Barriers and Facilitators to Cognitive Participation in Peer Support for Complementary Feeding in LMICs - A Theory-Informed Systematic Review

Sep 30, 2026

Uploaded by Angel

Suboptimal complementary feeding remains a major challenge in low- and middle-income countries, and peer support is promising yet insufficiently understood regarding sustained uptake. This theory-led systematic review uses Normalisation Process Theory and an integrative mixed-methods synthesis to explain why people participate, provide support, and continue peer-led complementary feeding. Searches covered January 1990 to February 2025 studies, analyzed narratively through cognitive participation subconstructs. Findings distinguish shifting facilitators and emerging barriers across financial, structural, sociocultural, training, and capacity domains.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

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Abstract

1 Introduction

Summary

Peer Support and Social Context

Maternal & Child Nutrition REVIEW ARTICLE Barriers and Facilitators to Cognitive Participation in Peer Support for Complementary Feeding in LMICs: A Theory‐Informed Systematic Review Asnake Ararsa Irenso1,2,3 | Hirbo Shore4 | Karen Campbell5 | Rachel Laws5 1Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia | 2Ambo University, Ambo, Ethiopia | 3Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Australia | 4University of Southern Queensland, Toowoomba, Australia | 5Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia Correspondence: Asnake Ararsa Irenso ([abbaabokku@gmail.com](abbaabokku@gmail.com)) Received: 18 April 2025 | Revised: 19 November 2025 | Accepted: 2 December 2025 Keywords: cognition | complementary feeding | developing countries | peer support | volunteers ABSTRACT Suboptimal complementary feeding practices remain a significant challenge in LMICs. Peer support shows promise in improving these practices; however, their long‐term success hinges on sustained engagement and integration into existing support systems, aspects that remain poorly understood. This theory‐led systematic review aimed to understand why people participate, support, and continue using peer support for complementary feeding practices. The literature search covered studies conducted between January 1990 and February 2025. This pragmatic, Normalisation Process Theory‐led review employs an integrative mixed‐methods synthesis. We conducted a theory‐informed systematic review guided by the four subconstructs of cognitive participation, presenting the findings narratively into barriers and facilitators. While peer‐led complementary feeding promotion involves multiple actors at different levels, few studies directly included family members and caregivers beyond mothers, thereby limiting their cognitive participation. Most studies were donor‐driven. Financial, structural, sociocultural, training, and capacity‐related factors strongly influence peer‐led complementary feeding support. Their influences were not fixed; what served as facilitators in the initial stages of studies became barriers later, and vice versa. Household and local leaders and gatekeepers constrained peer support early in the interventions, but this later reversed with their involvement. Incentives boosted interest and increased enrolment. However, this also led to volunteers being less motivated and to attrition when resources were limited. Weak supportive supervision diminished the legitimacy of peer support, causing a loss of confidence in volunteers' skills. Keeping the momentum of early implementation stages requires a predictable funding model, primarily from domestic sources, and sustained engagement in the intervention. This can address multifaceted operational problems, ranging from recruitment to embedding the intervention in the health system. Political commitment, especially when translated into operational support, can strengthen the financial sustainability of peer support programmes. 1 | Introduction Suboptimal complementary feeding practices continue to be a global public health concern (Lutter et al. 2021) . A review by Kupka et al. (2020) based on data from low‐ and middle‐income countries (LMICs) revealed striking gaps. One‐third of children aged 6–23 months did not start solid foods by 6 months; only 53% met the minimum meal frequency (MMF), and 29% met the minimum dietary diversity (MDD) . Only one in five children met both the MMF and the MDD. Dietary quality is lowest for children from families with low incomes, who often struggle to afford it (Kupka et al. 2020) . This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s) . Maternal &

FAQs

What is the main aim of the systematic review?

To understand why people participate in peer support, provide it, and continue using it for complementary feeding in LMICs, using theory-informed analysis.

Which theory framework guides the review?

The review is guided by Normalisation Process Theory and uses four subconstructs of cognitive participation.

What factors most strongly influence peer-led complementary feeding support?

Financial, structural, sociocultural, training, and capacity-related factors, which can change over time from facilitators to barriers and vice versa.

Sep 30, 2026

Uploaded by Angel