Engaging community members in setting priorities for nutrition interventions in rural northern Ghana.
Engaging community members in setting priorities for nutrition interventions in rural northern Ghana.
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DOI：
10.1371/journal.pgph.0000447
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发表时间：
2022
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中科院分区：
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本研究使用了“共同选择”（CHAT）这一协商参与工具，对营养干预措施进行优先排序，并了解加纳北部一个农村社区选择干预措施的原因。研究采用探索性横断面设计，并在2020年12月至2021年2月期间使用混合方法收集数据。通过政策审查、与不同利益相关者的互动以及与社区成员的焦点小组讨论，确定了11项营养干预措施。这些干预措施被用于一个改良的CHAT工具进行成本核算——这是一个类似棋盘的游戏，干预措施用彩色编码的扇形表示，干预措施的成本用贴纸孔表示。在受过培训的引导员的支持下，六个社区小组使用该工具对干预措施进行优先排序。讨论过程进行了录音，转录后进行主题分析。参与者对营养敏感型和营养特定型干预措施都进行了优先排序，这反映了研究地区的贫困程度以及营养特定型干预措施带来的直接和即时效益。优先考虑的干预措施涉及生计赋权，因为它们将为全年农业产出创造有利环境，从而提高农民的粮食安全和收入。另一个与营养敏感且与教育相关的优先干预措施是男性参与食物和营养实践；作为户主和主要决策者，人们认为男性能够优化母婴营养。优先考虑的营养特定型干预措施是微量营养素补充。尽管参与者文化水平较低，但他们能够使用CHAT材料并共同对干预措施进行优先排序。总之，在公众协商中对CHAT工具进行改良并用于在文化水平较低的农村地区对营养干预措施进行优先排序是可行的。这些社区对营养敏感型和营养特定型干预措施都进行了优先排序。关注社区得出的营养优先事项可能会提高营养卫生政策的相关性和有效性，因为这些优先事项反映了此类政策实施的背景。
This study used “Choosing All Together” (CHAT), a deliberative engagement tool to prioritise nutrition interventions and to understand reasons for intervention choices of a rural community in northern Ghana. The study took an exploratory cross-sectional design and used a mixed method approach to collect data between December 2020 and February 2021. Eleven nutrition interventions were identified through policy reviews, interaction with different stakeholders and focus group discussions with community members. These interventions were costed for a modified CHAT tool—a board-like game with interventions represented by colour coded pies and the cost of the interventions represented by sticker holes. Supported by trained facilitators, six community groups used the tool to prioritise interventions. Discussions were audio-recoded, transcribed and thematically analysed. The participants prioritised both nutrition-sensitive and nutrition-specific interventions, reflecting the extent of poverty in the study districts and the direct and immediate benefits derived from nutrition-specific interventions. The prioritised interventions involved livelihood empowerment, because they would create an enabling environment for all-year-round agricultural output, leading to improved food security and income for farmers. Another nutrition-sensitive, education-related priority intervention was male involvement in food and nutrition practices; as heads of household and main decision makers, men were believed to be in a position to optimise maternal and child nutrition. The prioritised nutrition-specific intervention was micronutrient supplementation. Despite low literacy, participants were able to use CHAT materials and work collectively to prioritize interventions. In conclusion, it is feasible to modify and use the CHAT tool in public deliberations to prioritize nutrition interventions in rural settings with low levels of literacy. These communities prioritised both nutrition-sensitive and nutrition-specific interventions. Attending to community derived nutrition priorities may improve the relevance and effectiveness of nutrition health policy, since these priorities reflect the context in which such policy is implemented.