Impact of a nutrition-based educational intervention on kindergarten teachers' knowledge of complementary feeding: A randomised controlled trial

Abstract

Objective: This study evaluates the effectiveness of a nutrition-based educational intervention in improving kindergarten teachers' knowledge of complementary feeding (CF) practices.

Methods: A randomised controlled trial was conducted from September 2024 to July 2025 among 100 kindergarten teachers from six public kindergartens in Ramadi, Iraq. Participants were randomly assigned (1:1) to either an intervention or control group using a computer-generated simple randomisation sequence. The intervention group received a four-session, evidence-based nutrition education program focused on CF, while the control group received no training during the study period. Teachers’ knowledge was assessed using a validated 10-item questionnaire at baseline, immediately post-intervention, and six weeks later. Data were analysed using repeated measures ANOVA, with statistical significance set at p < 0.05.

Results: At baseline, both groups had similarly poor CF knowledge (mean score: 21.92 ± 1.70 vs. 21.90 ± 2.37; p = 0.96). Post-intervention, the experimental group’s mean score increased significantly to 45.54 ± 2.22 (p < 0.001), with 100% attaining "good" knowledge. These gains were sustained at six weeks (mean score: 45.34 ± 2.16), while the control group showed no significant change over time (p = 0.600). The intervention yielded a large effect size (Cohen’s d > 9.0).

Conclusion: Nutrition education interventions can significantly and sustainably improve kindergarten teachers’ knowledge of complementary feeding. Integrating such training into teacher development programs may enhance child nutrition outcomes, particularly in socio-cultural contexts where educators serve as trusted community figures.