Program impact pathway of a community‐based nutrition approach in improving child nutritional status in rural Ethiopia: a process evaluation study

Abstract

The implementation process of complex nutrition interventions needs to be examined to better understand how they achieve expected outcomes. We conducted a program impact pathway (PIP) analysis to understand how a community‐based participatory nutrition promotion (CPNP) program—involving a two‐week group nutrition session—improved child nutritional status in rural Ethiopia. Five program components: (1) quality of the CPNP implementation process, (2) participants’ acceptance of the CPNP program, (3) participants’ message recall, (4) infant and child feeding practices, and (5) the influence of exposure to other ongoing nutrition programs, were evaluated. We reviewed the attendance records of participants (n = 3,299) and monitoring records of nutrition sessions (n = 372) and extracted process evaluation indicators such as the percentage of dose delivered, percentage of dose received, and percentage of fidelity to the intervention protocols. We conducted a household survey every three months for a year as part of a cluster randomized trial among 914 and 876 mothers randomly selected from control and intervention areas, respectively, to assess engagement to the ENA and CMAM programs. Among the survey mothers, the recall of mothers’ (n = 197) experiences related to the CPNP group sessions was assessed. CPNP sessions were delivered at 81% of the expectation level; fidelity to intervention protocols varied between 68% and 92% of the expectation. Out of 197 participants, 95% ever contributed materials to a session, 90% showed positive perception to the session practices, and ~70% rated their participation level as active. We found a higher involvement of CPNP participants in the existing program (e.g., Essential Nutrition Action) over the project period compared to non‐participants within the same intervention area (32.1% vs. 19.5%, P < 0.001). The CPNP program was adequately implemented and well‐accepted among participants, giving the additional benefit of positively influencing the ongoing ENA program, and eventually resulting in improved child nutritional status.Support or Funding InformationThis study was supported by World Vision Korea and Korea International Cooperation Agency (KOICA).