This study aims to evaluate whether revised food voucher programs, combined with nutrition education sessions, can improve food security, dietary quality, nutrition knowledge, and nutritional outcomes among low-income households in the Philippines. Researchers will compare different monthly voucher amounts-Philippine Peso (PhP) 3,000, PhP 5,000, and PhP 8,000-with a no-voucher control group to determine which approach is most effective.
The main questions the study aims to answer are:
* Do food vouchers improve household food security, reduce hunger, and improve dietary quality and nutrient intake? * Do larger voucher amounts lead to greater improvements in nutrition and health outcomes? * Does enhanced nutrition education improve nutrition knowledge and healthy eating practices?
Participants will:
* Receive either a monthly food voucher or no voucher, depending on study group assignment * Attend nutrition education and Social and Behavior Change Communication (SBCC) sessions if assigned to a voucher group * Complete household interviews on food consumption, household expenditures, food security, and nutrition knowledge * Participate in dietary assessments and anthropometric measurements for women and children under 5 years of age
Households enrolled in the REVIVE study sample drawn from Listahanan 3-eligible low-income households
Residency within selected study clusters in the study municipalities
Household consent to participate in the study and all survey components
Availability of a primary respondent (meal planner or primary food preparer) willing to participate in household interviews
Households unwilling or unable to provide informed consent
Households not residing within the designated study clusters at the time of baseline data collection
Inability to complete core survey modules due to communication barriers or other conditions preventing reliable data collection
Parallel
Food Voucher + SBCC (PhP 3,000)
BehavioralHouseholds receive a monthly food voucher valued at PhP 3,000 with a structured allocation of 10% for carbohydrates and oils, 45% for protein-rich foods, and 45% for fruits and vegetables. Vouchers are redeemable continuously throughout the month. The intervention is combined with six structured social and behavior change communication (SBCC) sessions focused on nutrition knowledge, healthy dietary practices, maternal and child nutrition, and WASH behaviors, delivered by trained local government staff.
Food Voucher + SBCC (PhP 5,000)
BehavioralHouseholds receive a monthly food voucher valued at PhP 5,000 with the same allocation structure (10% carbohydrates and oils, 45% protein, 45% fruits and vegetables) and continuous redemption design. The voucher is paired with six SBCC sessions covering nutrition education and behavior change topics related to diet quality and household nutrition.
Food Voucher + SBCC (PhP 8,000)
BehavioralHouseholds receive a monthly food voucher valued at PhP 8,000 with the same structured food group allocation and continuous redemption system. The intervention includes six SBCC sessions aimed at improving nutrition knowledge and dietary practices for maternal and child health.
Nutrition Knowledge
Composite measure of nutrition knowledge assessed using a structured questionnaire administered to the primary household meal planner. The instrument includes items on food groups, dietary diversity, micronutrient-rich foods, maternal and child feeding practices, and understanding of voucher allocation rules. A total score will be constructed by summing correct responses and standardizing across respondents. Subdomain scores (e.g., dietary diversity knowledge, micronutrient knowledge, child feeding knowledge) will also be analyzed.
Individual Nutrient Adequacy
Summary measure of dietary nutrient adequacy among women of reproductive age and children under five years, derived from 24-hour dietary recall data. Probability of adequacy will be estimated for energy, macronutrients, and selected micronutrients (vitamin A, B-complex vitamins, vitamin C, calcium, iron, and zinc). The mean probability of adequacy will be calculated by averaging across 11 micronutrients.
Minimum Dietary Diversity for Women (MDD-W)
Minimum Dietary Diversity for Women (MDD-W), defined as the proportion of women of reproductive age who consume foods from at least 5 of 10 food groups during the previous 24 hours, based on a 24-hour dietary recall.
Global Dietary Quality Score (GDQS)
Global Dietary Quality Score (GDQS), a food-based metric derived from 24-hour dietary recall data that assesses overall dietary quality by accounting for consumption of both healthy and unhealthy food groups. GDQS ranges from 0 to 49, with higher scores indicating better dietary quality and lower risk of nutrient inadequacy and diet-related non-communicable diseases.
Household Food Consumption Score (FCS)
The Food Consumption Score (FCS) is a composite measure of household dietary diversity, food frequency, and relative nutritional importance of foods consumed. The FCS is calculated using a 7-day recall of household food consumption across standardized food groups. Consumption frequencies are weighted according to the nutritional value of each food group and summed to generate the total score. The FCS ranges from 0 to 112, with higher scores indicating better household food consumption, greater dietary diversity, and improved food access. Lower scores indicate poorer food consumption patterns and greater vulnerability to food insecurity.
Height-for-Age Z-score (HAZ) in Children Under Five Years of Age
Height-for-age z-score (HAZ) among children under five years of age, calculated using the World Health Organization (WHO) Child Growth Standards. HAZ is a standardized measure of linear growth relative to age and sex. HAZ values typically range from approximately -6 to +6, with higher values indicating better growth status. Children with HAZ \< -2 standard deviations are classified as stunted.
Weight-for-Age Z-score (WAZ) in Children Under Five Years of Age
Weight-for-age z-score (WAZ) among children under five years of age, calculated using the World Health Organization (WHO) Child Growth Standards. WAZ is a standardized measure of body weight relative to age and sex. WAZ values typically range from approximately -6 to +6, with higher values indicating better nutritional status. Children with WAZ \< -2 standard deviations are classified as underweight.
Weight-for-Height Z-score (WHZ) in Children Under Five Years of Age
Weight-for-height z-score (WHZ) among children under five years of age, calculated using the World Health Organization (WHO) Child Growth Standards. WHZ is a standardized measure of body weight relative to height. WHZ values typically range from approximately -5 to +5, with higher values indicating better nutritional status. Children with WHZ \< -2 standard deviations are classified as wasted.
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