TY - JOUR
T1 - An Iterative Process for Training Design and Implementation Increased Health Workers' Knowledge for Taking Nutrition Behavior Change to Scale
AU - Gonzalez, Wendy
AU - Bonvecchio Arenas, Anabelle
AU - García-Guerra, Armando
AU - Vilar-Compte, Mireya
AU - Villa De La Vega, Alejandría
AU - Quezada, Laura
AU - Rosas, Cynthia
AU - Lozada-Tequeanes, Ana Lilia
AU - Hernández, Amira
N1 - Funding Information:
Funds for the research reported in this manuscript were provided by the National Coordination of the Progresa-Oportunidades-PROSPERA (now called PROSPERA Programa de Inclusión Social), Secretary of Social Development, Government of Mexico, Mexico City. Funding for this supplement was provided by Instituto Nacional de Salud Pública (INSP), Cuernavaca, México, and the Global Alliance for Improved Nutrition. Author disclosures: WG, AB, AG-G, MV-C, AVdlV, LQ, CR, ALL-T, and AH, no conflicts of interest. Supplemental Figure 1, and Supplemental Tables 1 and 2 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/. INSP, National Institute of Public Health of Mexico. Publication costs for this supplement were defrayed in part by the payment of page charges. This article appears as part of the supplement “Implementation research for improvement of nutrition actions in an at-scale social protection program in Mexico,” sponsored by the INSP, and the Global Alliance for Improved Nutrition (GAIN). The guest editors of the supplement, Lynnette M Neufeld and Anabelle Bonvecchio Arenas, have the following conflicts of interest: LMN is employed by GAIN, ABA is employed by INSP. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, Editor, or Editorial Board of The Journal of Nutrition. Address correspondence to AG-G (e-mail: garciaf@insp.mx). Abbreviations used: BCC, behavior change communication; CCT-POP, conditional cash transfer program PROSPERA; EsIAN, Integrated Strategy for Attention to Nutrition; IMSS, Mexican Institute of Social Security; INSP, National Institute of Public Health; IYCF, infant and young child feeding; PHC, primary health care; PLW, pregnant and lactating women; PSM, propensity score matching.
Publisher Copyright:
Copyright © American Society for Nutrition 2019.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers' routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions.
AB - The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers' routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions.
KW - evidence-based practice
KW - Mexico
KW - nutrition transition
KW - scaling up nutrition
KW - systems strengthening
UR - http://www.scopus.com/inward/record.url?scp=85076113193&partnerID=8YFLogxK
U2 - 10.1093/jn/nxz203
DO - 10.1093/jn/nxz203
M3 - Article
C2 - 31793649
AN - SCOPUS:85076113193
SN - 0024-2160
VL - 20
SP - 2323S-2331S
JO - Library
JF - Library
IS - 1
ER -