Formative Research Methods Research Articles

Creating culturally-informed protocols for a stunting intervention using a situated values-based approach (WeValue InSitu): a double case study in Indonesia and Senegal

International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing ‘cultural protocols’ to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which ‘crystallize’ their envelope of local shared values, making them communicable to outsiders.Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.

평화교육 수업 설계 모형 개발

Objectives The purpose of this study is to develop a peace education model that can be flexibly applied to diverse learners and diverse educational contexts.
 Methods Components of the peace education model were derived through a literature review. Based on this, a model was designed, and the designed model went through a validity verification process through formative research methods. For internal validation, I consulted with four experts who majored in education, and for external validation, I evaluated the usability of seven peace education practitioners and looked at learner responses in the educational field. Through this process, the model was modified and supplemented.
 Results The final model, which went through internal and external validation processes, was found to be valid. The peace education class design model developed in this study aims to 'cultivate peace sensitivity' and 'practice in life', starting with 'forming peace relationships', 'safe space', 'attitude open to various perspectives', ‘Ability to start anew’ is a content element. And the operating methods are education about peace (understanding), education for peace (application), and education by peace (acquisition).
 Conclusions This study presents a peace education class design model that can be used and applied in peace education fields. The peace education class design model developed in this study has a limitation in that the scope and level of use may vary depending on the instructor's understanding and experience of peace education and the educational environment.

Developing preservice bilingual teachers’ transformative agency

U.S. bilingual educators struggle with English hegemonic ideology and inadequate ethnolinguistic resources. Using the theoretical framework of transformative agency by double stimulation, this qualitative case study investigated how preservice Chinese and Spanish bilingual teachers actively confronted such struggles during their practicum experiences to improve their culturally responsive pedagogies. Four types of warping actions were found: amplifying bilingual instruction, formulating support for bilingual learning, generating new bilingual pedagogical knowledge, and taking charge of their own professional growth as bilingual teachers. The study concludes that preservice teachers’ transformative agency can be pedagogically facilitated with mediational tools offered through formative intervention research methods. (100 words).

Provider perspectives on patient-centredness: participatory formative research and rapid analysis methods to inform the design and implementation of a facility-based HIV care improvement intervention in Zambia.

Implementation of patient-centred care (PCC) practices in HIV treatment depends on healthcare workers' (HCWs) perceptions of the acceptability, appropriateness and feasibility of such practices (e.g. use of intentional, metric-driven activities to improve patient experiences). We applied rapid, rigorous formative research methods to refine a PCC intervention for future trial. In 2018, we conducted focus group discussions (FGDs) with 46 HCWs purposefully selected from two pilot sites. We elicited HCW perceptions of HIV service delivery, HCW motivation and perceived value of patient experience measures intended to improve PCC. FGDs utilized participatory methods to understand HCW responses to patient-reported care engagement challenges and Scholl's PCC Framework principles (e.g. seeing a patient as a unique person), enablers (e.g. care coordination) and activities (e.g. patient involvement). Our rapid analysis used analytic memos, thematic analysis, research team debriefs and HCW feedback to inform time-sensitive trial implementation. While HCWs nearly universally identified with and supported principles of PCC in both facilities, they raised practical barriers given the practice environment. HCWs described motivation to help patients, attached value to seeing positive health outcomes and the importance of teamwork. However, HCWs reported challenges with enablers needed to deliver PCC. HCWs cited a work culture characterized by differential power dynamics between cadres and departments restricting HCW autonomy and resource access. Barriers included inflexibility in accommodating individual patient needs due to high patient volumes, limited human resources, laboratory capacity, infrastructure and skills translating patient perspectives into practice. HCW motivation was negatively influenced by encounters with "difficult patients," and feeling "unappreciated" by management, resulting in cognitive dissonance between HCW beliefs and behaviours. However, the enactment of PCC values also occurred. Results suggested that PCC interventions should reduce practice barriers, highlighting the value of mentors who could help HCWs dynamically engage with health system constraints, to facilitate PCC. While HCWs perceived PCC principles as acceptable, they did not think it universally appropriate or feasible given the practice environment. Participatory and rapid methods provided timely insight that PCC interventions must provide clear and effective systems enabling PCC activities by measuring and mitigating relational and organizational constraints amenable to change such as inter-cadre coordination.

Maximizing community participation and engagement: lessons learned over 2 decades of field trials in rural Ghana

BackgroundSuccessful implementation of community-based research is dominantly influenced by participation and engagement from the local community without which community members will not want to participate in research and important knowledge and potential health benefits will be missed. Therefore, maximising community participation and engagement is key for the effective conduct of community-based research. In this paper, we present lessons learnt over two decades of conducting research in 7 rural districts in the Brong Ahafo region of Ghana with an estimated population of around 600,000. The trials which were mainly in the area of Maternal, Neonatal and Child Health were conducted by the Kintampo Health Research Centre (KHRC) in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM).MethodsThe four core strategies which were used were formative research methods, the formation of the Information, Education and Communication (IEC) team to serve as the main link between the research team and the community, recruitment of field workers from the communities within which they lived, and close collaboration with national and regional stakeholders.ResultsThese measures allowed trust to be built between the community members and the research team and ensured that potential misconceptions which came up in the communities were promptly dealt with through the IEC team. The decision to place field workers in the communities from which they came and their knowledge of the local language created trust between the research team and the community. The close working relationship between the District health authorities and the Kintampo Health Research Centre supported the acceptance of the research in the communities as the District Health Authorities were respected and trusted.ConclusionThe successes achieved during the past 2 decades of collaboration between LSHTM and KHRC in conducting community-based field trials were based on involving the community in research projects. Community participation and engagement helped not only to identify the pertinent issues, but also enabled the communities and research team to contribute towards efforts to address challenges.

Reporting Cultural Adaptation in Psychological Trials - The RECAPT criteria.

There is a lack of empirical evidence on the level of cultural adaptation required for psychological interventions developed in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies to be effective for the treatment of common mental disorders among culturally and ethnically diverse groups. This lack of evidence is partly due to insufficient documentation of cultural adaptation in psychological trials. Standardised documentation is needed in order to enhance empirical and meta-analytic evidence. A "Task force for cultural adaptation of mental health interventions for refugees" was established to harmonise and document the cultural adaptation process across several randomised controlled trials testing psychological interventions for mental health among refugee populations in Germany. Based on the collected experiences, a sub-group of the task force developed the reporting criteria presented in this paper. Thereafter, an online survey with international experts in cultural adaptation of psychological interventions was conducted, including two rounds of feedback. The consolidation process resulted in eleven reporting criteria to guide and document the process of cultural adaptation of psychological interventions in clinical trials. A template for documenting this process is provided. The eleven criteria are structured along A) Set-up; B) Formative research methods; C) Intervention adaptation; D) Measuring outcomes and implementation. Reporting on cultural adaptation more consistently in future psychological trials will hopefully improve the quality of evidence and contribute to examining the effect of cultural adaptation on treatment efficacy, feasibility, and acceptability.

Using Formative Research to Inform a BCC Strategy to Increase Food Security and Dietary Diversity in Low-Income Rural Communities

Background: Adequate nutrition is a public health priority, particularly in low-income rural areas where there is a high prevalence of malnutrition and stunting. Baluchistan is an arid desert and mountainous province with the worst health indicators in Pakistan. The objective of this research study was to identify current knowledge, attitudes and practices of vulnerable women with young children residing in remote areas of Baluchistan and assess their information needs to guide the development of a BCC nutrition strategy materials and activities. Methods: This study design incorporated formative research via eight focus group discussions with demand and supply-side program beneficiaries (n=124) to assess current nutrition knowledge, attitudes and beliefs toward kitchen gardens and proposed nutrition resources. Semi-structured interviews (n=16) were also conducted to provide program intelligence from key informants. A literature review supported the development of discussion agenda based on predominant behavioral theories. Data analysis was conducted with in vivo qualitative software coupled with grounded theory with qualitative findings triangulated. Results: The study identified important factors for the development of BCC resources and activities. Opportunities included effective nutrition education, improved income and livelihoods from kitchen gardens, women’s empowerment and gender equality. Challenges included traditional cultural practices, entrenched food preparation behaviour, environmental and infrastructural constraints. Conclusions: Lessons learned highlight the benefits of integrating formative research methods with a comprehensive literature review and behavioural theories for the development of BCC resources for nutrition programs in insecure and resource-constrained settings.

Using formative evaluation to plan for electronic psychosocial screening in pediatric oncology.

To demonstrate how formative research methods can be used to plan for implementation of evidence-based psychosocial screening in pediatric oncology. Multidisciplinary pediatric oncology professionals participated in focus groups to adapt the distress thermometer for electronic administration and develop health systems processes to promote psychosocial screening in the pediatric oncology outpatient clinic setting. Seven 1-hour focus groups were conducted using a structured guide based on the reach, efficacy, adoption, implementation, and maintenance framework and transcribed verbatim. Two independent raters coded transcripts using a quasi-deductive approach with high inter-coder reliability (Cohen kappa >0.80). Participants' (N = 44) responses were used to identify overarching topics related to the adoption, implementation, and maintenance of electronic screening (e-screening) including: barriers to meeting families' psychosocial needs, identification of champions, suggestions to adapt the proposed e-screening program, perceived barriers to e-screening, and potential impact of carrying out e-screening. Following review of qualitative data, we employed specific implementation strategies to promote adoption, implementation, and maintenance of an e-screening program. Perceived barriers to the implementation of psychosocial screening remain substantial, yet enthusiasm for using electronic health records (EHRs) technology to help meet patient needs through regular assessment was evident among pediatric oncology professionals. Electronic administration of screening and integration of results into the EHR in real time were identified as critical needs to overcome barriers to e-screening. Formative research including qualitative data from stakeholders can be used to tailor implementation strategies to successfully support the adoption, implementation, and maintenance of e-screening programs in pediatric oncology.

Ensuring Organization-Intervention Fit for a Participatory Organizational Intervention to Improve Food Service Workers' Health and Wellbeing: Workplace Organizational Health Study.

Food-service workers' health and wellbeing is impacted by their jobs and work environments. Formative research methods were used to explore working conditions impacting workers' health to inform intervention planning and implementation and to enhance the intervention's "fit" to the organization. Four qualitative methods (worker focus groups; manager interviews; worksite observations; multi-stakeholder workshop) explored in-depth and then prioritized working conditions impacting workers' health as targets for an intervention. Prioritized working conditions included: ergonomics; work intensity; career development; and job enrichment. Data revealed necessary intervention mechanisms to enhance intervention implementation: worker and management communication infrastructure; employee participation in intervention planning and implementation; tailored worksite strategies; and ensuring leadership commitment. These targeted, comprehensive methods move away from a typical focus on generic working conditions, for example, job demands and physical work environment, to explore those conditions unique to an organization. Thereby, enhancing "intervention-fit" at multiple levels within the company context.

The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting.

The treatment gap for autism globally is high. Our previous PASS intervention, delivered by community based lay health workers, showed effectiveness. This article reports the development and evaluation of a new "PASS 'Plus'" intervention in a rural population in India. Using formative research methods, we supplemented the PASS intervention with additional (Plus) modules to address autism comorbidities. This is the first time that a rigorous methodology has been used to evaluate autism symptom outcomes in a low and middle-income country setting. 40 parent-child dyads were recruited in a pilot randomized controlled trial against usual care (mean age 65 months (34 boys); n = 19 PASS Plus, n = 21 UC). 89% of intervention families partially or entirely completed the 12-session intervention. Intention to treat analysis showed a reduction in mean scores of autism symptom severity, though the confidence interval contains zero, (adjusted mean difference AMD -2.42 95% CI -7.75, 2.92; ES 0.22); large treatment effects on proximal outcomes of proportion of parent synchronous responses (AMD 0.35; 95% CI 0.18, 0.52; effect size ES 3.97) and proportion of child communication initiations with parent (AMD 0·17; 95% CI 0.03, 0.32; ES 1.02). Confidence intervals for effects on mutual shared attention (AMD 0.10; 95% CI -0.07, 0.27; ES 0.5) and co-morbid symptoms (AMD -9.0; 95% CI -24.26, 6.26; ES 0.32) contained zero. There were significant effects to improve parental mental health. PASS Plus shows good feasibility and adds to the evidence of the effectiveness of task sharing complex autism interventions to lay health workers in India. Autism Res 2019, 12: 328-339 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This article describes the development of a comprehensive, community-delivered, intervention for young children with autism, which combines a previously developed parent-mediated communication intervention with support for co-morbid problems like challenging behaviors and sensory sensitivities. The unique aspect of this intervention is that it can be delivered by community health workers, addressing the lack of specialists in low resource settings. Our study reports the encouraging findings of a pilot trial evaluating its feasibility and effectiveness.

Meeting the urgent need for rabies education in Haiti.

The highest rate of human rabies deaths reported in the Americas is in Haiti, and most of these deaths result from rabies virus infections that occur after individuals are bitten by infected dogs and do not receive rabies post-exposure prophylaxis. One barrier to rabies prevention in Haiti is a lack of knowledge about this disease among healthcare professionals and community members. During the past 4years, The US Centers for Disease Control and Prevention has collaborated with public health officials and partners to develop, test and refine educational materials aimed at filling this need for rabies education. This report summarizes the use of feedback from knowledge, attitudes and practises surveys; key informant interviews; and focus groups to develop culturally appropriate rabies prevention materials for community members, health officials, clinicians, laboratory professionals, veterinary professionals, government officials and national and local district leaders about ways to prevent rabies. These formative research methods were critically important in ensuring that the materials would be culturally appropriate and would stand the greatest likelihood of motivating Haitians to protect themselves from rabies. Centers for Disease Control and Prevention is using lessons learned in Haiti to develop and test materials in other countries with high rates of canine rabies.

Formative research to identify community partnerships and foster relationships for health promotion research in South Mississippi

ObjectivesThe purpose of this short communication is to describe the trust building and collaboration, fostering phases of a community-academic partnership between churches and academic researchers using a community-based participatory research approach. Study design and methodsAn academic-community partnership with church leaders was initiated using survey administration and was further developed using focus groups. A coalition was developed, and it guided a subsequent focus group with church members. ResultsMost churches surveyed did not have a health ministry in place but were agreeable that a variety of health topics were appropriate for the church setting. Church leaders felt that church members were key to engage in health programs in the church, whereas church members viewed pastoral support as important. Church leaders felt that working with a university brings credibility to their own health programs. ConclusionThis early work provides a valuable example of how community collaborations may be initiated and developed using formative research methods, serving both community and research agendas.

A typology of female sex work in the Metropolitan Region of Santiago, Chile

In Chile, sex work takes place covertly in a variety of venues and locations. Formative research using time-location sampling methods is important in order to understand the nature of this diversity. This study used qualitative methods to develop a typology of female sex work in the Metropolitan Region of Santiago, Chile, using semi-structured interviews, focus groups and ethnographic fieldwork during visits to sex work venues. The study identified seven types of venue, which reflect the context and regulatory framework of the country and the structural vulnerabilities that affect female sex workers in Chile. These venues and locations include: cafés con piernas (coffee with legs); nightclubs, topless bars and cabarets; brothels; hotels; street and highway soliciting; massage parlours; and private residences. Formative research methods were helpful in identifying and characterising the venues and locations in which sex work occurred. Barriers to accessing and mapping specific locations were also identified. Recommendations for addressing these barriers include working with non-governmental organisations to map venues and initiate contact with the populations of interest. A comprehensive typology of sex work in the Metropolitan Region of Santiago, Chile, is an essential element for future time-location sampling and bio-behavioural research in the context of second-generation surveillance for HIV and sexually transmitted infections in Chile.

Firefighting and mental health: Experiences of repeated exposure to trauma.

Firefighters must be ready to respond to a broad range of emergencies every duty day. In the course of many of these emergencies, firefighters witness events which have the potential to induce emotional trauma, such as badly injured people, deceased children, and individuals who are highly distraught. Previous research suggests that repeated exposure to these traumas (RET) may have negative impacts on the emotional and mental health of fire service personnel. Research on the mental health of firefighters has been limited to small surveys reporting the prevalence of specific mental health problems such as depression and post-traumatic stress disorder among firefighters. Despite the likelihood that RET leads to negative outcomes in firefighters, data is lacking on how exposure impacts fire service personnel. The current study examines the experiences of firefighters related to RET. Using formative research methods, we examined the beliefs and experiences of firefighters and administrators from across the United States regarding the impact of RET on firefighter health. Study findings highlight the cumulative psychological toll of repeated exposure to traumatic events including desensitization, flashbacks, and irritability. Results of the current study suggest that RET is a significant concern for emergency responders that warrants additional research and attention. It is likely that the long term consequences of RET are closely intertwined with other mental health outcomes and general well-being of this important occupational group.

Abstract A38: Participatory cancer education through illustrated story maps to address cancer health disparities

Abstract Background: Many racial and ethnic minorities consider cancer to be a death sentence, will not speak of it, and shun those who have it. Community use of focused, illustrated “story maps,” i.e. visual storytelling using imagery, to share experiences with cancer and start conversations about cancer may help to overcome barriers to cancer prevention and control, enhanced survivorship, and quality of life, such as alleviating fear and helplessness. The purpose was to develop and integrate story maps into an existing cancer health disparities educational program in churches. Methods: Building on a community-based participatory research approach and using formative research methods, a story map was produced depicting origins of cancer, cancer prevention and control, treatment, and survivorship emphasizing quality of life throughout. Focus groups (n=11) and feedback sessions with individuals and groups of stakeholders were conducted over an 18-month period to iteratively develop the maps with a graphic artist. Notes were maintained and used to guide development and revisions. An overall story map was developed with three smaller maps depicting sections describing cancer prevention, screening, and outcomes/treatment/survivorship. Maps are available in banner, large, and placemat size and on electronic media for projection. Church program facilitators were trained on how to use the story maps as part of the cancer educational program. A brief video was produced to provide additional training and technical assistance. Results: Facilitators are currently using the maps to address cancer-related health disparities in the African-American community. Sessions using the maps are designed to last one hour but often go longer due to participant dialogue. Facilitators guide the sessions focusing participants on the graphics and caricatures on the maps. Discussion begins by asking participants what they see on the maps. Responses typically lead to personal discussions and stories about cancer. Questions about how individuals, and families, stay on “the long-life highway” (shown on the map) and out of “the stream of cancer” (also shown on the map) are posed and stories shared. Pre- and post-test evaluation of the integration of the maps into the program, effect of the maps on intentions to prevent and control cancer as well as attitudes, beliefs, and fatalism, and efforts to address cancer disparities is being conducted. Conclusion: The process of developing the story maps was participatory and iterative, thus allowing the process to incorporate community beliefs into the maps to prompt discussion. From our previous use of story maps and the excitement shown by the facilitators, we anticipate positive evaluation results on the use of the maps. We expect to show significant improvement in self-efficacy, lower cancer fatalism, and equal or greater indications of intention to act on cancer information. Local, participatory communication appears to be more effective and credible in promoting healthful change to address cancer-related health disparities. Citation Format: John R. Ureda, Kimberly C. Rawlinson, Heather M. Brandt, Wanda Green, Deloris G. Williams, Andrea S. Gibson. Participatory cancer education through illustrated story maps to address cancer health disparities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A38.

Integrating Users in an Interactive Video Education Project: Reframing the Patient-Centered Strategy of a Cystic Fibrosis Centre

This article reports on the formative evaluation of WebPEP (“Web-Based Patient Education Program”), an interactive video education project at ErasmusMC–Sophia Children’s Hospital (SCH) in Rotterdam, the Netherlands. Through monthly live webcasts, doctors, nurses, psychologists, and other healthcare professionals affiliated to SCH’s Cystic Fibrosis Team gave presentations on medical and psychosocial aspects related to cystic fibrosis (CF). These webcasts were first intended to educate and be educational to children between the ages of twelve and eighteen, but during the first year of the project they failed to attract this specific group. Instead, they generated unexpected enthusiasm among parents of young patients. The central question in this article is: How were patients “integrated” in the development of the WebPEP application? We show how the project’s initiator reacted to the lacking participation by prospective users: informed by the evaluation, he gradually shifted his attention from live interaction to the expansion of the video library, where the webcasts were stored for on demand viewing. Based on interviews and participant observations, we describe how the initiator reconfigured the WebPEP application and its users, and therewith reframed the CF Centre’s online patient education strategy. We discuss the importance of investigating the prospective and actual use of patient-centered e-health (PCEH) applications, and argue that a single technological artefact can be involved in different, coexisting practices of patient-centeredness. We conclude with a reflection on how formative research methods can contribute to the development of PCEH.

Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: An overview

Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: An overview

Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: an overview.

Nutritional and developmental insults in the first few years of life have profound public health implications, including substantial contributions to neonatal, infant, and early childhood morbidity and mortality, as well as longer term effects on cognitive development, school achievement, and worker productivity. Optimal development that can lead to the attainment of an individual's fullest potential, therefore, requires a combination of genetic capacity, adequate nutrition, psychosocial stimulation, and safe, clean physical environments. Researchers and policymakers have called for integrated child nutrition and development interventions for more than 20 years, yet there are only a handful of efficacy trials and even fewer examples of integrated interventions that have been taken to scale. While a critical component in the design of such interventions is formative research, there is a dearth of information in both the literature and policy arenas to guide this phase of the process. To move the field forward, this paper first provides an overview of formative research methods with a focus on qualitative inquiry, a description of the critical domains to be assessed (infant and young child feeding, responsive feeding, and child development), and currently available resources. Application of these methods is provided through a real-world case study--the design of an integrated nutrition and child development efficacy trial in Andhra Pradesh, India. Recommendations for next steps are discussed, the most important of which is the need for a comprehensive set of formative guidelines for designing locally tailored, culturally appropriate, integrated interventions.

Formative study on the acceptance of Wheat Soy Blend Plus Plus (WSB++) as a daily complementary food supplement (CFS) in rural Bangladesh

During a preparatory phase of a CFS feeding trial in rural NW Bangladesh, we field tested WSB++, an enhanced fortified blended food, using formative research methods to examine its acceptance by mothers and children and potential barriers to its use. Mothers (n = 44) living in the (JiVitA) study area with a child aged 6 to 18 months received pre‐cooked or uncooked WSB++ for 10 to 12 days. Acceptability and amount of WSB++ consumed were assessed through observation, interview and focus group discussion. Mothers liked feeding the WSB++ and found it as easy or easier to prepare as traditional complementary foods, but many added sugar or other spices to “improve the flavor”. Compliance (child consumed >;75% of the daily portion) was highest (100%) among mothers who cooked WSB++ at home with daily field worker visits, compared to those who prepared WSB++ without worker visits (63%) or who received pre‐cooked WSB++ (55%). Child illness was the main reason given for lower intake. Mothers reported reduced consumption of other complementary foods during WSB++ distribution compared to before, especially when the CFS was offered at usual mealtimes. Although diet replacement is a potential challenge for effective CFS use, mothers’ willingness to cook and feed WSB++, especially with some encouragement, suggests it is an acceptable CFS to use in rural Bangladesh.Grant Funding Source: USDA (FANEP, NIFA), USA; WFP, Italy; DSM, Switzerland

Improving community participation to eliminate lymphatic filariasis in American Samoa

In 2000, the American Samoa Department of Health initiated a campaign of annual mass drug administration (MDA) with albendazole and diethylcarbamazine (DEC) to eliminate transmission of filariasis. Drug coverage was well below prescribed targets in the first three campaigns, ranging from 24 to 52% of the total population. Evaluation findings from a variety of formative research methods identified opportunities to improve MDA coverage and ensuing program modifications resulted in increased drug coverage of 65–71% in the following four annual distributions. Partnering with churches for drug distribution and using multiple media channels for health promotion led to sustained program improvements. With the increased emphasis on the use of mass distribution for delivery of drugs for a number of neglected tropical diseases, other programs may benefit from a similar approach.