Effective information dissemination is essential for improving caregivers’ knowledge, beliefs, and MNP feeding adherence. However, evidence on how different communication channels and content influence these outcomes among caregivers remains limited in rural settings. This study aimed to examine the associations between MNP information dissemination and caregivers’ knowledge, health beliefs, and adherence to recommended MNP feeding practices, providing evidence to inform future health communication strategies in nutrition interventions. Methods A cross-sectional study was conducted in 2019 among 1,229 caregivers of children aged 6–36 months in six counties in western China, selected using a multistage sampling method. Data were collected through face-to-face interviews using structured questionnaires. Propensity score matching and regression analyses were performed to examine the associations between different channels and content of MNP information dissemination and caregivers’ MNP-related knowledge, health beliefs, and adherence to recommended MNP feeding practices. Results Receiving information from a doctor was positively associated with caregivers’ MNP-related knowledge ( β = 0.75, 95% CI = 0.59–0.91), health beliefs ( β = 0.75, 95% CI = 0.57–1.58), and adherence to recommended MNP feeding practices (OR = 1.96, 95% CI = 1.48–2.61). Receiving information from the mass media and wider community were both positively associated with caregivers’ MNP-related knowledge ( β mass media = 0.46, 95% CI = 0.13–0.79; β wider community = 0.25, 95% CI = 0.04–0.46) and health beliefs ( β mass media = 2.05, 95% CI = 0.85–3.24; β wider community = 0.83, 95% CI = 0.11–1.56). For MNP content, information on the benefits of MNP and how to use them were both positively associated with caregivers’ MNP-related knowledge ( β benefits = 0.62, 95% CI = 0.47–0.77; β feeding method = 0.22, 95% CI = 0.05–0.40), health beliefs ( β benefits = 1.73, 95% CI = 1.23–2.23; β feeding method = 1.27, 95% CI = 0.66–1.89) and adherence (OR benefits =1.37, 95% CI = 1.03–1.83; OR feeding method =1.56, 95% CI = 1.01–2.39). Conclusions Targeted MNP dissemination strategies—especially those delivered by doctors and emphasizing key content such as the benefits of MNP and proper feeding methods—may help to promote caregivers’ MNP-related knowledge, health beliefs, and adherence to recommended MNP feeding practices, which may contribute to improved child health in low-resource settings. These findings can inform the optimization of future information dissemination strategies for the micronutrient powder program in rural western China, contributing to healthier child development in these areas. Micronutrient powders Information dissemination Health beliefs adherence behavior Rural China Figures Figure 1 Introduction Anemia is a global public health problem that seriously affects the health of young children, with the World Health Organization (WHO) estimating in 2019 that 40% of children aged 6–59 months worldwide suffer from anemia [ 1 ]. Anemia in early life may lead to stunting, wasting, low body weight, and even adversely affect the future development of cognitive and immune function in affected children [ 2 ]. The WHO recommends improving child nutrition through the distribution of micronutrient powders (MNPs) in countries where the prevalence of child anemia is greater than 20% [ 1 ]. Since 2012, China has been implementing a micronutrient home fortification (MHF) program in its rural western regions and certain parts of its central rural regions. The MHF program distributes free MNPs to caregivers of children aged 6–24 months at township health centers and village clinics. Alongside distribution, these facilities are responsible for disseminating information to the public about the benefits of MNP and encouraging caregivers to receive and administer them. There is evidence that implementation of the program has led to significant improvements in child nutrition, as governmental child nutrition monitoring data indicate that anemia prevalence among children aged 6–24 months has decreased from 32.9% in 2012 to 23.5% in 2018 in all program implementation areas [ 3 ]. However, in the rural areas of western China, anemia rates remain concerningly high: A 2018 study found that about 40% of children aged 6–30 months in these regions were anemic[ 4 ], and a 2021 systematic review discovered that anemia rates among children 6–12 months of age soared as high as 50.09% [ 5 ]. The poorer performance observed in these areas may reflect regional disparities in health infrastructure, caregiver education and awareness, acceptability of MNPs, and variability in the implementation and communication strategies of the program [ 6 ]. Although China’s MNP program has led to commendable nutritional improvements [ 7 ], the adherence of caregivers to recommended MNP feeding practices is not optimal. Studies have shown that 36–50% of caregivers do not adhere to the program’s recommended feeding standards, and that many caregivers in the project areas either never adopt or remain completely unaware of MNP [ 8 , 9 ]. Finding ways to effectively disseminate information about MNPs to rural caregivers in order to encourage adoption and sustainment of MNP feeding is crucial for the program to attain desired outcomes in all target areas. For the caregivers of young children in rural western China, MNPs is a novel concept. According to the theory of diffusion of innovations, information dissemination is the first step in the acceptance of a novel item by a population. Lasswell (1948)’s “5W communication model” outlined the elements of information dissemination within society, including who, what content, through what channel, to whom, and with what effect [ 10 ]. According to this model, the pathways of communication as well as the content of communication are critical components of the information dissemination process. Previous research on health behaviors found that information dissemination can induce cognitive, decision-making, and behavioral change; for example, one study revealed that interpersonal information dissemination positively influenced the likelihood of condom use and condom-use behaviors among female college students [ 11 ]. Another study on medication purchasing behavior in patients with chronic illnesses discovered that individuals who received information from professional sources exhibited more positive medication purchasing behaviors [ 12 ]. However, limited research exists on MNP information dissemination in China beyond descriptions of the current state of dissemination, such as in studies by Wu et al [ 9 ]. In light of this, further investigation is needed to examine the relationship between MNP information dissemination and caregivers’ MNP knowledge, beliefs, and adherence to recommended feeding practices. The primary aim of this study is to evaluate the effectiveness of MNP information dissemination in rural western China to inform the development of optimized dissemination strategies. Specifically, we first describe the current status of MNP information dissemination among caregivers of young children. Second, we explore the associations between different dissemination channels and content and caregivers’ knowledge, health beliefs, and adherence to recommended MNP feeding practices. By examining both dissemination channels and the specific information content received through each channel, this study provides nuanced insights into which communication elements are most strongly associated with desired outcomes—particularly valuable in resource-limited settings where program implementers must prioritize among available strategies. Methods Study design and participants This study used a multi-stage whole cluster random sampling method to obtain the study population. In the first stage, six sample counties were randomly selected from among the 32 counties (19 of which were ethnic minority counties) in Sichuan province where the MNP program was carried out, including two majority Han counties, two minority Zang counties, and two minority Yi counties. In the second stage, six sample townships were randomly selected from among the townships in each sample county, for a total of 36 townships. In the third stage, 7-8 sample villages with more than 800 residents were randomly selected from each sample township, totaling 283 villages. In the fourth stage, from each sampled village, children in the eligible age range and their primary caregiver were included as participants in the study. The sampling and survey process is shown in Figure 1, total 1229 caregivers were surveyed. Figure 1 to be placed here. The MNP program provides free MNPs for children aged 6-24 months; however, implementation varied slightly from township to township, with some extending eligibility up to 36 months. Therefore, considering the actual ages of the children at the time of MNP consumption, those aged 6-36 months (along with their caregivers) were included in this study. The survey was conducted in October to November of 2019. Development of survey questionnaire Drawing from health communication theory and the health belief model [10, 13–15], a structured interview questionnaire was developed through a literature review, expert consultation, and team discussions. First, an initial questionnaire was prepared based on the literature review and field findings from a preliminary survey assessing the distribution, collection, and feeding practices of MNPs. Next, a Delphi expert consultation method was employed [16], involving 12 experts from various relevant fields, who participated in two rounds of consultations through email. Expert opinions were then compiled and used to refine the questionnaire through deletions, additions, and adjustments. The response rate was 100% and Kendall’s W coefficient was calculated at 0.433. The Cronbach’s alpha coefficients for the questionnaire dimensions ranged from 0.61-0.72 and KMOs ranged from 0.64-0.81. The questionnaire is available in Additional file 1. Outcome variable MNP-related core knowledge (RCK): Knowledge of MNPs was measured through 6 questions, which are as follows: (a) What ingredients are in the MNP?; (b) What is the purpose of the MNP?; (c) How many packets of MNP should be given to your baby in a week?; (d) How should you feed an MNP to your baby?; (e) How should you store the MNP?; and (f) If your child has black stools or yellow urine after taking MNP, do you think it is still okay to continue giving them MNP? Correct answers were worth 1 point and incorrect answers worth 0 points; RCK scores ranged from 0 to 6. MNP-related health beliefs (RHB): Health beliefs about MNPs were assessed with the Health Belief Model [15], which includes five dimensions: (a) Perceived Susceptibility: This dimension was evaluated using the following questions: “Is it possible for a baby up to 2 years of age to be deficient in nutrients?” and “Is it possible for a baby up to 2 years of age to be anemic?” (b) Perceived Severity: Two questions were used to measure this: “If a baby is chronically undernourished, do you think it may lead to negative consequences?” and “If a baby is persistently anemic, do you think it could lead to negative consequences?” (c) Perceived Barriers: This was assessed through three questions: “Do you find it convenient to receive the MNPs?”, “Do you think it is easy to understand how to use the MNPs?”, and “Do you find it easy to prepare the packets?” (d) Perceived Benefits: Two questions were used to measure perceived benefits: “Do you believe that using the MNPs consistently will make babies grow taller or stronger?” and “Do you believe that using the MNPs consistently will prevent babies from becoming anemic?” (e) Self Efficacy: This was measured with two questions: “Do you believe that you can solve a problem that arises (e.g., your child dislikes the taste) when feeding the MNP?” and “Do you believe that you can insist on feeding the MNP to the child?” The perceived susceptibility was scored on a 3-point scale, with the caregiver answering “would not” at -1, “fair” at 0, and “would” at 1; and the rest of the items were scored on a 5-point Likert scale, with caregivers scoring from -2 to 2 on a scale from “very unconvinced/unlikely” to “very convinced/likely”. If a dimension scores 0, it means that the caregiver has no apparent perception of beliefs on this dimension. The scores for all items were summed to give a total health belief score, with higher scores indicating better beliefs about adherence to feeding the MNP. Adherence to recommended MNP feeding practices (AMP): According to guidelines from China’s micronutrient home fortification program, caregiver adherence to the MNP is defined as feeding young children four or more sachets of MNP over a seven-day period, in accordance with program recommendations [17]. If MNP feeding was suspended at any time during the survey period due to reasons such as illness or temporary absence from the home, the average number of MNP packets fed per week was used to determine adherence status. AMP was included in the analysis as a binary variable in this study. Independent variables General characteristics: Child characteristics included age in months and sex. Caregiver characteristics included generation (parental or grandparental), age, gender, ethnicity, education level, occupation status, and household assets information. Household assets were assessed using a fixed asset score derived from principal components analysis. This score was determined based on the ownership of fixed assets within the household, such as refrigerators, air conditioners, water heaters, televisions, computers, internet access, washing machines, motorcycles, and automobiles. Households were then categorized into four asset levels: low, lower-middle, upper-middle, and high. MNP information dissemination: Caregivers were asked if they had received information about MNPs through the following dissemination channels: doctors, printed media (i.e., posters, bulletin boards, pamphlets), broadcast media (radio or TV), social media, family members, and friends, and relatives. If a caregiver reported receiving information about MNPs through a channel, we asked about the content that was received through that channel. We categorized doctors as a separate information channel due to their dual role as communicators and information channels. While they communicate MNP information directly to caregivers during MNP distribution, their professional expertise sets them apart from typical interpersonal communication within the general population. Finally, we divided all information channels into three broad categories: (1) doctors; (2) mass media, including printed media, broadcast media, and social media; and (3) the wider community, including family members, friends, and relatives. We sorted the content of disseminated MNP information into five groups: information that MNPs are free of charge; information about the benefits of MNPs; and information about feeding, storing, and handling adverse reactions to MNPs. Statistical analysis Propensity score matching was used to explore the effects of MNP information dissemination channels and content on caregivers’ RCK, RHB, and AMP. This method was adopted to minimize potential confounding by balancing observed covariates between groups exposed to different dissemination strategies [18]. Each dissemination channel or dissemination content was used as a subgrouping variable separately, and a model was constructed using logistic regression to compute propensity scores. Based on the scores, a 1:1 match with put-back was performed using the closest match method, with the caliper value set at 0.02. With the matched data, regression analyses were used to explore the specific role of each information dissemination channel or content on caregivers’ RCK, RHB, and AMP. Ethical approval The study was approved by the Medical Ethics Committee of **** (approval number: ****). Researchers introduced the background and significance of the study, the study process, the benefits and risks of the study, and personal privacy issues to the primary caregivers of the sampled children before survey conduction. Caregiver consent was obtained and informed consent forms were signed before survey conduction. Results General characteristics Table 1 shows the basic characteristics of the sampled children and caregivers. A total of 1229 caregiver-child dyads were included in this study. Among the children, 27.42% and 30.76% were between 13-18 and 19-24 months of age, respectively, with a male-to-female sex ratio close to 1:1. Among the caregivers surveyed, the ethnicity of caregivers was distributed as follows: Han at 35.42%, Zang at 29.72%, and Yi at 34.85%. Most caregivers were the sample child’s parent (69.19%). Nearly half of the caregivers had not received formal education, and 42.88% of caregivers remained at home with their children. Table 1. General characteristics of caregiver-child dyads (N=1229). Characteristic Number/( ±s) Percentage (%) Child’s age (months) 6-12 242 19.69 13-18 337 27.42 19-24 378 30.76 25-36 272 22.13 Child’s sex Male 647 52.61 Female 582 47.39 Caregiver’s gender Male 142 11.43 Female 1087 88.57 Caregiver’s ethnicity Han 435 35.42 Zang 366 29.72 Yi 428 34.85 Caregiver’s generation Parent 837 69.19 Grandparent 392 31.89 Caregiver’s education level No schooling 564 46.03 Primary school 312 25.35 Middle school 209 16.93 High school and above 144 11.69 Caregiver’s occupation Caregiver 527 42.88 Farmer 557 45.32 Other a 145 11.8 Household assets level Low 317 25.79 Lower middle 289 23.52 Upper middle 348 28.32 High 275 22.38 Information channel: doctors Yes 994 90.86 No 100 9.14 Information channel: mass media Yes 110 10.09 No 980 89.91 Information channel: wider community Yes 302 27.66 No 790 72.34 Information content: MNP is free Yes 502 45.43 No 603 54.57 Information content: MNP benefits Yes 703 63.62 No 402 36.38 Information content: MNP feeding method Yes 569 51.49 No 569 48.51 Information content: MNP storage method Yes 204 18.46 No 901 81.54 Information content: Responding to abnormal reactions Yes 92 8.33 No 1013 91.67 MNP-related core knowledge 3.81±1.38 MNP-related health beliefs 8.78±4.56 Adherence to recommended MNP feeding practices Yes 481 47.39 No 534 52.61 a Including Self-employed business, Government worker, nomads and so on. Table 1 to be placed here. Regarding information dissemination channels, doctors were the main channel, with 90.86% of caregivers reporting to have received information about MNP from doctors (Table 1). Regarding the content of the information, only a few caregivers had received information on how to store the MNP (18.46%) and how to respond to abnormal reactions (8.33%). Regarding caregiver’s adherence to MNP, 47.39% of caregivers demonstrated adherence to recommended feeding practices. Propensity score matching Logistic regression analysis was used to construct propensity scores, and three information dissemination channels and five information contents were used as grouping variables to match the research subjects. After 1:1 nearest neighbor matching with put-back, the standardized differences of confounding variables in each model decreased significantly, indicating that the research subjects were balanced on confounding variables after matching. The standardized differences of each model are presented in detail in Supplementary Table S1-S8. Regression analysis of MNP information dissemination on RCK, RHB and AMP after PSM Separate multifactor linear regressions or logistic analyses with matched data were conducted to explore the effects of information dissemination channels and content on caregivers’ MNP-related core knowledge (RCK), MNP-related health beliefs (RHB), and adherence to recommended MNP feeding practices (AMP). The regression results after controlling for confounders are shown in Table 2. Regarding information dissemination channels, receiving MNP information from a doctor was positively associated with RCK ( β =0.75, 95%CI [0.59-0.91]), RHB ( β =1.07, 95%CI [0.57-1.58]), and AMP (OR=1.96, 95%CI [1.48-2.61]). Moreover, receiving information from mass media and the community was also positively associated with RCK ( β mass media =0.46, 95%CI [0.13-0.79]; β wider community =0.25, 95%CI [0.04-0.46]) and RHB ( β mass media =2.05, 95%CI [0.85-3.24]; β wider community =0.83, 95%CI [0.11-1.56]). Regarding the content of information, receiving information on both MNP benefits and how to use MNPs were positively associated with RCK ( β benefits =0.62, 95%CI [0.47-0.77]; β feeding method =0.22, 95%CI [0.05-0.40]), and RHB ( β benefits =1.73, 95%CI [1.23-2.23]; β feeding method =1.27; 95%CI [0.66-1.89]), and AMP (OR benefits =1.37, 95%CI [1.03-1.83] and OR feeding method =1.56, 95%CI [1.01-2.39]). Table 2. Regression analysis of MNP information dissemination on caregivers’ RCK, RHB, and AMP after PSM. Independent variable Outcome RCK RHB AMP β (95% CI ) β (95% CI ) OR (95% CI ) Channel-doctors (N=655) 0.75(0.59-0.91) *** 1.07(0.57-1.58) *** 1.96(1.48-2.61) *** Channel-mass media (N=938) 0.46(0.13-0.79) ** 2.05(0.85-3.24) ** 1.02 (0.47-2.19) Channel- wider community (N=935) 0.25(0.04-0.46) * 0.83(0.11-1.56) * 1.27 (0.83-1.93) Content-free (N=893) -0.02 (-0.18-0.15) -0.39 (-0.94-0.15) 0.96 (0.69-1.33) Content-benefits (N=841) 0.62(0.47-0.77) *** 1.73(1.23-2.23) *** 1.37(1.03-1.83) * Content-feeding method (N=770) 0.22(0.05-0.40) * 1.27(0.66-1.89) *** 1.56(1.01-2.39) * Content-storage method (N=894) -0.06(-0.34-0.21) 0.37 (-0.67-1.41) 1.17 (0.62-2.20) Content-response to abnormal reactions (N=861) -0.08(-0.42-0.26) 1.15 (-0.01-2.30) 1.66 (0.66-4.14) Note: Owing to the caliper restriction in the propensity score matching, the number of participants included in each dissemination channel analysis differs from the original sample sizes reported in Table 1. Boldface indicates statistical significance(* p <0.05, ** p <0.01, *** p <0.001). N indicates the sample size on common support after PSM. a. Linear regressions of RCK and RHB controlled for the effects of the infant’s sex and age(months); caregivers’ sex, ethnicity, generation, education, occupation, and household assets, and the three types information dissemination channels and the five types of information dissemination contents. b. In the logistic regression of AMP, the effects of RCK and RHB were controlled for in addition to the above factors Sensitivity analysis of PSM Our sensitivity analysis also used logistic regression to construct propensity scores, but the matching method was changed to 1:2 nearest matching and the caliper value was set to a stricter 0.01. The research subjects were re-matched with the three information dissemination pathways and five information contents as the grouping variables. After matching, the standardized differences of the confounding variables in each model were substantially reduced, indicating a good matching effect. Detailed results are presented in Supplementary Table S9. Sensitivity analyses were conducted using data after 1:2 matching. The results showed that the direction and statistical significance of the β or OR values for the main study variables remained consistent across all models, indicating good model robustness and the reliability of the analysis results. Detailed results are presented in Supplementary Table S10. Discussion This study explored the associations between different channels and content of MNP information dissemination and caregivers’ MNP-related core knowledge (RCK), MNP-related health beliefs (RHB), and adherence to recommended MNP feeding practices (AMP) in the rural areas of western China. The findings of this study revealed that about 90% of the sampled caregivers received information about MNPs from doctors, suggesting that doctors in rural western China serve not only as MNP distributors but also as the main disseminators of MNP information, reaching the widest audience among the target population. However, the findings also showed that merely 30% and 10% of caregivers received MNP information from the community and mass media, respectively. This indicates that MNP information has not been extensively disseminated through these channels in the study area, despite their theoretical potential for reaching large audiences. Finally, in terms of information content, most caregivers received MNP information regarding its free availability, benefits, and feeding methods. Fewer caregivers received guidance on MNP storage methods and addressing adverse reactions to MNP. We also found that MNP information disseminated by doctors was a positive influencing factor for caregivers’ RCK, RHB, and AMP. This finding is similar to those of two studies conducted in Peru and Ethiopia, which highlighted the importance of guidance and counseling provided to caregivers by doctors who distribute MNP in promoting rural caregivers’ continued use of MNP [19, 20]. This was attributed to the fact that face-to-face guidance and counseling by an authoritative health professional can enable caregivers to master feeding techniques and bolster their confidence in MNP administration [20]. On the other hand, the literacy challenges associated with lower educational attainment among some caregivers may hinder their comprehension of printed textual media [19], underscoring the effectiveness of doctor-led promotional activities as a dissemination channel for caregivers with low socioeconomic status. It is important to note, however, that previous studies have identified instances where some MNP-distributing doctors have inadequate knowledge of MNP, potentially leading to negative impacts on caregivers’ MNP feeding behavior [21]. Thus, considering the important role played by doctors in MNP information dissemination, periodic training is essential to equip MNP-distributing doctors with the knowledge and skills necessary for proper MNP information dissemination. In this study, the utilization of mass media and community channels for MNP information dissemination was low. One possible explanation is that the study area includes ethnic minority regions with relatively low socioeconomic status and scattered populations [22], which may limit the accessibility of community-based dissemination. In addition, the generally low educational attainment among caregivers may hinder their ability to access or comprehend information disseminated via mass media. The study also found that, although these two channels were not associated with caregivers’ AMP, they were significantly positively associated with caregivers' RCK and RHB. According to social cognitive theory and the health belief model, knowledge and beliefs are influences on the cognitive dimension of behavior [15, 23], which means that information disseminated from these two channels may help promote caregiver feeding behavior by improving the necessary knowledge base and beliefs. Positive health beliefs being perpetuated by either individuals surrounding the caregiver or the media consumed by the caregiver may facilitate the caregiver’s MNP feeding behavior. Given that mass media and community channels are generally more accessible to caregivers than face-to-face consultations with doctors, they can serve as valuable supplementary channels for MNP information dissemination. However, it is important to ensure that mass media materials are tailored to the literacy levels of the target population. Using intuitive and low-literacy-friendly formats—such as videos, illustrated instructions, or audio messages—may enhance comprehension and engagement, particularly in rural or low-education settings. Finally, we found that information on the benefits of MNP and how to feed MNP were positive influencing factors for caregivers’ RCK, RHB, and AMP, but no association was found between information that MNPs are free of charge or information about storing and handling adverse reactions to MNPs and caregivers’ RCK, RHB, and AMP. This discrepancy may be attributed to caregivers' primary concern about the potential health outcomes of MNP for their children. Previous research suggests that caregivers tend to prioritize the health benefits of MNP over its economic cost. For example, a qualitative study conducted in underdeveloped areas of Bangladesh found that caregivers were willing to pay for MNP if they saw an increase in appetite in their infants and young children after consuming MNP, even if they had limited financial means [24]. This suggests that disseminating information on the benefits of MNP may reinforce positive health beliefs and promote the adoption of MNP feeding behaviors. Similarly, previous research indicates that caregivers may be hesitant to adopt or sustain MNP feeding due to concerns about their ability to administer it correctly [20]. Aligning with these findings, our study revealed a positive association between information on MNP feeding methods and caregivers' RCK, RHB, and AMP. While previous research identified a lack of knowledge on MNP administration as a barrier, our results suggest that targeted dissemination of feeding method information could be an effective strategy to enhance caregivers’ confidence and adherence to MNP feeding practices. Taken together, these findings indicate that caregivers place greater emphasis on information directly linked to MNP’s primary function—improving child nutrition. As a result, information on its benefits and proper usage may be perceived as more central to caregivers. In contrast, information on MNPs being free of charge, storage, and adverse reaction management may not be immediately relevant to caregivers' primary concerns, which could explain the lack of significant associations observed between these types of information and caregivers’ RCK, RHB, and AMP. Based on these findings, future efforts should focus on strengthening the training of MNP-distributing doctors to ensure the accuracy and quality of the information provided. In addition, greater investment is needed to expand the use of mass media and community channels as complementary communication platforms, especially through user-friendly, visual, or audio-based materials adapted to the needs of low-literacy populations. Tailoring content to emphasize the nutritional benefits and practical feeding instructions of MNPs may be especially effective in promoting caregiver adoption and continued use. Strengths and limitations Several strengths of this study set it apart from most previous research on MNP information dissemination. First, previous studies have focused more on the effectiveness of MNP information channels and less on the content of the information being disseminated. This study uniquely evaluates both dimensions—channels and content. This dual-focus approach enables a more nuanced understanding of how both the mode and substance of communication relate to caregivers’ knowledge, health beliefs, and adherence, thereby offering practical guidance for designing more effective dissemination strategies, particularly in resource-limited rural settings. Second, this study used propensity score matching, which resulted in a more balanced distribution of confounders across groups and a more accurate assessment of the effects of information dissemination, as validated by sensitivity analyses; therefore, the results can be considered robust and credible. However, several limitations warrant mention. First, it is not possible to draw causal conclusions from this study, and the fact that the sample consisted of caregivers of children aged 6–36 months in rural western China limits the generalizability of the findings to other caregiver populations. Future studies using causal inference methods should be conducted among caregivers in different regions or with children of varying ages to provide more robust evidence. Second, as this study relied on self-reported measures, the assessment of some variables may have been affected by reporting or recall bias. Third, we acknowledge that our study does not address the potential cumulative or interactive effects of exposure to multiple communication channels. Future research is warranted to examine whether multi-channel exposure enhances message effectiveness Conclusion The present study provides evidence that among the caregivers of children aged 6-36 months in rural areas of western China, MNP information dissemination channels and content are closely associated in different ways with caregivers’ MNP-related core knowledge, MNP-related health beliefs, and adherence to recommended MNP feeding practices. In terms of information channels, all three information channel categories, or doctors, mass media, and the wider community, were positively associated with caregivers’ MNP-related core knowledge and MNP-related health beliefs. Particularly, information disseminated by doctors is also positively associated with caregiver adherence to recommended MNP feeding practices. Regarding information content, information about the benefits of MNPs and how to feed MNPs were positively associated with caregivers’ MNP-related knowledge, health beliefs, and adherence. These findings underscore the need to strengthen doctor-led communication and optimize the design and delivery of MNP-related messages in future nutrition interventions, particularly by tailoring content to caregivers' core concerns and expanding the use of accessible community and mass media channels to promote equitable uptake of MNP programs in rural and resource-limited settings. Abbreviations AMP Adherence to recommended MNP feeding practices MHF Micronutrient home fortification MNP Micronutrient powders RCK MNP-related core knowledge RHB MNP-related health beliefs WHO World Health Organization Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Medical Ethics Review Committee of Sichuan University (Approval No. K2018103). All the caregivers of the sampled children signed an informed consent form prior to participation. And informed consent was obtained from the legal guardians of all children involved in the project. All of the participants were voluntary and their information was kept completely confidential. The methods used in this study were conducted according to the relevant regulations and standards. Consent for publication Not applicable. Data availability The datasets are not publicly available due to institutional policy. However, the data can be available through the corresponding author under reasonable request. Competing interests The authors declare no competing interests. Funding This study was funded by National Natural Science Foundation of China (Grant Number: 71874114). Author contributions XX, XY contributed to the conception and design of the study. XX, XY, LL contributed to data preparation, collection, and organization. XX performed the statistical analysis and wrote the first draft of the manuscript with assistance of XY，LL, JF. XY, LL, JF, YW, HZ contributed to manuscript revision. All authors read and approved the submitted version. Acknowledgments We greatly appreciate the collaboration of the local officials and all participants from each of the participating sites in this research. Also, we acknowledge the investigators from the West China School of Public Health in Sichuan University for their hard work and dedication. Author details 1 Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu 610041, China. 2 Department of Health Education, Chengdu Center for Disease Control and Prevention (Chengdu Health Supervision Institute), No.4 Longxiang Road, Chengdu 610041, China. 3 Stanford Center on China’s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA. References WHO, Anaemia. Apr. https://www.who.int/health-topics/anaemia . Accessed 10 2024. United Nations Children’s Fund, World Health Organization, International Bank for Reconstruction and Development. Levels and trends in child malnutrition: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: key findings of the 2020 edition. 2020. https://www.who.int/publications-detail-redirect/9789240003576 . Accessed 10 Apr 2024. China National Bureau of Statistics. Statistical monitoring report on the Outline for the Development of Chinese Children (2011–2020). 2019. https://www.stats.gov.cn/xxgk/sjfb/zxfb2020/201912/t20191206_1767561.html . Accessed 10 Apr 2024. Wang L, Sun Y, Liu B, Zheng L, Li M, Bai Y, et al. Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis. Int J Environ Res Public Health. 2018;15:1825. Du Y, Liao Y, Leng F, Li L, Ye R, Mao Y, et al. Anaemia prevalence and its associated factors in children under 5 years in Western China: a systematic review. BMJ Paediatr Open. 2022;6:e001185. Liu R, Ye R, Wang Q, Pappas L, Dill S-E, Rozelle S, et al. The association between micronutrient powder delivery patterns and caregiver feeding behaviors in rural China. BMC Public Health. 2022;22:1366. Li Z, Li X, Sudfeld CR, Liu Y, Tang K, Huang Y, et al. The Effect of the Yingyangbao Complementary Food Supplement on the Nutritional Status of Infants and Children: A Systematic Review and Meta-Analysis. Nutrients. 2019;11:2404. Zhou H, Sun S, Luo R, Sylvia S, Yue A, Shi Y, et al. Impact of Text Message Reminders on Caregivers’ Adherence to a Home Fortification Program Against Child Anemia in Rural Western China: A Cluster-Randomized Controlled Trial. Am J Public Health. 2016;106:1256–62. Wu Q, Zhang Y, Chang S, Wang W, Helena van Velthoven M, Han H, et al. Monitoring and evaluating the adherence to a complementary food supplement (Ying Yang Bao) among young children in rural Qinghai, China: a mixed methods evaluation study. J Glob Health. 2017;7:011101. Harold L. The Structure and Function of Communication in Society. New York; 1948. Francis DB, Zelaya CM, Fortune DA, Noar SM. Black College Women’s Interpersonal Communication in Response to a Sexual Health Intervention: A Mixed Methods Study. Health Commun. 2021;36:217–25. Ju I, Park T, Ohs JE. Consumer Engagement with Prescription Medicine Decisions: Influences of Health Beliefs and Health Communication Sources. Health Commun. 2020;35:135–47. Edwards MJC. Health Communication: A Handbook for Health Professionals. AORN J. 1985;42:952–952. Hayes J. Health communication: theory and practice. Health Expect. 2008;11:201–2. Becker ME. The Health Belief Model and Personal Health Behavior. Health Educ Monogr. 1974;2. Dalkey N. An experimental study of group opinion: The Delphi method. Futures. 1969;1:408–26. China Department of Maternal and Child Health. Circular on the issuance of the 2014 Nutrition Improvement Program for Children in impoverished Area. 2014. http://www.nhc.gov.cn/fys/s3585/201411/254523446f9241a3a3553e19dec77421.shtml . Accessed 14 Apr 2024. Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivar Behav Res. 2011;46:399–424. Pelto GH, Tumilowicz A, Schnefke CH, Gebreyesus SH, Hrabar M, Gonzalez W, et al. Ethiopian mothers’ experiences with micronutrient powders: Perspectives from continuing and noncontinuing users. Matern Child Nutr. 2019;15:e12708. Brewer JD, Shinnick J, Román K, Santos MP, Paz-Soldan VA, Buttenheim AM. Behavioral Insights Into Micronutrient Powder Use for Childhood Anemia in Arequipa, Peru. Glob Health Sci Pract. 2020;8:721–31. Reerink I, Namaste SM, Poonawala A, Nyhus Dhillon C, Aburto N, Chaudhery D, et al. Experiences and lessons learned for delivery of micronutrient powders interventions. Matern Child Nutr. 2017;13(1 Suppl 1):e12495. Guo S, Deng X, Ran J, Ding X. Spatial and Temporal Patterns of Ecological Connectivity in the Ethnic Areas, Sichuan Province, China. Int J Environ Res Public Health. 2022;19:12941. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall, Inc; 1986. Sarma H, Uddin MF, Harbour C, Ahmed T. Factors Influencing Child Feeding Practices Related to Home Fortification With Micronutrient Powder Among Caregivers of Under-5 Children in Bangladesh. Food Nutr Bull. 2016;37:340–52. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx Additionalfile2.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 10 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers invited by journal 15 May, 2025 Editor assigned by journal 13 May, 2025 Editor invited by journal 21 Apr, 2025 Submission checks completed at journal 17 Apr, 2025 First submitted to journal 17 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6436855","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458102074,"identity":"eba6a81a-3b94-40dd-8789-cfd2cf79b081","order_by":0,"name":"Xiannan Xian","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xiannan","middleName":"","lastName":"Xian","suffix":""},{"id":458102075,"identity":"3c0d960f-18b1-4ff7-8692-063caf7538a5","order_by":1,"name":"Xiuchun Yao","email":"","orcid":"","institution":"Chengdu Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Xiuchun","middleName":"","lastName":"Yao","suffix":""},{"id":458102076,"identity":"2870f535-af91-43ec-94b1-52b1dab4d22c","order_by":2,"name":"Linhua Li","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Linhua","middleName":"","lastName":"Li","suffix":""},{"id":458102077,"identity":"38bb1c85-7456-443a-b68c-a66bfefdd147","order_by":3,"name":"Jieyuan Feng","email":"","orcid":"","institution":"Stanford University","correspondingAuthor":false,"prefix":"","firstName":"Jieyuan","middleName":"","lastName":"Feng","suffix":""},{"id":458102078,"identity":"12c5d4ec-38ed-4852-a2da-71b8b4d9b4a1","order_by":4,"name":"Yuju Wu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yuju","middleName":"","lastName":"Wu","suffix":""},{"id":458102079,"identity":"c19d4dfe-6dfd-478d-afa4-ef1eebc8b3c6","order_by":5,"name":"Huan Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDACCQYGZhDND+Eyk6BFsoFkLQYHiNUiP7v5mHRhm12e8fnDzyQYKqwTG9jPHsCrhXHOsTTpmW3JxWY30swkGM6kJzbw5CXg1cIskWMmzdvGnLjtBg+bBGPb4cQGCR4DvFrYIFrqEzf3nwFq+UeEFh6IlsOJGxhygFoaiNAiIZGWbM1z7njijBtpxhYJx9KN23hy8GuRn5F88DZPWXVif//hhzc+1FjL9rOfwa8FFSSAfEeC+lEwCkbBKBgFOAAAozQ7uSJNWjkAAAAASUVORK5CYII=","orcid":"","institution":"Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Huan","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2025-04-13 02:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6436855/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6436855/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83198874,"identity":"e7ea5429-b8ba-4198-a249-a5b5f3b0aa15","added_by":"auto","created_at":"2025-05-21 06:06:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60874,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSampling framework\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLegend: Sampling framework of the study in six counties of western China. The flow diagram shows the multi-stage sampling strategy used to select caregiver-child dyads for the survey, including selection at the county, township, and village levels.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6436855/v1/63ba1ce8d82324f99613514c.png"},{"id":83201684,"identity":"52a1e9f5-d293-440c-8152-1679a103c878","added_by":"auto","created_at":"2025-05-21 06:30:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":972543,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6436855/v1/5f0deffd-f5f4-43f4-89c9-160852456ac0.pdf"},{"id":83198875,"identity":"a11e8139-eb6e-44b9-8da0-e1cd3b719869","added_by":"auto","created_at":"2025-05-21 06:06:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":33284,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6436855/v1/565e5fc3ff44cffbe6d3fbc6.docx"},{"id":83198904,"identity":"8bfd0568-e7fd-4938-ae58-325667c79399","added_by":"auto","created_at":"2025-05-21 06:06:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":51896,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6436855/v1/977bac7ff8901c158b42a9f4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between micronutrient powder information dissemination and caregivers' knowledge, health beliefs, and adherence in rural western China: a propensity score-matched analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnemia is a global public health problem that seriously affects the health of young children, with the World Health Organization (WHO) estimating in 2019 that 40% of children aged 6\u0026ndash;59 months worldwide suffer from anemia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Anemia in early life may lead to stunting, wasting, low body weight, and even adversely affect the future development of cognitive and immune function in affected children [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The WHO recommends improving child nutrition through the distribution of micronutrient powders (MNPs) in countries where the prevalence of child anemia is greater than 20% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince 2012, China has been implementing a micronutrient home fortification (MHF) program in its rural western regions and certain parts of its central rural regions. The MHF program distributes free MNPs to caregivers of children aged 6\u0026ndash;24 months at township health centers and village clinics. Alongside distribution, these facilities are responsible for disseminating information to the public about the benefits of MNP and encouraging caregivers to receive and administer them. There is evidence that implementation of the program has led to significant improvements in child nutrition, as governmental child nutrition monitoring data indicate that anemia prevalence among children aged 6\u0026ndash;24 months has decreased from 32.9% in 2012 to 23.5% in 2018 in all program implementation areas [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, in the rural areas of western China, anemia rates remain concerningly high: A 2018 study found that about 40% of children aged 6\u0026ndash;30 months in these regions were anemic[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and a 2021 systematic review discovered that anemia rates among children 6\u0026ndash;12 months of age soared as high as 50.09% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The poorer performance observed in these areas may reflect regional disparities in health infrastructure, caregiver education and awareness, acceptability of MNPs, and variability in the implementation and communication strategies of the program [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although China\u0026rsquo;s MNP program has led to commendable nutritional improvements [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], the adherence of caregivers to recommended MNP feeding practices is not optimal. Studies have shown that 36\u0026ndash;50% of caregivers do not adhere to the program\u0026rsquo;s recommended feeding standards, and that many caregivers in the project areas either never adopt or remain completely unaware of MNP [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Finding ways to effectively disseminate information about MNPs to rural caregivers in order to encourage adoption and sustainment of MNP feeding is crucial for the program to attain desired outcomes in all target areas.\u003c/p\u003e \u003cp\u003eFor the caregivers of young children in rural western China, MNPs is a novel concept. According to the theory of diffusion of innovations, information dissemination is the first step in the acceptance of a novel item by a population. Lasswell (1948)\u0026rsquo;s \u0026ldquo;5W communication model\u0026rdquo; outlined the elements of information dissemination within society, including who, what content, through what channel, to whom, and with what effect [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. According to this model, the pathways of communication as well as the content of communication are critical components of the information dissemination process. Previous research on health behaviors found that information dissemination can induce cognitive, decision-making, and behavioral change; for example, one study revealed that interpersonal information dissemination positively influenced the likelihood of condom use and condom-use behaviors among female college students [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Another study on medication purchasing behavior in patients with chronic illnesses discovered that individuals who received information from professional sources exhibited more positive medication purchasing behaviors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, limited research exists on MNP information dissemination in China beyond descriptions of the current state of dissemination, such as in studies by Wu et al [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In light of this, further investigation is needed to examine the relationship between MNP information dissemination and caregivers\u0026rsquo; MNP knowledge, beliefs, and adherence to recommended feeding practices.\u003c/p\u003e \u003cp\u003eThe primary aim of this study is to evaluate the effectiveness of MNP information dissemination in rural western China to inform the development of optimized dissemination strategies. Specifically, we first describe the current status of MNP information dissemination among caregivers of young children. Second, we explore the associations between different dissemination channels and content and caregivers\u0026rsquo; knowledge, health beliefs, and adherence to recommended MNP feeding practices. By examining both dissemination channels and the specific information content received through each channel, this study provides nuanced insights into which communication elements are most strongly associated with desired outcomes\u0026mdash;particularly valuable in resource-limited settings where program implementers must prioritize among available strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used a multi-stage whole cluster random sampling method to obtain the study population. In the first stage, six sample counties were randomly selected from among the 32 counties (19 of which were ethnic minority counties) in Sichuan province where the MNP program was carried out, including two majority Han counties, two minority Zang counties, and two minority Yi counties. In the second stage, six sample townships were randomly selected from among the townships in each sample county, for a total of 36 townships. In the third stage, 7-8 sample villages with more than 800 residents were randomly selected from each sample township, totaling 283 villages. In the fourth stage, from each sampled village, children in the eligible age range and their primary caregiver were included as participants in the study. The sampling and survey process is shown in Figure 1, total 1229 caregivers were surveyed.\u003c/p\u003e\n\u003cp\u003eFigure 1 to be placed here.\u003c/p\u003e\n\u003cp\u003eThe MNP program provides free MNPs for children aged 6-24 months; however, implementation varied slightly from township to township, with some extending eligibility up to 36 months. Therefore, considering the actual ages of the children at the time of MNP consumption, those aged 6-36 months (along with their caregivers) were included in this study. The survey was conducted in October to November of 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevelopment of survey questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDrawing from health communication theory and the health belief model\u0026nbsp;[10, 13\u0026ndash;15], a structured interview questionnaire was developed through a literature review, expert consultation, and team discussions. First, an initial questionnaire was prepared based on the literature review and field findings from a preliminary survey assessing the distribution, collection, and feeding practices of MNPs. Next, a Delphi expert consultation method was employed\u0026nbsp;[16], involving 12 experts from various relevant fields, who participated in two rounds of consultations through email. Expert opinions were then compiled and used to refine the questionnaire through deletions, additions, and adjustments. The response rate was 100% and Kendall\u0026rsquo;s W coefficient was calculated at 0.433. The Cronbach\u0026rsquo;s alpha coefficients for the questionnaire dimensions ranged from 0.61-0.72 and KMOs ranged from 0.64-0.81. The questionnaire is available in Additional file 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMNP-related core knowledge (RCK):\u003c/strong\u003e Knowledge of MNPs was measured through 6 questions, which are as follows: (a) What ingredients are in the MNP?; (b) What is the purpose of the MNP?; (c) How many packets of MNP should be given to your baby in a week?; (d) How should you feed an MNP to your baby?; (e) How should you store the MNP?; and (f) If your child has black stools or yellow urine after taking MNP, do you think it is still okay to continue giving them MNP? Correct answers were worth 1 point and incorrect answers worth 0 points; RCK scores ranged from 0 to 6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMNP-related\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ehealth beliefs (RHB):\u003c/strong\u003e Health beliefs about MNPs were assessed with the Health Belief Model\u0026nbsp;[15], which includes five dimensions:\u003c/p\u003e\n\u003cp\u003e(a) Perceived Susceptibility: This dimension was evaluated using the following questions: \u0026ldquo;Is it possible for a baby up to 2 years of age to be deficient in nutrients?\u0026rdquo; and \u0026ldquo;Is it possible for a baby up to 2 years of age to be anemic?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(b) Perceived Severity: Two questions were used to measure this: \u0026ldquo;If a baby is chronically undernourished, do you think it may lead to negative consequences?\u0026rdquo; and \u0026ldquo;If a baby is persistently anemic, do you think it could lead to negative consequences?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(c) Perceived Barriers: This was assessed through three questions: \u0026ldquo;Do you find it convenient to receive the MNPs?\u0026rdquo;, \u0026ldquo;Do you think it is easy to understand how to use the MNPs?\u0026rdquo;, and \u0026ldquo;Do you find it easy to prepare the packets?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(d) Perceived Benefits: Two questions were used to measure perceived benefits: \u0026ldquo;Do you believe that using the MNPs consistently will make babies grow taller or stronger?\u0026rdquo; and \u0026ldquo;Do you believe that using the MNPs consistently will prevent babies from becoming anemic?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(e) Self Efficacy: This was measured with two questions: \u0026ldquo;Do you believe that you can solve a problem that arises (e.g., your child dislikes the taste) when feeding the MNP?\u0026rdquo; and \u0026ldquo;Do you believe that you can insist on feeding the MNP to the child?\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThe perceived susceptibility was scored on a 3-point scale, with the caregiver answering \u0026ldquo;would not\u0026rdquo; at -1, \u0026ldquo;fair\u0026rdquo; at 0, and \u0026ldquo;would\u0026rdquo; at 1; and the rest of the items were scored on a 5-point Likert scale, with caregivers scoring from -2 to 2 on a scale from \u0026ldquo;very unconvinced/unlikely\u0026rdquo; to \u0026ldquo;very convinced/likely\u0026rdquo;. If a dimension scores 0, it means that the caregiver has no apparent perception of beliefs on this dimension. The scores for all items were summed to give a total health belief score, with higher scores indicating better beliefs about adherence to feeding the MNP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdherence to recommended MNP feeding practices (AMP):\u0026nbsp;\u003c/strong\u003eAccording to guidelines from China\u0026rsquo;s micronutrient home fortification program, caregiver adherence to the MNP is defined as feeding young children four or more sachets of MNP over a seven-day period, in accordance with program recommendations [17]. If MNP feeding was suspended at any time during the survey period due to reasons such as illness or temporary absence from the home, the average number of MNP packets fed per week was used to determine adherence status. AMP was included in the analysis as a binary variable in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral characteristics:\u0026nbsp;\u003c/strong\u003eChild characteristics included age in months and sex. Caregiver characteristics included generation (parental or grandparental), age, gender, ethnicity, education level, occupation status, and household assets information. Household assets were assessed using a fixed asset score derived from principal components analysis. This score was determined based on the ownership of fixed assets within the household, such as refrigerators, air conditioners, water heaters, televisions, computers, internet access, washing machines, motorcycles, and automobiles. Households were then categorized into four asset levels: low, lower-middle, upper-middle, and high.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMNP information dissemination:\u003c/strong\u003e Caregivers were asked if they had received information about MNPs through the following dissemination channels: doctors, printed media (i.e., posters, bulletin boards, pamphlets), broadcast media (radio or TV), social media, family members, and friends, and relatives. If a caregiver reported receiving information about MNPs through a channel, we asked about the content that was received through that channel. We categorized doctors as a separate information channel due to their dual role as communicators and information channels. While they communicate MNP information directly to caregivers during MNP distribution, their professional expertise sets them apart from typical interpersonal communication within the general population. Finally, we divided all information channels into three broad categories: (1) doctors; (2) mass media, including printed media, broadcast media, and social media; and (3) the wider community, including family members, friends, and relatives.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe sorted the content of disseminated MNP information into five groups: information that MNPs are free of charge; information about the benefits of MNPs; and information about feeding, storing, and handling adverse reactions to MNPs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePropensity score matching was used to explore the effects of MNP information dissemination channels and content on caregivers\u0026rsquo; RCK, RHB, and AMP. This method was adopted to minimize potential confounding by balancing observed covariates between groups exposed to different dissemination strategies\u0026nbsp;[18]. Each dissemination channel or dissemination content was used as a subgrouping variable separately, and a model was constructed using logistic regression to compute propensity scores. Based on the scores, a 1:1 match with put-back was performed using the closest match method, with the caliper value set at 0.02. With the matched data, regression analyses were used to explore the specific role of each information dissemination channel or content on caregivers\u0026rsquo; RCK, RHB, and AMP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Medical Ethics Committee of **** (approval number: ****). Researchers introduced the background and significance of the study, the study process, the benefits and risks of the study, and personal privacy issues to the primary caregivers of the sampled children before survey conduction. Caregiver consent was obtained and informed consent forms were signed before survey conduction.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 shows the basic characteristics of the sampled children and caregivers. A total of 1229 caregiver-child dyads were included in this study. Among the children, 27.42% and 30.76% were between 13-18 and 19-24 months of age, respectively, with a male-to-female sex ratio close to 1:1. Among the caregivers surveyed, the ethnicity of caregivers was distributed as follows: Han at 35.42%, Zang at 29.72%, and Yi at 34.85%. Most caregivers were the sample child\u0026rsquo;s parent (69.19%). Nearly half of the caregivers had not received formal education, and 42.88% of caregivers remained at home with their children.\u003c/p\u003e\n\u003cp\u003eTable 1. General characteristics of caregiver-child dyads (N=1229).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eNumber/(\u0026nbsp;\u0026plusmn;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eChild\u0026rsquo;s age (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e6-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e19.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e13-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e27.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e19-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e30.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e25-36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e22.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eChild\u0026rsquo;s sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e52.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e47.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eCaregiver\u0026rsquo;s gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e11.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e88.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eCaregiver\u0026rsquo;s ethnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eHan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e35.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eZang\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e29.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e34.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eCaregiver\u0026rsquo;s generation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eParent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e69.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eGrandparent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e31.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eCaregiver\u0026rsquo;s education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e46.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e25.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eMiddle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e16.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eHigh school and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e11.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eCaregiver\u0026rsquo;s occupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eCaregiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e42.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e45.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eOther\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eHousehold assets level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e25.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eLower middle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e23.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eUpper middle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e28.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e22.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eInformation channel: doctors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e994\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e90.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eInformation channel: mass media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e10.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e89.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eInformation channel:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ewider community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e27.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e72.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eInformation content: MNP is free\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e45.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e54.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eInformation content: MNP benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e63.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e36.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eInformation content:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMNP feeding method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e51.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e48.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eInformation content:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMNP storage method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e18.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e81.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eInformation content:\u003c/p\u003e\n \u003cp\u003eResponding to abnormal reactions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e91.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eMNP-related core knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e3.81\u0026plusmn;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eMNP-related health beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e8.78\u0026plusmn;4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 78px;\"\u003e\n \u003cp\u003eAdherence to recommended MNP feeding practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e47.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e52.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eIncluding Self-employed business, Government worker, nomads and so on.\u003c/p\u003e\n\u003cp\u003eTable 1 to be placed here.\u003c/p\u003e\n\u003cp\u003eRegarding information dissemination channels, doctors were the main channel, with 90.86% of caregivers reporting to have received information about MNP from doctors (Table 1). Regarding the content of the information, only a few caregivers had received information on how to store the MNP (18.46%) and how to respond to abnormal reactions (8.33%). \u0026nbsp;Regarding caregiver\u0026rsquo;s adherence to MNP, 47.39% of caregivers demonstrated adherence to recommended feeding practices.\u003c/p\u003e\n\u003cp id=\"_Toc134264853\"\u003e\u003cstrong\u003ePropensity score matching\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLogistic regression analysis was used to construct propensity scores, and three information dissemination channels and five information contents were used as grouping variables to match the research subjects. After 1:1 nearest neighbor matching with put-back, the standardized differences of confounding variables in each model decreased significantly, indicating that the research subjects were balanced on confounding variables after matching. The standardized differences of each model are presented in detail in Supplementary Table S1-S8.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegression analysis of MNP information dissemination on RCK, RHB and AMP after PSM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeparate multifactor linear regressions or logistic analyses with matched data were conducted to explore the effects of information dissemination channels and content on caregivers\u0026rsquo; MNP-related core knowledge (RCK), MNP-related health beliefs (RHB), and adherence to recommended MNP feeding practices (AMP). The regression results after controlling for confounders are shown in Table 2.\u003c/p\u003e\n\u003cp\u003eRegarding information dissemination channels, receiving MNP information from a doctor was positively associated with RCK (\u003cem\u003e\u0026beta;\u003c/em\u003e=0.75, 95%CI [0.59-0.91]), RHB (\u003cem\u003e\u0026beta;\u003c/em\u003e=1.07, 95%CI [0.57-1.58]), and AMP (OR=1.96, 95%CI [1.48-2.61]). Moreover, receiving information from mass media and the community was also positively associated with RCK (\u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003emass media\u003c/sub\u003e=0.46, 95%CI [0.13-0.79]; \u0026nbsp;\u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003ewider community\u003c/sub\u003e=0.25, 95%CI [0.04-0.46]) and RHB (\u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003emass media\u003c/sub\u003e=2.05, 95%CI [0.85-3.24]; \u0026nbsp;\u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003ewider community\u003c/sub\u003e=0.83, 95%CI [0.11-1.56]).\u003c/p\u003e\n\u003cp\u003eRegarding the content of information, receiving information on both MNP benefits and how to use MNPs were positively associated with RCK (\u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003ebenefits\u003c/sub\u003e=0.62, 95%CI [0.47-0.77]; \u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003efeeding method\u003c/sub\u003e=0.22, 95%CI [0.05-0.40]), and RHB (\u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003ebenefits\u003c/sub\u003e=1.73, \u0026nbsp;95%CI [1.23-2.23]; \u003cem\u003e\u0026beta;\u003c/em\u003e\u003csub\u003efeeding method\u003c/sub\u003e=1.27; 95%CI [0.66-1.89]), and AMP (OR\u003csub\u003ebenefits\u003c/sub\u003e=1.37, 95%CI [1.03-1.83] and OR\u003csub\u003efeeding method\u003c/sub\u003e=1.56, 95%CI [1.01-2.39]).\u003c/p\u003e\n\u003cp\u003eTable 2. Regression analysis of MNP information dissemination on caregivers\u0026rsquo; RCK, RHB, and AMP after PSM.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eIndependent variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 67.0771%;\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.8834%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.4698%;\"\u003e\n \u003cp\u003eRCK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.2825%;\"\u003e\n \u003cp\u003eRHB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4698%;\"\u003e\n \u003cp\u003eAMP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.8834%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e(95%\u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e(95%\u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e(95%\u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.8834%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eChannel-doctors\u003cbr\u003e\u0026nbsp;(N=655)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.75(0.59-0.91)\u003c/strong\u003e\u003cstrong\u003e***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.07(0.57-1.58)\u003c/strong\u003e\u003cstrong\u003e***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.96(1.48-2.61)\u003c/strong\u003e\u003cstrong\u003e***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.8834%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eChannel-mass media\u003cbr\u003e\u0026nbsp;(N=938)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.46(0.13-0.79)\u003c/strong\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.05(0.85-3.24)\u003c/strong\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e1.02 (0.47-2.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eChannel-\u0026nbsp;wider community\u003cbr\u003e(N=935)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.25(0.04-0.46)\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.83(0.11-1.56)\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e1.27 (0.83-1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eContent-free\u003cbr\u003e\u0026nbsp;(N=893)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e-0.02 (-0.18-0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e-0.39 (-0.94-0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e0.96 (0.69-1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eContent-benefits\u003cbr\u003e\u0026nbsp;(N=841)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.62(0.47-0.77)\u003c/strong\u003e\u003cstrong\u003e***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.73(1.23-2.23)\u003c/strong\u003e\u003cstrong\u003e***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.37(1.03-1.83)\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eContent-feeding method\u003cbr\u003e\u0026nbsp;(N=770)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.22(0.05-0.40)\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.27(0.66-1.89)\u003c/strong\u003e\u003cstrong\u003e***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.56(1.01-2.39)\u003c/strong\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eContent-storage method\u003cbr\u003e\u0026nbsp;(N=894)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e-0.06(-0.34-0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e0.37 (-0.67-1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e1.17 (0.62-2.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 24.1941%;\"\u003e\n \u003cp\u003eContent-response to abnormal reactions\u003cbr\u003e\u0026nbsp;(N=861)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e-0.08(-0.42-0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 20.2825%;\"\u003e\n \u003cp\u003e1.15 (-0.01-2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 23.4698%;\"\u003e\n \u003cp\u003e1.66 (0.66-4.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"19\" style=\"width: 1.8834%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Owing to the caliper restriction in the propensity score matching, the number of participants included in each dissemination channel analysis differs from the original sample sizes reported in Table 1. Boldface indicates statistical significance(*\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026lt;0.01, ***\u003cem\u003ep\u003c/em\u003e\u0026lt;0.001). N indicates the sample size on common support after PSM.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea.\u0026nbsp;\u003c/sup\u003eLinear regressions of RCK and RHB controlled for the effects of the infant\u0026rsquo;s sex and age(months); caregivers\u0026rsquo; sex, ethnicity, generation, education, occupation, and household assets, and the three types information dissemination channels and the five types of information dissemination contents.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb.\u003c/sup\u003e In the logistic regression of AMP, the effects of RCK and RHB were controlled for in addition to the above factors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity analysis of PSM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur sensitivity analysis also used logistic regression to construct propensity scores, but the matching method was changed to 1:2 nearest matching and the caliper value was set to a stricter 0.01. The research subjects were re-matched with the three information dissemination pathways and five information contents as the grouping variables. After matching, the standardized differences of the confounding variables in each model were substantially reduced, indicating a good matching effect. Detailed results are presented in Supplementary Table S9. Sensitivity analyses were conducted using data after 1:2 matching. The results showed that the direction and statistical significance of the \u003cem\u003e\u0026beta;\u003c/em\u003e or OR values for the main study variables remained consistent across all models, indicating good model robustness and the reliability of the analysis results. Detailed results are presented in Supplementary Table S10.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the associations between different channels and content of MNP information dissemination and caregivers\u0026rsquo;\u0026nbsp;MNP-related core knowledge (RCK), MNP-related health beliefs (RHB), and adherence to recommended MNP feeding practices (AMP) in the rural areas of western China. The findings of this study revealed that about 90% of the sampled caregivers received information about MNPs from doctors, suggesting that doctors in rural western China serve not only as MNP distributors but also as the main disseminators of MNP information, reaching the widest audience among the target population. However, the findings also showed that merely 30% and 10% of caregivers received MNP information from the community and mass media, respectively. This indicates that MNP information has not been extensively disseminated through these channels in the study area, despite their theoretical potential for reaching large audiences. Finally, in terms of information content, most caregivers received MNP information regarding its free availability, benefits, and feeding methods. Fewer caregivers received guidance on MNP storage methods and addressing adverse reactions to MNP.\u003c/p\u003e\n\u003cp\u003eWe also found that MNP information disseminated by doctors was a positive influencing factor for caregivers\u0026rsquo; RCK, RHB, and AMP. This finding is similar to those of two studies conducted in Peru and Ethiopia, which highlighted the importance of guidance and counseling provided to caregivers by doctors who distribute MNP in promoting rural caregivers\u0026rsquo; continued use of MNP [19, 20]. This was attributed to the fact that face-to-face guidance and counseling by an authoritative health professional can enable caregivers to master feeding techniques and bolster their confidence in MNP administration [20]. On the other hand, the literacy challenges associated with lower educational attainment among some caregivers may hinder their comprehension of printed textual media [19], underscoring the effectiveness of doctor-led promotional activities as a dissemination channel for caregivers with low socioeconomic status. It is important to note, however, that previous studies have identified instances where some MNP-distributing doctors have inadequate knowledge of MNP, potentially leading to negative impacts on caregivers\u0026rsquo; MNP feeding behavior [21]. Thus, considering the important role played by doctors in MNP information dissemination, periodic training is essential to equip MNP-distributing doctors with the knowledge and skills necessary for proper MNP information dissemination.\u003c/p\u003e\n\u003cp\u003eIn this study, the utilization of mass media and community channels for MNP information dissemination was low. One possible explanation is that the study area includes ethnic minority regions with relatively low socioeconomic status and scattered populations [22], which may limit the accessibility of community-based dissemination. In addition, the generally low educational attainment among caregivers may hinder their ability to access or comprehend information disseminated via mass media. The study also found that, although these two channels were not associated with caregivers\u0026rsquo; AMP, they were significantly positively associated with caregivers\u0026apos; RCK and RHB. According to social cognitive theory and the health belief model, knowledge and beliefs are influences on the cognitive dimension of behavior [15, 23], which means that information disseminated from these two channels may help promote caregiver feeding behavior by improving the necessary knowledge base and beliefs. Positive health beliefs being perpetuated by either individuals surrounding the caregiver or the media consumed by the caregiver may facilitate the caregiver\u0026rsquo;s MNP feeding behavior. Given that mass media and community channels are generally more accessible to caregivers than face-to-face consultations with doctors, they can serve as valuable supplementary channels for MNP information dissemination. However, it is important to ensure that mass media materials are tailored to the literacy levels of the target population. Using intuitive and low-literacy-friendly formats\u0026mdash;such as videos, illustrated instructions, or audio messages\u0026mdash;may enhance comprehension and engagement, particularly in rural or low-education settings.\u003c/p\u003e\n\u003cp\u003eFinally, we found that information on the benefits of MNP and how to feed MNP were positive influencing factors for caregivers\u0026rsquo; RCK, RHB, and AMP, but no association was found between information that MNPs are free of charge or information about storing and handling adverse reactions to MNPs and caregivers\u0026rsquo; RCK, RHB, and AMP. This discrepancy may be attributed to caregivers\u0026apos; primary concern about the potential health outcomes of MNP for their children. Previous research suggests that caregivers tend to prioritize the health benefits of MNP over its economic cost. For example, a qualitative study conducted in underdeveloped areas of Bangladesh found that caregivers were willing to pay for MNP if they saw an increase in appetite in their infants and young children after consuming MNP, even if they had limited financial means [24]. This suggests that disseminating information on the benefits of MNP may reinforce positive health beliefs and promote the adoption of MNP feeding behaviors. Similarly, previous research indicates that caregivers may be hesitant to adopt or sustain MNP feeding due to concerns about their ability to administer it correctly [20]. Aligning with these findings, our study revealed a positive association between information on MNP feeding methods and caregivers\u0026apos; RCK, RHB, and AMP. While previous research identified a lack of knowledge on MNP administration as a barrier, our results suggest that targeted dissemination of feeding method information could be an effective strategy to enhance caregivers\u0026rsquo; confidence and adherence to MNP feeding practices. Taken together, these findings indicate that caregivers place greater emphasis on information directly linked to MNP\u0026rsquo;s primary function\u0026mdash;improving child nutrition. As a result, information on its benefits and proper usage may be perceived as more central to caregivers. In contrast, information on MNPs being free of charge, storage, and adverse reaction management may not be immediately relevant to caregivers\u0026apos; primary concerns, which could explain the lack of significant associations observed between these types of information and caregivers\u0026rsquo; RCK, RHB, and AMP.\u003c/p\u003e\n\u003cp\u003eBased on these findings, future efforts should focus on strengthening the training of MNP-distributing doctors to ensure the accuracy and quality of the information provided. In addition, greater investment is needed to expand the use of mass media and community channels as complementary communication platforms, especially through user-friendly, visual, or audio-based materials adapted to the needs of low-literacy populations. Tailoring content to emphasize the nutritional benefits and practical feeding instructions of MNPs may be especially effective in promoting caregiver adoption and continued use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral strengths of this study set it apart from most previous research on MNP information dissemination. First, previous studies have focused more on the effectiveness of MNP information channels and less on the content of the information being disseminated. This study uniquely evaluates both dimensions\u0026mdash;channels and content. This dual-focus approach enables a more nuanced understanding of how both the mode and substance of communication relate to caregivers\u0026rsquo; knowledge, health beliefs, and adherence, thereby offering practical guidance for designing more effective dissemination strategies, particularly in resource-limited rural settings. Second, this study used propensity score matching, which resulted in a more balanced distribution of confounders across groups and a more accurate assessment of the effects of information dissemination, as validated by sensitivity analyses; therefore, the results can be considered robust and credible.\u003c/p\u003e\n\u003cp\u003eHowever, several limitations warrant mention. First, it is not possible to draw causal conclusions from this study, and the fact that the sample consisted of caregivers of children aged 6\u0026ndash;36 months in rural western China limits the generalizability of the findings to other caregiver populations. Future studies using causal inference methods should be conducted among caregivers in different regions or with children of varying ages to provide more robust evidence. Second, as this study relied on self-reported measures, the assessment of some variables may have been affected by reporting or recall bias. Third, we acknowledge that our study does not address the potential cumulative or interactive effects of exposure to multiple communication channels. Future research is warranted to examine whether multi-channel exposure enhances message effectiveness\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study provides evidence that among the caregivers of children aged 6-36 months in rural areas of western China, MNP information dissemination channels and content are closely associated in different ways with \u0026nbsp;caregivers\u0026rsquo; MNP-related core knowledge, MNP-related health beliefs, and adherence to recommended MNP feeding practices. In terms of information channels, all three information channel categories, or doctors, mass media, and the wider community, were positively associated with caregivers\u0026rsquo; MNP-related core knowledge and MNP-related health beliefs. Particularly, information disseminated by doctors is also positively associated with caregiver adherence to recommended MNP feeding practices. Regarding information content, information about the benefits of MNPs and how to feed MNPs were positively associated with caregivers\u0026rsquo; MNP-related knowledge, health beliefs, and adherence. These findings underscore the need to strengthen doctor-led communication and optimize the design and delivery of MNP-related messages in future nutrition interventions, particularly by tailoring content to caregivers\u0026apos; core concerns and expanding the use of accessible community and mass media channels to promote equitable uptake of MNP programs in rural and resource-limited settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAMP \u0026nbsp; \u0026nbsp; \u0026nbsp;Adherence to recommended MNP feeding practices\u003c/p\u003e\n\u003cp\u003eMHF \u0026nbsp; \u0026nbsp; Micronutrient home fortification\u003c/p\u003e\n\u003cp\u003eMNP\u0026nbsp; \u0026nbsp;Micronutrient powders\u003c/p\u003e\n\u003cp\u003eRCK\u0026nbsp; \u0026nbsp;\u0026nbsp;MNP-related core knowledge\u003c/p\u003e\n\u003cp\u003eRHB\u0026nbsp; \u0026nbsp;\u0026nbsp;MNP-related health beliefs\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp;World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Medical Ethics Review Committee of Sichuan University (Approval No. K2018103). All the caregivers of the sampled children signed an informed consent form prior to participation. And informed consent was obtained from the legal guardians of all children involved in the project. All of the participants were voluntary and their information was kept completely confidential. The methods used in this study were conducted according to the relevant regulations and standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets are not publicly available due to institutional policy. However, the data can be available through the corresponding author under reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by National Natural Science Foundation of China (Grant Number: 71874114).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXX, XY contributed to the conception and design of the study. XX, XY, LL contributed to data preparation, collection, and organization. XX performed the statistical analysis and wrote the first draft of the manuscript with assistance of XY，LL, JF. XY, LL, JF, YW, HZ contributed to manuscript revision. All authors read and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe greatly appreciate the collaboration of the local officials and all participants from each of the participating sites in this research. Also, we acknowledge the investigators from the West China School of Public Health in Sichuan University for their hard work and dedication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu 610041, China.\u0026nbsp;\u003csup\u003e2\u003c/sup\u003eDepartment of Health Education, Chengdu Center for Disease Control and Prevention (Chengdu Health Supervision Institute), No.4 Longxiang Road, Chengdu 610041, China.\u0026nbsp;\u003csup\u003e3\u003c/sup\u003eStanford Center on China\u0026rsquo;s Economy and Institutions, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA 94305, USA.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO, Anaemia. 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Health Commun. 2021;36:217\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJu I, Park T, Ohs JE. Consumer Engagement with Prescription Medicine Decisions: Influences of Health Beliefs and Health Communication Sources. Health Commun. 2020;35:135\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdwards MJC. Health Communication: A Handbook for Health Professionals. AORN J. 1985;42:952\u0026ndash;952.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayes J. Health communication: theory and practice. Health Expect. 2008;11:201\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecker ME. The Health Belief Model and Personal Health Behavior. Health Educ Monogr. 1974;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDalkey N. An experimental study of group opinion: The Delphi method. Futures. 1969;1:408\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChina Department of Maternal and Child Health. Circular on the issuance of the 2014 Nutrition Improvement Program for Children in impoverished Area. 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.nhc.gov.cn/fys/s3585/201411/254523446f9241a3a3553e19dec77421.shtml\u003c/span\u003e\u003cspan address=\"http://www.nhc.gov.cn/fys/s3585/201411/254523446f9241a3a3553e19dec77421.shtml\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 14 Apr 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivar Behav Res. 2011;46:399\u0026ndash;424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePelto GH, Tumilowicz A, Schnefke CH, Gebreyesus SH, Hrabar M, Gonzalez W, et al. Ethiopian mothers\u0026rsquo; experiences with micronutrient powders: Perspectives from continuing and noncontinuing users. Matern Child Nutr. 2019;15:e12708.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrewer JD, Shinnick J, Rom\u0026aacute;n K, Santos MP, Paz-Soldan VA, Buttenheim AM. Behavioral Insights Into Micronutrient Powder Use for Childhood Anemia in Arequipa, Peru. Glob Health Sci Pract. 2020;8:721\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReerink I, Namaste SM, Poonawala A, Nyhus Dhillon C, Aburto N, Chaudhery D, et al. Experiences and lessons learned for delivery of micronutrient powders interventions. Matern Child Nutr. 2017;13(1 Suppl 1):e12495.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo S, Deng X, Ran J, Ding X. Spatial and Temporal Patterns of Ecological Connectivity in the Ethnic Areas, Sichuan Province, China. Int J Environ Res Public Health. 2022;19:12941.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall, Inc; 1986.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarma H, Uddin MF, Harbour C, Ahmed T. Factors Influencing Child Feeding Practices Related to Home Fortification With Micronutrient Powder Among Caregivers of Under-5 Children in Bangladesh. Food Nutr Bull. 2016;37:340\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Micronutrient powders, Information dissemination, Health beliefs, adherence behavior, Rural China","lastPublishedDoi":"10.21203/rs.3.rs-6436855/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6436855/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn remote rural China, a micronutrient home fortification program has been implemented to prevent childhood anemia by providing free micronutrient powders (MNP) to caregivers. Effective information dissemination is essential for improving caregivers\u0026rsquo; knowledge, beliefs, and MNP feeding adherence. However, evidence on how different communication channels and content influence these outcomes among caregivers remains limited in rural settings. This study aimed to examine the associations between MNP information dissemination and caregivers\u0026rsquo; knowledge, health beliefs, and adherence to recommended MNP feeding practices, providing evidence to inform future health communication strategies in nutrition interventions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in 2019 among 1,229 caregivers of children aged 6\u0026ndash;36 months in six counties in western China, selected using a multistage sampling method. Data were collected through face-to-face interviews using structured questionnaires. Propensity score matching and regression analyses were performed to examine the associations between different channels and content of MNP information dissemination and caregivers\u0026rsquo; MNP-related knowledge, health beliefs, and adherence to recommended MNP feeding practices.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eReceiving information from a doctor was positively associated with caregivers\u0026rsquo; MNP-related knowledge (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.75, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.59\u0026ndash;0.91), health beliefs (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.75, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.57\u0026ndash;1.58), and adherence to recommended MNP feeding practices (OR\u0026thinsp;=\u0026thinsp;1.96, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.48\u0026ndash;2.61). Receiving information from the mass media and wider community were both positively associated with caregivers\u0026rsquo; MNP-related knowledge (\u003cem\u003eβ\u003c/em\u003e\u003csub\u003emass media\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.46, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.13\u0026ndash;0.79; \u003cem\u003eβ\u003c/em\u003e\u003csub\u003ewider community\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.25, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04\u0026ndash;0.46) and health beliefs (\u003cem\u003eβ\u003c/em\u003e\u003csub\u003emass media\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;2.05, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.85\u0026ndash;3.24; \u003cem\u003eβ\u003c/em\u003e\u003csub\u003ewider community\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.83, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11\u0026ndash;1.56). For MNP content, information on the benefits of MNP and how to use them were both positively associated with caregivers\u0026rsquo; MNP-related knowledge (\u003cem\u003eβ\u003c/em\u003e\u003csub\u003ebenefits\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.62, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.47\u0026ndash;0.77; \u003cem\u003eβ\u003c/em\u003e\u003csub\u003efeeding method\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.22, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05\u0026ndash;0.40), health beliefs (\u003cem\u003eβ\u003c/em\u003e\u003csub\u003ebenefits\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.73, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.23\u0026ndash;2.23; \u003cem\u003eβ\u003c/em\u003e\u003csub\u003efeeding method\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;1.27, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.66\u0026ndash;1.89) and adherence (OR\u003csub\u003ebenefits\u003c/sub\u003e=1.37, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.03\u0026ndash;1.83; OR\u003csub\u003efeeding method\u003c/sub\u003e=1.56, 95%\u003cem\u003eCI\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.01\u0026ndash;2.39).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTargeted MNP dissemination strategies\u0026mdash;especially those delivered by doctors and emphasizing key content such as the benefits of MNP and proper feeding methods\u0026mdash;may help to promote caregivers\u0026rsquo; MNP-related knowledge, health beliefs, and adherence to recommended MNP feeding practices, which may contribute to improved child health in low-resource settings. These findings can inform the optimization of future information dissemination strategies for the micronutrient powder program in rural western China, contributing to healthier child development in these areas.\u003c/p\u003e","manuscriptTitle":"Association between micronutrient powder information dissemination and caregivers' knowledge, health beliefs, and adherence in rural western China: a propensity score-matched analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-21 06:06:43","doi":"10.21203/rs.3.rs-6436855/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-10T21:15:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46706863672275119733891613986805588941","date":"2025-06-02T14:28:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T10:39:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T09:34:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-21T18:25:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-17T09:58:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-04-17T09:57:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"44e84aea-a41e-4fa5-9bce-bc1884c51fc9","owner":[],"postedDate":"May 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-21T06:06:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-21 06:06:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6436855","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6436855","identity":"rs-6436855","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}