Work

Trust in targeting: Perceptions of the appropriateness of targeted balanced energy and protein supplementation based on maternal thinness in Bangladesh

Year: 2026

Type: article

Abstract: Rationale Targeting balanced energy-protein (BEP) supplements to mothers at greater nutritional risk has been proposed to increase cost effectiveness in resource limited settings. In practice, the success of targeted programs may rely less on targeting metrics and more on community perceptions and trust in program staff. Objective To examine how pregnant women and their families perceive BEP targeting criteria of low body mass index and inadequate gestational weight gain and how relational dynamics with health workers influenced targeting’s appropriateness. Methods A mixed-methods study was conducted in northwest Bangladesh among participants in a randomized trial evaluating targeted BEP’s effect on birth weight. Interviews and focus groups were conducted with 98 women, husbands, mothers-in-law, and community health research workers (CHRWs). Qualitative data were analyzed thematically, and quantitative data were analyzed using Top 3 agreement and Spearman’s Rho. Results Pregnancy was perceived by participants as a vulnerable period, and concerns arose that targeting could deprive non-recipients of benefits. Locally appropriate targeting criteria included experiential signs of deficiency, like weakness, rather than anthropometric categories, like thinness. Women who received additional counseling on weight faltering expressed greater support for weight-based targeting criteria. Women and families cited trusting relationships with CHRWs as reasons for intervention acceptance, although trust in CHRWs did not automatically translate into acceptance of targeting. Conclusions Targeting is often justified based on cost-effectiveness, but attention to community trust is essential. Programs pursuing targeted supplementation should incorporate frontline counseling that bridges biomedical and emic understandings of vulnerability, while recognizing that such trust is negotiated at the household and community level. ClinicalTrials.Gov Registration NCT05576207

Source: SSM - Qualitative Research in Health

DOI: 10.1016/j.ssmqr.2026.100885