Abstract
Food fortification has proven to be an effective approach for preventing micronutrient deficiencies in many settings. Factors that lead to successful fortification programs are well established. However, due to the multisectoral nature of fortification and the added complexities present in many settings, the barriers to success are not always evident and the strategies to address them are not always obvious. We developed a systematic process for identifying and addressing gaps in the implementation of a food fortification program. The framework is composed of 4 phases: (1) connect program theory of change to program implementation; (2) develop an implementation research agenda; (3) conduct implementation research; and (4) analyze findings and develop/disseminate recommendations for next steps. We detail steps in each phase to help guide teams through the process. To our knowledge, this is the first attempt to outline a systematic process for applying implementation science research to food fortification. The development of this framework is intended to promote implementation research in the field of food fortification, thus improving access to and effectiveness of this key public health intervention.
Highlights
Food fortification has been demonstrated to be an effective and cost-effective approach for reducing micronutrient deficiencies in many settings where governments have created, implemented, monitored, and enforced standards for the fortification of staple foods.[1,2] Factors that lead to successful food fortification programs are well established
The systematic process framework we present contributes to the existing literature by interpreting the concepts of implementation science and implementation research as they relate to food fortification
We have provided a template (Table 2) for the prioritization of implementation research questions, modeled on an approach found in the program assessment guide.[21]
Summary
Key Messages n There are many countries implementing food fortification programs but not all of them are achieving their public health goals. N Implementation challenges are best addressed not in an ad hoc way, but rather through a systematic approach known as implementation science. N The need for implementation science research in public health nutrition programs has been wellrecognized. N Implementation research teams (often composed of scientists, program implementers, and funders) should work together through a systematic process of identifying and addressing gaps in the implementation of a food fortification program. N This framework provides a systematic way to identify gaps in context-specific programmatic knowledge and action, formulate implementation research questions, prioritize those questions, and supply guidance on how to move forward after the conclusion and analysis of the implementation research studies
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