Using implementation research for evidence‐based programme development: a case study from Kenya

Abstract

The few available studies of programme effectiveness in nutrition find that programmes are less effective than would be predicted from the efficacy trials that are the basis for evidence‐based programming. Some of these are due to gaps in utilisation within households. To a greater extent, these gaps can be attributed to problems in programme design and implementation. ‘Implementation research in nutrition’ is an emerging area of study aimed at addressing this problem, by building an evidence base and a sound theory to design and implement programmes that will effectively deliver nutrition interventions. The purpose of this supplement to Maternal & Child Nutrition is to contribute to this growing area of implementation research. The series of papers presented and the reflections for policymaking and programmes, combined with the reflections on the application of ethnography to this area of inquiry, illustrate the value of systematic research undertaken for the purpose of supporting the design of nutrition interventions that are appropriate for the specific populations in which they are undertaken. © 2015 Blackwell Publishing Ltd

Using Ethnography to Identify Barriers and Facilitators to Optimal Infant and Young Child Feeding in Rural Ghana: Implications for Programs

“…Our findings corroborate those of other studies [8][9][10][11]15 that underscore the importance of the role of context in designing IYCF interventions. However, as in the FES in Kenya, 11,15 these studies not only identified 2 major sets of barriers and challenges to the adequacy of IYCF, they also revealed several positive elements of caregiver beliefs and behaviors, presenting opportunities to adapt or introduce context appropriate interventions to improve IYCF in these distinct agrarian Ghanaian populations.…”

“…Formative research is recognized as a tool that provides context-specific data to inform evidencebased decisions for nutrition and public health interventions. [8][9][10][11] It is particularly valuable in identifying suitable interventions or potential barriers that are likely to affect the success of an intervention.…”

“…In line with this, the Global Alliance for Improved Nutrition (GAIN) has supported the development of a formative research tool, the "Focused Ethnographic Study for Infant and Young Child Feeding 6 to 23 Months: Behaviors, Beliefs, Contexts, and Environments" (FES-IYCF) to identify key context factors that influence IYC feeding practices, 12 and has been applied in different country settings for GAIN's IYC nutrition programming. 13 The GAIN and the US Agency for International Development (USAID) have since conducted collaborative FES-IYCF research in conjunction with dietary intake surveys and Optifood linear programming analysis 14 to identify context-specific food-based recommendations for IYC diets in Kenya 11,15 and Ghana (Armar-Klemesu et al [unpublished data] note1, Brouwer et al [unpublished data] note 2). This article reports on the FES carried out in 2 rural districts in Ghana to identify the main constraints and facilitators to optimal IYCF.…”

Is there a “complementary feeding cultural core” in rural Kenya? Results from ethnographic research in five counties

“…In addition to these questions, the closely related topics of what proportion of IYC diets are composed of complementary feeding cultural core foods (if any), as distinct from household foods, and the process of integration of IYC into household diet, lie outside the scope of this paper and are not addressed here. To examine the four questions, we draw from the database of ethnographic and dietary information that was generated in a multisite study in Kenya, which was part of a multidisciplinary research effort to produce a landscape analysis that could be used to inform the development of interventions to improve nutrition of children and women (Pelto & Thuita, 2016;Tumilowicz, McClafferty, Neufeld, Hotz, & Pelto, 2015). Following the FES manual, the study design entailed a two-phase study in which key informants were interviewed in Phase I to obtain basic information on IYCF.…”

“…To address the broad question—“Is there a complementary feeding cultural core in rural Kenya?”—we identified four specific questions: Is there consensus about what foods are fed to infants and young children? Do infants and young children receive foods that are specially purchased and/or prepared for them? Are specially prepared foods shared with other members of the household? Are there any foods prepared for household consumption that are not shared with IYC? In addition to these questions, the closely related topics of what proportion of IYC diets are composed of complementary feeding cultural core foods (if any), as distinct from household foods, and the process of integration of IYC into household diet, lie outside the scope of this paper and are not addressed here. To examine the four questions, we draw from the database of ethnographic and dietary information that was generated in a multisite study in Kenya, which was part of a multidisciplinary research effort to produce a landscape analysis that could be used to inform the development of interventions to improve nutrition of children and women (Pelto & Thuita, ; Tumilowicz, McClafferty, Neufeld, Hotz, & Pelto, ).…”