Assessing Inadequate Dietary Diversity among Bangladeshi Adolescent Girls using COM-B Model: A Review

Abstract

Inadequate dietary diversity of adolescent girls has long been a problem in Bangladesh which contributed to the high
prevalence of undernourishment among adolescent girls. Regardless of the socio-economic condition,the majority of
the adolescent girls’ diet belongs to least diverse groups compared to other members of the households. Moreover,
there is a lack of evidence on the determinants of this inadequate diversity. This review aims to identify these
determinants using COM-B (capability, opportunity, motivation, and behavior) model. Eight databases and other
sources were searched, and after removing irrelevant literature, 18 articles and reports were included to identify and
categorize determinants in three components (capability, opportunity, and motivation) of COM-B model. The evidence
revealed that the most important determinants of adolescent girls’ inadequate dietary diversity are: food insecurity and
market availability of varieties of foods (determine the physical opportunity and capacity of girl and their households);
lack of knowledge and awareness (the main driver of psychological capacity and motivations to have diverse diet); and
pro-male socio-cultural and gender norms (limit girl’s social opportunity and reflectively motivate household members
to curb girl’s accessibility to varieties of nutritious foods).Most of the determinants interact with each other to make
complex nexus, making it difficult even for adolescent girls from wealthy and educated households to meet their
nutritional demands by availing varieties of foods. Especially, socio-cultural and gender norms interfere with each
determinant, making the adolescent girl’s more vulnerable to inadequacy. Comprehensive multi-component programs
and interventions are imperative, which not only remove the external factors related to the physical opportunity of
having diverse foods but also abolish the attitude-behaviour gap by creating the conducive socio-cultural environment
for adolescent girls.