{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:29:57Z","timestamp":1780338597435,"version":"3.54.1"},"reference-count":38,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T00:00:00Z","timestamp":1629158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Bill and Melinda Gates Foundation","award":["OPP1182519"],"award-info":[{"award-number":["OPP1182519"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Diet diversity has an important role in the prevention and treatment of anemia. Based on formative research in the community and the theory of normative social behavior, we designed an intervention to improve diet diversity among women of reproductive age. Our study, the Reduction in Anemia through Normative Innovations (RANI) Project, investigated the effect of a social norms-based intervention on diet diversity among women of reproductive age. We randomized villages in Odisha, India, into treatment or control arms, with a minimum of one village buffer between them. We assessed exposure to the intervention by frequency of self-reported images seen from the participatory learning modules, videos watched, and number of hemoglobin tests administered. We assessed diet diversity with the Food and Agriculture Organization\u2019s Minimum Dietary Diversity for Women (MDD-W) questionnaire. We used multiple logistic regression to examine the associations between intervention and diet diversity, adjusting for covariates. Compared with baseline, diet diversity score increased in both treatment and control groups. The odds of having a diverse diet was 47% higher in the treatment group. Higher level of exposure to the RANI intervention was associated with a better diet diversity score, indicating that the intervention was effective in improving diet quality.<\/jats:p>","DOI":"10.3390\/nu13082822","type":"journal-article","created":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T21:27:40Z","timestamp":1629235660000},"page":"2822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["A Social Norms-Based Intervention Improves Dietary Diversity among Women in Rural India: The Reduction in Anemia through Normative Innovations (RANI) Project"],"prefix":"10.3390","volume":"13","author":[{"given":"Sameera A.","family":"Talegawkar","sequence":"first","affiliation":[{"name":"Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichen","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Sedlander","sequence":"additional","affiliation":[{"name":"Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7185-7747","authenticated-orcid":false,"given":"Rohini","family":"Ganjoo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Laboratory Sciences, School of Medicine and Health Sciences, The George Washington University, Ashburn, VA 20147, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satyaranjan","family":"Behera","sequence":"additional","affiliation":[{"name":"DCOR Consulting, Bhubaneshwar 751007, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loretta","family":"DiPietro","sequence":"additional","affiliation":[{"name":"Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Rimal","sequence":"additional","affiliation":[{"name":"Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA"},{"name":"Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,17]]},"reference":[{"key":"ref_1","unstructured":"Benoist, B.D., McLean, E., Egll, I., and Cogswell, M. (2008). Worldwide Prevalence of Anaemia 1993\u20132005: WHO Global Database on Anaemia, WHO."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0306-9192(02)00070-2","article-title":"The economics of iron deficiency","volume":"28","author":"Horton","year":"2003","journal-title":"Food Policy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1093\/ajcn\/55.5.985","article-title":"Anemia vs iron deficiency: Increased risk of preterm delivery in a prospective study","volume":"55","author":"Scholl","year":"1992","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_4","first-page":"14","article-title":"The consequences of iron deficiency and anaemia in pregnancy on maternal health, the foetus and the infant","volume":"11","author":"Viteri","year":"1994","journal-title":"SCN News"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"649S","DOI":"10.1093\/jn\/131.2.649S","article-title":"A review of studies on the effect of iron deficiency on cognitive development in children","volume":"131","author":"Ani","year":"2001","journal-title":"J. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/sj.ejcn.1601504","article-title":"The burden of anemia among women in India","volume":"57","author":"Bentley","year":"2003","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_7","unstructured":"International Institute for Population Sciences (2017). National Family Health Survey (NFHS-4), 2015\u20132016, International Institute for Population Sciences (IIPS)."},{"key":"ref_8","unstructured":"Raykar, N., Majumder, M., Laxminarayanan, R., and Menon, P. (2015). India Health Report: Nutrition 2015, Public Health Foundation of India."},{"key":"ref_9","unstructured":"World Health Organisation (2016). Strategies to Prevent Anaemia: Recommendations from an Expert Group Consultation, New Delhi, India, 5\u20136 December 2016, WHO."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1177\/2516602620980595","article-title":"Poverty and Food Insecurity Disparities and Their Causes in the Eastern Indian State of Odisha","volume":"2","author":"Mohapatra","year":"2020","journal-title":"Int. J. Community Soc. Dev."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Pradhan, A., Anasuya, A., Pradhan, M.M., Ak, K., Kar, P., Sahoo, K.C., Panigrahi, P., and Dutta, A. (2016). Trends in Malaria in Odisha, India\u2014an analysis of the 2003\u20132013 time-series data from the national vector borne disease control program. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149126"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1017\/S0021932009990149","article-title":"Exploring socioeconomic vulnerability of anaemia among women in eastern Indian States","volume":"41","author":"Ghosh","year":"2009","journal-title":"J. Biosoc. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.cegh.2020.09.008","article-title":"Geographic variation and factors associated with anemia among under-fives in India: A multilevel approach","volume":"9","author":"Yadav","year":"2021","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4103\/2224-3151.228423","article-title":"The burden of iron-deficiency anaemia among women in India: How have iron and folic acid interventions fared?","volume":"7","author":"Rai","year":"2018","journal-title":"WHO South East Asia J. Public Health"},{"key":"ref_15","unstructured":"Anuradha, G., Rakesh, K., Salhotra, V., Mohan, A., and Sheetal, R. (2013). Guidelines for Control of Iron Deficiency Anaemia."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e001010","DOI":"10.1136\/bmjgh-2018-001010","article-title":"Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006 to 2016","volume":"3","author":"Nguyen","year":"2018","journal-title":"BMJ Glob. Health"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Yilma, H., Sedlander, E., Rimal, R.N., Pant, I., Munjral, A., and Mohanty, S. (2020). The reduction in anemia through normative innovations (RANI) project: Study protocol for a cluster randomized controlled trial in Odisha, India. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-8271-2"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/j.1468-2885.2005.tb00329.x","article-title":"An explication of social norms","volume":"15","author":"Lapinski","year":"2005","journal-title":"Commun. Theory"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/comt.12080","article-title":"A re-explication of social norms, ten years later","volume":"25","author":"Rimal","year":"2015","journal-title":"Commun. Theory"},{"key":"ref_20","first-page":"540","article-title":"Predictors of multivitamin supplement use among African-American female students: A prospective study utilizing the theory of planned behavior","volume":"15","author":"Pawlak","year":"2005","journal-title":"Ethn. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sedlander, E., Long, M.W., Mohanty, S., Munjral, A., Bingenheimer, J.B., Yilma, H., and Rimal, R.N. (2020). Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-08574-z"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/1479-5868-7-86","article-title":"Is healthy behavior contagious: Associations of social norms with physical activity and healthy eating","volume":"7","author":"Ball","year":"2010","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sedlander, E., Talegawkar, S., Ganjoo, R., Ladwa, C., DiPietro, L., Aluc, A., and Rimal, R.N. (2021). How Gender Norms affect Anemia in Select Villages in Rural, Odisha India: A Qualitative Study. J. Nutr., in press.","DOI":"10.1016\/j.nut.2021.111159"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1177\/0093650205275385","article-title":"How behaviors are influenced by perceived norms: A test of the theory of normative social behavior","volume":"32","author":"Rimal","year":"2005","journal-title":"Commun. Res."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sedlander, E., Long, M.W., Bingenheimer, J.B., and Rimal, R.N. (2021). Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0249646"},{"key":"ref_26","first-page":"15","article-title":"The RANI Project: A socio-normative intervention to reduce anemia in Odisha, India: A formative research protocol","volume":"2","author":"Sedlander","year":"2018","journal-title":"Gates Open Res."},{"key":"ref_27","unstructured":"FAO, and FHI 360 (2016). Minimum Dietary Diversity for Women: A Guide to Measurement, FAO."},{"key":"ref_28","unstructured":"Constitution of India (2021, July 31). The Constitution (Scheduled Tribes) Order, Available online: https:\/\/legislative.gov.in\/sites\/default\/files\/19_The%20Constitution%20%28ST%29%20Order%201950.pdf."},{"key":"ref_29","unstructured":"World Health Organization (2011). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity, World Health Organization."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1177\/0379572116632137","article-title":"Pregnant women diet quality and its sociodemographic determinants in southwestern Bangladesh","volume":"37","author":"Shamim","year":"2016","journal-title":"Food Nutr. Bull."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3201","DOI":"10.1017\/S1368980015000671","article-title":"Low dietary diversity and micronutrient adequacy among lactating women in a peri-urban area of Nepal","volume":"18","author":"Henjum","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1038\/ejcn.2015.224","article-title":"Seasonality of food groups and total energy intake: A systematic review and meta-analysis","volume":"70","author":"Kleiser","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1093\/ije\/dyp223","article-title":"Seasonality in maternal intake and activity influence offspring\u2019s birth size among rural Indian mothers--Pune Maternal Nutrition Study","volume":"38","author":"Rao","year":"2009","journal-title":"Int. J. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/03670244.2013.792076","article-title":"Changing food patterns across the seasons in rural Pakistan: Analysis of food variety, dietary diversity and calorie intake","volume":"53","author":"Hussain","year":"2014","journal-title":"Ecol. Food Nutr."},{"key":"ref_35","first-page":"46","article-title":"Food security: More than a determinant of health","volume":"24","author":"McIntyre","year":"2003","journal-title":"Policy Options Montr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S0950-3293(02)00010-1","article-title":"Motives for food choice: A comparison of consumers from Japan, Taiwan, Malaysia and New Zealand","volume":"13","author":"Prescott","year":"2002","journal-title":"Food Qual. Prefer."},{"key":"ref_37","first-page":"347","article-title":"Impact of nutrition education on knowledge and haemoglobin status of hill women in Uttarakhand State of India","volume":"17","author":"Upadhyay","year":"2011","journal-title":"Malays. J. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Grimm, P. (2010). Social desirability bias. Wiley International Encyclopedia of Marketing, John Wiley & Sons.","DOI":"10.1002\/9781444316568.wiem02057"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/8\/2822\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:45:58Z","timestamp":1760165158000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/8\/2822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,17]]},"references-count":38,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["nu13082822"],"URL":"https:\/\/doi.org\/10.3390\/nu13082822","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,17]]}}}