1
|
Siegal K, Musau K, Woodruff BA, Custer E, Vergari L, Anyango H, Donkor W, Kiprotich M, Rohner F, Wegmüller R. Factors associated with nutrition intervention adherence: Evidence from a cluster-randomised controlled trial in Kenya. MATERNAL & CHILD NUTRITION 2023; 19:e13467. [PMID: 36507550 PMCID: PMC10019062 DOI: 10.1111/mcn.13467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
Nutrition experts point to the importance of a multipronged approach to address high stunting rates in rural areas. This can include nutrition-specific and -sensitive interventions, such as the provision of micronutrient powder, eggs, and chlorine, and nutrition training to improve feeding practices. In 2018, an agricultural nongovernmental organisation initiated a multipronged approach as part of a randomised trial. However, adherence to a programme with so many components can be challenging for participants. The aim of this study is to understand which factors are associated with high adherence in complex multifaceted nutrition-sensitive agricultural programmes. We used a mixed method approach in which we used bivariate and multivariable analyses to estimate the relationship between child and caregiver demographic factors with product adherence. We analyzed data from six focus groups and 120 feedback sessions on barriers to product adherence. We found that the age and sex of the child did not influence product adherence, but caregivers were more likely to adhere to all products if they were not the child's biological mother (most often grandmothers) (0.28 higher adherence score; p < 0.001) and if caregivers were older (0.34 higher adherence score, p < 0.001). A higher monthly training attendance, combining product distribution and interactive training, predicted stronger product adherence. Participants noted that adherence was supported by the early demonstration of positive results, regular reminders, interactive trainings, and the encouragement of family members. These findings underscore the importance of combining product distribution with training and include potentially targeting grandmothers and other caregivers who may demonstrate higher product adherence.
Collapse
Affiliation(s)
- Kim Siegal
- One Acre FundKakamegaKenya
- Present address:
Mathematica Policy ResearchWashingtonDistrict of ColumbiaUSA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Robert RC, Feijoo BL. Beneficiary and Local Stakeholder Participation in Community-Based Nutrition Interventions. Curr Dev Nutr 2022; 6:nzac131. [PMID: 36157848 PMCID: PMC9492256 DOI: 10.1093/cdn/nzac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Beneficiary and local stakeholder participation is an essential element to the success of community-based nutrition interventions. We sought to define active participation and review the available evidence on beneficiary and local stakeholder participation in community-based nutrition interventions in Africa. From reviewing the literature, we provide a reflective assessment on the process and findings. Participation falls on a continuum of community involvement from passive (no real involvement) to empowerment and community ownership (full active involvement). However, we found a clear gap in the research on defining active participation and identifying what constitutes active participation on behalf of beneficiaries and local stakeholders. However, progress was found; evidence included the use of participatory methods to engage beneficiaries and local stakeholders in the assessment and design phase. Beneficiary and local stakeholder participation in delivering interventions has moved forward with quantitative measures from process evaluation and implementation science. Research has started on the extent of beneficiary engagement (as recipients) and connecting this to outcomes. Evaluation has benefited from qualitative inquiry with insights from participants on engagement itself, and the barriers and facilitators to engagement. Yet questions remain in each study phase around defining and quantifying active participation and in understanding the personal, social, and motivational elements of active participation. We offer a simple framework to stimulate thought and commitment to research on participation in community-based nutrition interventions.
Collapse
Affiliation(s)
- Rebecca C Robert
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
| | - Brittany L Feijoo
- Conway School of Nursing, The Catholic University of America, Washington, DC, USA
| |
Collapse
|
3
|
Tumilowicz A, Vossenaar M, Kjaer K, Vettersand J, Possolo E, Pelto GH, Jefferds ME, Norte A, Dos Santos Dias K, Osman N, Gonzalez W, Poonawala A, Neufeld LM. Mixed methods evaluation explains bypassing of vouchers in micronutrient powder trial in Mozambique. MATERNAL AND CHILD NUTRITION 2020; 15:e12718. [PMID: 31622037 PMCID: PMC6856962 DOI: 10.1111/mcn.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Abstract
Micronutrient powders (MNP) are recommended by the World Health Organization as an effective intervention to address anaemia in children. A formative process evaluation was conducted to assess the viability of a model using free vouchers in two districts of Mozambique to deliver MNP and motivate adherence to recommendations regarding its use. The evaluation consisted of (a) an examination of programme outcomes using a cross-sectional survey among caregivers of children 6-23 months (n = 1,028) and (b) an ethnographic study to investigate delivery experiences and MNP use from caregiver perspectives (n = 59), programme managers (n = 17), and programme implementers (n = 168). Using a mixed methods approach allowed exploration of unexpected programme outcomes and triangulation of findings. The survey revealed that receiving a voucher was the main implementation bottleneck. Although few caregivers received vouchers (11.5%, CI [9.7, 13.6]), one-fourth received MNP by bypassing the voucher system (26.3%, CI [23.6, 29.0]). Caregivers' narratives indicated that caregivers were motivated to redeem vouchers but encountered obstacles, including not knowing where or how to redeem them or finding MNP were not available at the shop. Observing these challenges, many programme implementers redeemed vouchers and distributed MNP to caregivers. Virtually, all caregivers who received MNP reported ever feeding it to their child. This study's findings are consistent with other studies across a range of contexts suggesting that although programmes are generally effective in motivating initial use, more attention is required to improve access to MNP and support continued use.
Collapse
Affiliation(s)
| | | | | | | | - Edna Possolo
- Department of Nutrition, Ministry of Health, Maputo, Mozambique
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Maria Elena Jefferds
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Augusto Norte
- A-Consultants Statistical Services, Mendoza, Argentina
| | | | - Nadia Osman
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Wendy Gonzalez
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Alia Poonawala
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | |
Collapse
|
4
|
Schnefke CH, Tumilowicz A, Pelto GH, Gebreyesus SH, Gonzalez W, Hrabar M, Mahmood S, Pedro C, Picolo M, Possolo E, Scarlatescu OA, Tarlton D, Vettersand J. Designing an ethnographic interview for evaluation of micronutrient powder trial: Challenges and opportunities for implementation science. MATERNAL AND CHILD NUTRITION 2019; 15:e12804. [PMID: 31622039 PMCID: PMC6856841 DOI: 10.1111/mcn.12804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 02/03/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Abstract
The evidence base for micronutrient powder (MNP) interventions predominantly consists of quantitative studies focused on measuring coverage, utilization, and/or biological outcomes. We need other types of studies to broaden the scope of our knowledge about determinants of MNP programme effectiveness. Addressing this knowledge gap, this paper focuses on the process of designing an ethnographic research protocol to obtain caregivers' perspectives on the factors that influenced their use of intervention delivery services and their adherence to MNP recommendations. The research was undertaken within the context of formative evaluations conducted in Mozambique and Ethiopia. Ethnography provides a means for acquiring and interpreting this knowledge and is an approach particularly well suited for formative evaluation to understand the response of a population to new interventions and programme delivery processes. We describe decisions made and challenges encountered in developing the protocol, and their implications for advancing methodology in implementation research science. In addition to a core team of three investigators, we added an “advisory group” of 10 experts to advise us as we developed the protocol. The advisory group reviewed multiple drafts of the interview protocol and participated in mock interviews. In the protocol development process, we faced the issues and made decisions about concerned gaps in content, cultural adaptations and comprehension, and interview guide structure and format. Differences between the core team and the advisory group in methodological approaches to the structure and content of questions call attention to the importance of establishing greater communication among implementation scientists working in nutrition interventions.
Collapse
Affiliation(s)
- Courtney H Schnefke
- Public Health Research Division, RTI International, Research Triangle Park, North Carolina
| | | | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Seifu Hagos Gebreyesus
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wendy Gonzalez
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | - Shanzeh Mahmood
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Catia Pedro
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Melanie Picolo
- Maternal and Child Survival Program/PATH, Maputo, Mozambique
| | - Edna Possolo
- Department of Nutrition, Ministry of Health, Maputo, Mozambique
| | | | - Dessie Tarlton
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | |
Collapse
|
5
|
Pelletier D, DePee S. Micronutrient powder programs: New findings and future directions for implementation science. MATERNAL & CHILD NUTRITION 2019; 15:e12802. [PMID: 30828965 PMCID: PMC6857038 DOI: 10.1111/mcn.12802] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Affiliation(s)
- David Pelletier
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Saskia DePee
- Nutrition DivisionWorld Food ProgrammeRomeItaly
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- Human NutritionWageningen UniversityWageningenthe Netherlands
| |
Collapse
|
6
|
Tumilowicz A, Ruel MT, Pelto G, Pelletier D, Monterrosa EC, Lapping K, Kraemer K, De Regil LM, Bergeron G, Arabi M, Neufeld L, Sturke R. Implementation Science in Nutrition: Concepts and Frameworks for an Emerging Field of Science and Practice. Curr Dev Nutr 2019; 3:nzy080. [PMID: 30864563 PMCID: PMC6400593 DOI: 10.1093/cdn/nzy080] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/04/2018] [Accepted: 10/02/2018] [Indexed: 01/17/2023] Open
Abstract
Malnutrition in all its forms has risen on global and national agendas in recent years because of the recognition of its magnitude and its consequences for a wide range of human, social, and economic outcomes. Although the WHO, national governments, and other organizations have endorsed targets and identified appropriate policies, programs, and interventions, a major challenge lies in implementing these with the scale and quality needed to achieve population impact. This paper presents an approach to implementation science in nutrition (ISN) that builds upon concepts developed in other policy domains and addresses critical gaps in linking knowledge to effective action. ISN is defined here as an interdisciplinary body of theory, knowledge, frameworks, tools, and approaches whose purpose is to strengthen implementation quality and impact. It includes a wide range of methods and approaches to identify and address implementation bottlenecks; means to identify, evaluate, and scale up implementation innovations; and strategies to enhance the utilization of existing knowledge, tools, and frameworks based on the evolving science of implementation. The ISN framework recognizes that quality implementation requires alignment across 5 domains: the intervention, policy, or innovation being implemented; the implementing organization(s); the enabling environment of policies and stakeholders; the individuals, households, and communities of interest; and the strategies and decision processes used at various stages of the implementation process. The success of aligning these domains through implementation research requires a culture of inquiry, evaluation, learning, and response among program implementers; an action-oriented mission among the research partners; continuity of funding for implementation research; and resolving inherent tensions between program implementation and research. The Society for Implementation Science in Nutrition is a recently established membership society to advance the science and practice of nutrition implementation at various scales and in varied contexts.
Collapse
|