Grandmothers as Change Agents: Developing a Culturally Appropriate Program to Improve Maternal and Child Nutrition in Sierra Leone
Grandmothers as Change Agents: Developing a Culturally Appropriate Program to Improve Maternal and Child Nutrition in Sierra Leone
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DOI：
10.1093/cdn/nzz141
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发表时间：
2020-01-01
影响因子：
4.8
通讯作者：
Girard, Amy Webb
中科院分区：
文献类型：
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作者：
MacDonald, Carolyn A.;Aubel, Judi;Girard, Amy Webb
背景 关于最佳孕产妇和儿童营养 (MCN) 做法的全球建议很明确；然而，关于 1) 探索家庭成员的角色如何影响这些实践以及 2) 相应地设计项目的文献有限。在南半球国家采用家庭系统方法的研究人员发现，祖母往往在 MCN 中发挥着至关重要的作用，但大多数营养计划都狭隘地针对母亲，从而可能限制了有效性。 目标 本文报告了定性研究的结果，探讨塞拉利昂南部家庭成员对 MCN 的作用和影响、当地的 MCN 信仰和实践，以及这些发现如何为文化上适当的计划的设计提供信息。 方法 9 年与母亲、父亲和祖母进行了焦点小组讨论 (FGD)。塞拉利昂邦特区的社区。我们使用参与式工具来探索家庭成员的角色以及当地 MCN 的信仰和实践。访谈由记录员记录，并使用内容分析方法进行编码和分析。 结果 共有 88 名母亲、125 名祖母和 79 名父亲参加了 FGD。所有群体均表示：1) 祖母是文化上指定的女性在 MCN 问题上的顾问和监督者，2) 母亲不是自主决策者，深受祖母的影响。该研究确定了有益的 MCN 实践以及最佳 MCN 实践与现有 MCN 实践之间的差距，特别是与怀孕期间的母亲饮食和 6 个月纯母乳喂养相关的差距。研究结果用于设计祖母包容性计划。 结论 我们的研究表明，母亲融入了照顾和监督的家庭系统中，祖母对 MCN 实践具有主要影响，这显然支持祖母在社区 MCN 计划中发挥核心作用的必要性。它还指出在设计公共卫生营养计划时需要更多地使用家庭系统方法。
Background Global recommendations on optimal maternal and child nutrition (MCN) practices are clear; however, there is limited literature 1) exploring how roles of family members influence those practices and on 2) designing programs accordingly. Researchers using a family-systems approach in the Global South find that grandmothers often play a vital role in MCN, yet most nutrition programs narrowly target mothers, thereby potentially limiting effectiveness.Objectives This article reports on the results of qualitative research exploring the roles and influence of family members on MCN in southern Sierra Leone, the local MCN beliefs and practices, and how those findings informed the design of a culturally appropriate program.Methods Focus group discussions (FGDs) were conducted with mothers, fathers, and grandmothers in 9 communities in Bonthe District, Sierra Leone. We used participatory tools to explore family members' roles and local MCN beliefs and practices. Interviews were recorded by notetakers and coded and analyzed using a content analysis approach.Results A total of 88 mothers, 125 grandmothers, and 79 fathers participated in the FGDs. All groups indicated that 1) grandmothers are the culturally designated advisors and supervisors of women on MCN issues and 2) mothers are not autonomous decision makers and are greatly influenced by grandmothers. The research identified both beneficial MCN practices and gaps between optimal and existing MCN practices-particularly related to maternal diet during pregnancy and exclusive breastfeeding for 6 mo. Research findings were used to design a grandmother-inclusive program.Conclusions Our research showed that mothers are embedded in a family system of caring and supervision where grandmothers have primary influence on MCN practices, clearly supporting the need for grandmothers to have a central role in community MCN programs. It also points to the need for increased use of a family-systems approach in designing public health nutrition programs.