Program Impact Pathway Analysis of a Social Franchise Model Shows Potential to Improve Infant and Young Child Feeding Practices in Vietnam
Program Impact Pathway Analysis of a Social Franchise Model Shows Potential to Improve Infant and Young Child Feeding Practices in Vietnam
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DOI：
10.3945/jn.114.194464
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发表时间：
2014-10-01
影响因子：
4.2
通讯作者：
Rawat, Rahul
中科院分区：
文献类型：
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作者：
Nguyen, Phuong H.;Menon, Purnima;Rawat, Rahul
通过绘制干预措施预期实现影响的机制，项目影响路径（PIP）分析列出了项目活动、成果和影响之间的理论因果关系。本研究探讨了通过生存与发展（A&T）社会特许经营模式旨在改善越南婴幼儿喂养（IYCF）实践的途径。采用混合方法，包括与特许经营管理委员会成员（n = 12）的定性访谈，与卫生服务提供者（n = 120），咨询意见（n = 160）和家庭调查（n = 2045）的调查。评估了PIP的六个组成部分：1）特许经营管理，2）卫生服务提供者的培训和IYCF知识，3）服务提供，4）计划曝光和利用，5）产妇行为决定因素（知识，信念和意图），以实现最佳IYCF做法，和6）IYCF做法。数据收集从A& T密集区（A & T-I;大众媒体+社会专营权）和A& T非密集区（A & T-NI;仅大众媒体）通过使用群集随机对照试验设计。将2013年的数据与有类似措施的基线进行了比较。结果表明，尽管日常监测面临挑战，但已建立了有效管理特许经营制度的机制。A&T培训与提供者能力的提高有关，导致在A& T-I领域提供更高质量的国际家庭年咨询（咨询期间更多的技术知识和沟通技能）。特许经营利用率从2012年的10%上升到2013年的45%，但低于预期的每对母子915次接触的频率。母乳喂养的知识，信念，意图和做法的改善更大的母亲在A&T-I地区比在A&T-NI地区。总之，在特许经营服务的影响路径上有许多沿着积极的变化，但应解决利用和创造需求方面的挑战，以实现充分的预期影响。
By mapping the mechanisms through which interventions are expected to achieve impact, program impact pathway (PIP) analysis lays out the theoretical causal links between program activities, outcomes, and impacts. This study examines the pathways through which the Alive & Thrive (A&T) social franchise model is intended to improve infant and young child feeding (IYCF) practices in Vietnam. Mixed methods were used, including qualitative interviews with franchise management board members (n = 12), surveys with health providers (n = 120), counseling observations (n = 160), and household surveys (n = 2045). Six PIP components were assessed: 1) franchise management, 2) training and IYCF knowledge of health providers, 3) service delivery, 4) program exposure and utilization, 5) maternal behavioral determinants (knowledge, beliefs, and intentions) toward optimal IYCF practices, and 6) IYCF practices. Data were collected from A&T-intensive areas (A & T-I; mass media + social franchise) and A&T-nonintensive areas (A & T-NI; mass media only) by using a cluster-randomized controlled trial design. Data from 2013 were compared with baseline where similar measures were available. Results indicate that mechanisms are in place for effective management of the franchise system, despite challenges to routine monitoring. A&T training was associated with increased capacity of providers, resulting in higher-quality IYCF counseling (greater technical knowledge and communication skills during counseling) in A&T-I areas. Franchise utilization increased from 10% in 2012 to 45% in 2013 but fell below the expected frequency of 915 contacts per mother-child dyad. Improvements in breastfeeding knowledge, beliefs, intentions, and practices were greater among mothers in A&T-I areas than among those in A&T-NI areas. In conclusion, there are many positive changes along the impact pathway of the franchise services, but challenges in utilization and demand creation should be addressed to achieve the full intended impact.