A Program Impact Pathway Analysis Identifies Critical Steps in the Implementation and Utilization of a Behavior Change Communication Intervention Promoting Infant and Child Feeding Practices in Bangladesh
A Program Impact Pathway Analysis Identifies Critical Steps in the Implementation and Utilization of a Behavior Change Communication Intervention Promoting Infant and Child Feeding Practices in Bangladesh
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DOI：
10.3945/jn.113.179085
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发表时间：
2013-12-01
影响因子：
4.2
通讯作者：
Frongillo, Edward A.
中科院分区：
文献类型：
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作者：
Avula, Rasmi;Menon, Purnima;Frongillo, Edward A.
绘制如何实施和利用干预措施的路径图，可以根据背景对结果进行解释，区分设计不良和实施不良，并确定可能影响干预措施利用的因素。很少有营养学研究全面考察了行为改变沟通（BCC）干预措施的实施和利用步骤，从而限制了对BCC干预措施变量影响的解释。使用计划影响途径（PIP）分析来研究孟加拉国实施的BCC干预措施，以改善婴幼儿喂养（IYCF）实践。PIP是通过与项目实施团队的迭代过程开发的; PIP然后指导方法和工具的选择。采用混合方法，我们审查了培训材料的内容，执行人员，测量他们的IYCF知识（n = 100），观察他们与母亲的沟通（n = 37），并检查影响IYCF的做法，他们的试验和母亲采用的推广因素（n = 64）。实施工作人员表现出良好的知识，并在很大程度上保持对干预措施的忠诚。母亲们将其确定为主要的信息来源，大多数母亲都尝试了所建议的国际家庭年做法。关键的促进因素包括家庭支持和资源的可用性，而缺乏时间、母亲和家庭对适龄喂养的看法以及缺乏资源是采用建议做法的突出障碍。使用PIP分析确定了与执行有关的关键问题（例如，有偿和志愿工作人员的作用）和利用（例如，由于资源和时间限制，需要采取补充性干预措施），需要进一步开展研究并在方案方面给予关注。
Mapping pathways of how interventions are implemented and utilized enables contextually grounded interpretation of results, differentiates poor design from poor implementation, and identifies factors that might influence the utilization of interventions. Few studies in nutrition have comprehensively examined the steps of implementation and utilization in behavior change communication (BCC) interventions, thus limiting the interpretation of variable impacts of BCC interventions. A program impact pathway (PIP) analysis was used to study a BCC intervention implemented in Bangladesh to improve infant and young child feeding (IYCF) practices. The PIP was developed through an iterative process with the program implementation team; the PIP then guided the choice of methods and tools. Using mixed methods, we reviewed the content of training materials for implementation staff, measured their IYCF knowledge (n = 100), observed their communication with mothers (n = 37), and examined factors influencing promotion of IYCF practices and their trial and adoption by mothers (n = 64). Implementation staff demonstrated good knowledge and maintained fidelity to the intervention to a large extent. Mothers identified them as their primary sources of information, and a majority of mothers tried recommended IYCF practices. Key facilitators included family support and availability of resources, whereas lack of time, maternal and family perceptions of age-appropriate feeding, and lack of resources were salient barriers to adopting recommended practices. Using a PIP analysis identified critical issues pertaining to implementation (e.g., the role of paid and volunteer staff) and utilization (e.g., resource and time constraints that require complementary interventions) and the need for further research and programmatic attention.