Impact Pathway Analysis Research Articles

Ex-Post Evaluation of the Impacts of the Science-Based Research and Innovation Program: A New Method Applied in the Case of Farmers’ Transition to Organic Production in the Camargue

This paper aims to assess the contribution, role, and impacts of the Science-Based Research and Innovation Program (ISRIP) on farmers’ transition to organic production in the Camargue. Focusing on how, and to what extent, research actors have contributed to the innovation pathway, we applied a methods-mix. The Participatory Impact Pathway Analysis (PIPA) was used to uncover complex mechanisms along the innovation process; the Outcome Harvesting method to adapt PIPA to the requirements of an ex-post evaluation, and the Social Network Analysis (SNA) to emphasize actors’ relationships in relation to the development process. We demonstrate that the research has contributed to change by developing co-learning interactions with farmers, although this was not critical to the success of the innovation. Rather, we highlight that agricultural policies, economic factors, testing conducted independently by farmers, and the institutional framework, are the most important and influential factors.JEL Codes: O32

Costs and benefits of low-sulphur fuel standard for Baltic Sea shipping

The maximum allowable fuel sulphur content for shipping in the Baltic Sea dropped from 1%S to 0.1%S in 1 January 2015. We provide a cost-benefit analysis of the sulphur reduction policy in the Baltic Sea Sulphur Emission Control Area (SECA). We calculated the abatement costs based on shipowners' optimal decision-making in choosing between low-sulphur fuel and a sulphur scrubber, and the benefits were modelled through a high-resolution impact pathway analysis, which took into account the formation and dispersion of the emissions, and considered the positive health impacts resulting from lowered ambient PM2.5 concentrations. Our basic result indicates that for the Baltic Sea only, the latest sulphur regulation is not cost-effective. The expected annual cost is roughly €465 M and benefit 2200 saved Disability Adjusted Life-Years (DALYs) or monetized €105 M. Based on our sensitivity analysis, the benefits yet have a potential to exceed the costs. The analysis neither takes into account the acidifying impact of sulphur nor the impact North Sea shipping has on the cost-benefit ratio. Lastly, a similar approach is found highly recommendable to study the implications of the upcoming Tier III NOx standard for shipping.

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

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).

Costs of Health Damage from Atmospheric Emissions of Toxic Metals: Part 1-Methods and Results.

Significant quantities of toxic metals are emitted to the air by the incineration of waste, as well as by the combustion of coal and oil. To optimize the regulations for their emissions one needs to know the cost of their damage. That requires an impact pathway analysis, with realistic dispersion models, exposure-response functions, and monetary values. In this article we explain the method and assumptions and present results for arsenic, cadmium, mercury, and lead, the most important toxic metals in terms of damage cost. We also estimate their contribution to the damage cost of waste incineration and electric power from coal for typical situations in Europe. The damage costs of As, Cd, and Pb are much higher than previous estimates because of a large number of new epidemiological studies, implying more and more serious health effects than what had been known before. New cost-benefit studies for the abatement of toxic metal emissions are advisable. The discussion of the epidemiological studies and the derivation of exposure-response functions are presented in two companion articles, one for As and Cd, the other for Hg and Pb.

Quantifying the Ancillary Benefits of the Representative Concentration Pathways on Air Quality in Europe

This paper presents economic benefit estimates of air quality improvements in Europe that occur as a side effect of GHG emission reductions. We consider two climate policy scenarios from two representative concentration pathways (RCPs), in which radiative forcing levels are reached in 2100. The policy tool is a global uniform tax on all GHG emissions in the integrated assessment model WITCH. The resulting consumption patterns of fossil fuels are used to estimate the physical impacts and the economic benefits of pollution reductions on human health and on key assets by implementing the most advanced version of the ExternE methodology with its impact pathway analysis. The mitigation scenario compatible with $$+2\,^{\circ }\hbox {C}$$ (RCP 2.6) reduces total pollution costs in Europe by 84 %. Discounted cumulative ancillary benefits are equal to about €1.7 trillion between 2015 and 2100, or €17 per abated tonne of $$\hbox {CO}_{2}$$ in Europe. The less strict climate policy scenario (RCP 4.5) generates benefits equal to €15.5 per abated tonne of $$\hbox {CO}_{2}$$ . Without discounting, the ancillary benefits are equal to €46 (RCP 2.6) and €51 (RCP 4.5) per tonne of $$\hbox {CO}_{2}$$ abated. For both scenarios, the local benefits per tonne of $$\hbox {CO}_{2}$$ decline over time and vary significantly across countries.

Quantifying the Ancillary Benefits of the Representative Concentration Pathways on Air Quality in Europe

This paper presents economic benefit estimates of air quality improvements in Europe that occur as a side effect of GHG emission reductions. We consider two climate policy scenarios from two representative concentration pathways (RCPs), in which radiative forcing levels are reached in 2100. The policy tool is a global uniform tax on all GHG emissions in the integrated assessment model WITCH. The resulting consumption patterns of fossil fuels are used to estimate the physical impacts and the economic benefits of pollution reductions on human health and on key assets by implementing the most advanced version of the ExternE methodology with its impact pathway analysis. The mitigation scenario compatible with $$+2\,^{\circ }\hbox {C}$$ (RCP 2.6) reduces total pollution costs in Europe by 84 %. Discounted cumulative ancillary benefits are equal to about €1.7 trillion between 2015 and 2100, or €17 per abated tonne of $$\hbox {CO}_{2}$$ in Europe. The less strict climate policy scenario (RCP 4.5) generates benefits equal to €15.5 per abated tonne of $$\hbox {CO}_{2}$$ . Without discounting, the ancillary benefits are equal to €46 (RCP 2.6) and €51 (RCP 4.5) per tonne of $$\hbox {CO}_{2}$$ abated. For both scenarios, the local benefits per tonne of $$\hbox {CO}_{2}$$ decline over time and vary significantly across countries.

Health for Life in Primary Schools Program, United Kingdom: A Program Impact Pathways (PIP) Analysis

Health for Life in Primary Schools Program, United Kingdom: A Program Impact Pathways (PIP) Analysis

Program Impact Pathway Analysis of a Social Franchise Model Shows Potential to Improve Infant and Young Child Feeding Practices in Vietnam

By mapping the mechanisms through which interventions are expected to achieve impact, program impact pathway (PIP) analysis lays out the theoretical causal links between program activities, outcomes, and impacts. This study examines the pathways through which the Alive & Thrive (A&T) social franchise model is intended to improve infant and young child feeding (IYCF) practices in Vietnam. Mixed methods were used, including qualitative interviews with franchise management board members (n = 12), surveys with health providers (n = 120), counseling observations (n = 160), and household surveys (n = 2045). Six PIP components were assessed: 1) franchise management, 2) training and IYCF knowledge of health providers, 3) service delivery, 4) program exposure and utilization, 5) maternal behavioral determinants (knowledge, beliefs, and intentions) toward optimal IYCF practices, and 6) IYCF practices. Data were collected from A&T-intensive areas (A&T-I; mass media + social franchise) and A&T-nonintensive areas (A&T-NI; mass media only) by using a cluster-randomized controlled trial design. Data from 2013 were compared with baseline where similar measures were available. Results indicate that mechanisms are in place for effective management of the franchise system, despite challenges to routine monitoring. A&T training was associated with increased capacity of providers, resulting in higher-quality IYCF counseling (greater technical knowledge and communication skills during counseling) in A&T-I areas. Franchise utilization increased from 10% in 2012 to 45% in 2013 but fell below the expected frequency of 9–15 contacts per mother-child dyad. Improvements in breastfeeding knowledge, beliefs, intentions, and practices were greater among mothers in A&T-I areas than among those in A&T-NI areas. In conclusion, there are many positive changes along the impact pathway of the franchise services, but challenges in utilization and demand creation should be addressed to achieve the full intended impact.

BeHealthy Charities Aid Foundation Program, Russia: a Program Impact Pathways (PIP) analysis.

In 2007, the Charities Aid Foundation Branch in Russia, under the initiative of and with financial support from the Mondelēz International Foundation and Mondelēz International, launched the charitable BeHealthy Program. The program's main focus is the implementation of four interrelated activities: conducting lessons for schoolchildren on healthy nutrition, with an emphasis on breakfast; healthy cooking lessons with children; cultivating nutritional plants; and providing conditions to encourage children to engage in more physical activity. The program serves more than 13,000 children attending public schools in the Leningrad (Lomonosovskii District), Vladimir, and Novgorod regions. BeHealthy provides funding for schools and comprehensive educational materials to help schoolchildren develop habits of healthy nutrition and physical activity, as well as consulting and expert support for school staff and other key stakeholders. The program brings in experts on program implementation and training for teachers. Curriculum support also includes printed and Web-based healthy lifestyle educational materials on best practices and positive experience, as well as meetings and conferences with school representatives and local authorities. One of the biggest challenges for program managers is to fully understand the complexities of the program, and why and how it is expected to induce changes in healthy lifestyle behaviors of the schoolchildren. For more comprehensive understanding, we performed a Program Impact Pathways (PIP) analysis to identify Critical Quality Control Points (CCPs) and a suite of core indicators of the program's impact on healthy lifestyles. The findings were presented at the Healthy Life-styles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation. First, we developed an updated logic model based on how the program was executed. We then translated the logic model into a PIP diagram, where pathways that lead from one activity to the next were defined as the program processes. The PIP diagram is a road map to help ensure that the program inputs and activities lead to expected outcomes. Based on this road map, the program identifies and tracks its CCPs. Ensuring implementation of program activities and evaluating pre-post knowledge and behavior of participants were identified as CCPs. The PIP analysis was very useful for understanding realistic expectations for the potential of BeHealthy and its inputs. As a result, we now plan to evaluate the impact of the program and, on this basis, further improve the program's implementation and dissemination to other locations.

"Cooking and Active Leisure" TAS Program, Spain: a Program Impact Pathways (PIP) analysis.

The "Cooking and Active Leisure" Tu y Alícia por la Salud (CAL-TAS) Program is a school-based pilot that addresses healthy lifestyle needs of Spanish secondary school students with initiatives that research has proven to improve dietary and physical activity behaviors. The objectives were to perform a Program Impact Pathways (PIP) analysis to describe key activities and processes of the CAL-TAS Program, identify Critical Quality Control Points (CCPs), and identify a suite of common indicators of healthy lifestyles to be applied across participant schools. The CAL-TAS Program designers and implementation team developed this PIP analysis through an iterative process and presented the results for feedback at the seven-country Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation. The team identified three PIP CCPs: teachers' motivation and training, changes in students' knowledge of healthy lifestyles, and changes in students' healthy lifestyle behavior. The selected indicators of the program's impact on healthy lifestyles are adequacy of food intake, level of knowledge of healthy lifestyles gained, and adequacy of physical activity level according to World Health Organization recommendations. A clear definition of impact indicators, as well as collection of accurate data on healthy lifestyle behaviors and knowledge, is essential to understanding the effectiveness of this program before it can be scaled up. CAL-TAS is an effective secondary school-based program encouraging healthy lifestyles. The PIP analysis was instrumental in identifying CCPs to sustain and improve the quality of the program. The team hopes to sustain and improve the program through these program evaluation recommendations.

Health in Action Program, Brazil: a Program Impact Pathways (PIP) analysis.

The Health in Action Program was established in Brazil in 2010 to address the critical issues of health and nutrition among vulnerable children in the northeast and southeast regions of the country. By offering school-based nutrition education and increased access to nutritious foods from school gardens, the program has benefited more than 200,000 children aged 6 through 14 years in 430 schools and an additional 670,000 family and community members. The program is now expanding to reach an additional 260,000 students in 570 schools. The purpose of this study was to perform a Program Impact Pathways (PIP) analysis to identify Critical Quality Control Points (CCPs) and a suite of impact indicators in order to better understand and illustrate the impact of the program. The analyses of the PIP and the suite of impact indicators were conducted in collaboration with INMED Brasil's program management and evaluation team and the international evaluation team of INMED Partnerships for Children. INMED presented the results at a seven-country Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, hosted by the Mondelēz International Foundation, where it received feedback from evaluation experts. The PIP analysis enabled INMED to clarify the goals of the program, understand the ways in which program activities lead to stated goals, identify CCPs to monitor, and select achievable impact indicators, including changes in diet, physical activity, and knowledge, attitudes, and behaviors, as well as body mass index. While the program had previously demonstrated benefits through internal impact evaluation, the PIP Healthy Lifestyles Program Evaluation Workshop led to the identification of potential improvements in program processes and activities, as well as corresponding evaluation methodologies.

Strong and healthy in Primary School Klasse2000 Program, Germany: a Program Impact Pathways (PIP) analysis.

Developing a Program Impact Pathways (PIP) diagram helps identify and clarify the key objectives, processes, activities, and evaluation indicators of school-based nutrition programs. The Mondelēz International Foundation has recently supported the development of PIP analyses for programs in seven countries around the world. The results were shared with other project organizers at a Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation. The objectives were to develop the PIP assessment of the Strong and Healthy in Primary School Klasse2000 Program in order to refine the primary, secondary, and tertiary objectives of the program; identify Critical Quality Control Points (CCPs); and identify core indicators of the program's impact on healthy lifestyles. The PIP report was developed based on detailed instructions provided prior to the workshop, taking into account the Klasse2000 Program evaluation reports. The following CCPs were identified: monitoring the qualifications and motivation of teaching staff (external health promoters and schoolteachers); assessing involvement of the students' environmental influences, including families, schools, and sponsors; and assessing the children's healthy lifestyle knowledge, attitudes, and behaviors before and after program exposure. The healthy lifestyle indicators identified were children's knowledge of healthy diets and health-enhancing physical activities; the availability of healthy breakfast and snacks; the frequency of consumption of fruits, vegetables, sweetened and unsweetened drinks,fast food, and sweets, as well as attitudes toward physical activity; and the frequency and extent of physical activity in school and during free time. Body mass index (BMI) was identified as the final outcome indicator. Developing a PIP report helped to focus the objectives of the program. Identifying CCPs helped draw attention to the processes linking critical program activities. As a result, plans for the upcoming school year include conducting a PIP-informed survey of participating parents and children to gauge their satisfaction with the program.

Health for Life in Primary Schools Program, United Kingdom: a Program Impact Pathways (PIP) analysis.

The Health for Life in Primary Schools Program helps schools promote healthy, active lifestyles through curriculum support related to healthy eating and cooking, growing food, physical activity, and family involvement. These interrelated strands are shown to have the greatest impact on healthy lifestyles, and the Health for Life in Primary Schools Program seeks to make these not one-off lessons, but a sustainable part of a school's culture. Each school involved with the program develops its own Action Plan in order to achieve program goals. Each school is assessed by an audit of facilities, skills, and curriculum at baseline and follow-up, and the pupils complete an on-line questionnaire at baseline and follow-up. Other impact measures are individual to the school and relate to its own Action Plan. Health for Life in Primary Schools sought to assess the cohesiveness and strength of the program using the Program Impact Pathways (PIP) model. The program was deconstructed to its individual parts, with each part assessed in terms of its contribution to the overall program and constraints upon its effectiveness. The PIP analysis helped clarify the logic and structure of the program, whether its objectives can be achieved, the Critical Quality Control Points (CCPs), and the impact measures required to demonstrate success. The core indicators identified for impact evaluation were knowledge, attitudes, and behaviors of pupils around healthy eating cooking, growing food, and physical activity. The PIP model confirmed that the Health for Life in Primary Schools Program is well structured and is well suited to achieve its goals. The findings were presented at the Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation.

Ready, Steady, Go! Program, Italy: a Program Impact Pathways (PIP) analysis.

Ready, Steady, Go! promotes proper nutrition and physical activity among people of all ages in targeted neighborhoods and encourages social integration and children's participation in decisions that affect their lives. It also seeks to involve parents in activities so that they can influence their children's attitudes toward lifestyles and personal development. This partnership has reached 70,000 Italian children and adults with new opportunities for physical activities and social experiences that help them improve nutritional behaviors while having fun with their peers. To assess the Ready, Steady, Go! Program logic and to identify Critical Quality Control Points (CCPs) and a core suite of impact indicators based on a Program Impact Pathways (PIP) analysis. The PIP analysis team reviewed the key activities and processes that form Ready, Steady, Go! and then identified key CCPs for the project. The findings were presented at the Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation. The PIP analysis confirmed that Ready, Steady, Go! has a structure that is likely to support the primary aims of the program. The CCPs identified are training of teachers in healthy lifestyles, teachers' active participation in the program, access to remodeled and well-equipped sports and recreational centers, participation of parents and grandparents, and involvement of local institutions and networks. A suite of impact indicators for changes in healthy lifestyle knowledge, attitudes, and behavior was identified. Project staff are now more aware of the importance of carefully monitoring the CCPs and have decided to conduct quarterly PIP-informed quality control evaluations.

Identifying common metrics for evaluating school-based healthy lifestyles programs in seven countries: introduction to workshop proceedings.

The worldwide childhood obesity pandemic highlights the need to instill healthy lifestyle habits in children and youths, in particular fostering and facilitating healthy eating behaviors and a high degree of physical activity. To achieve this it's important to strengthen local program evaluation capacity. To summarize the proceedings of the seven-country School-Based Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, on 13-14 September 2013 under the auspices of the Mondelēz International Foundation. Synthesis of workshop proceedings including illustrative participants' quotes. All seven countries' programs were successful at developing and presenting their Program Impact Pathway (PIP) analysis at the workshop. All countries found their PIP analyses useful and improved them based on feedback received at the workshop. As illustrated by the participants' quotes the PIP analyses proved to be very useful in leading to in-depth critical thinking and discussion about ways to improve the programs' processes, oversight, and outcomes.

Mondelēz Hope Kitchen Program, China: a Program Impact Pathways (PIP) analysis.

Mondelēz Hope Kitchen is a community program initiated jointly in 2009 by Mondelēz International and the China Youth Development Foundation (CYDF). In response to the urgent needs of students, parents, and teachers at primary and middle schools in poverty-stricken rural areas of China, the program addresses the complex and intertwined issues of undernutrition and obesity. By funding both kitchen equipment and teacher training in health and nutrition, the Mondelēz Hope Kitchen Program improves the capacity of schools to supply healthy meals, helping students to access safe and nutritious foods and, ultimately, to improve their nutritional status and health. In 2011, the Mondelēz International Foundation awarded CYDF a grant to formally assess the impact of the original program design. The Mondelēz International Foundation encouraged CYDF and six other healthy lifestyles-focused community partners around the world to participate in this program evaluation workshop. The goals of this study were to describe the logic model of the Mondelēz Hope Kitchen Program, summarize a recent evaluation of the Mondelēz Hope Kitchen Program, and conduct a Program Impact Pathways (PIP) analysis to identify Critical Quality Control Points (CCPs) and a suite of impact indicators. The findings were presented at the Healthy Lifestyles Program Evaluation Workshop held in Granada, Spain, 13-14 September 2013, under the auspices of the Mondelēz International Foundation. The authors developed the program's PIP diagram based on deliberations involving the program managers and Director and consulting the "Hope Kitchen Management Rules "and "Hope Kitchen Inspection and Acceptance Report". The PIP analyses identified three CCPs: buy-in from schools, kitchen infrastructure, and changes in teachers' knowledge of nutrition after training. In addition, changes in children's knowledge of nutrition will be added to the core suite of impact evaluation indicators that also includes children's dietary behaviors. Participation in this program evaluation workshop provided the Mondelēz Hope Kitchen team with the tools to improve the program using a sound monitoring system.

Understanding the implementation, utilization, and potential impact of a social franchise model to improve infant and young child feeding practices in Vietnam: a program impact pathway analysis (624.10)

Program impact pathway (PIP) analysis helps to lay out and study the causal links between program activities, outcomes and impacts. This PIP analysis‐based study examines the pathways by which the Alive & Thrive (A&T) social franchise model is expected to improve infant and young child feeding (IYCF) practices in Vietnam. Mixed methods (surveys, observations, facility assessments) were used to assess the following elements of the PIP: 1) training and knowledge of frontline health workers (FHWs) (n =447); 2) quality of service delivery and communication with clients (n =166); 3) mothers’ service utilization (n = 2,045); and 4) the program’s role in shaping maternal behavioral determinants of IYCF practices. A&T training was associated with improved FHWs’ IYCF knowledge and counseling skills, resulting in higher quality IYCF counseling. Franchise utilization increased from 10% in 2012 to 45% in 2013, but utilization fell far below the expected 9‐15 contacts specified in A&T guidelines. Improvements in breastfeeding knowledge, intentions, and beliefs were greater among mothers in intervention areas with social franchise and mass media, compared to media alone. In conclusion, many aspects of the franchise services are encouraging, but challenges in service delivery and utilization along the PIP should be addressed to achieve the full intended impact.Grant Funding Source: Funded by Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360

PARTICIPATORY ANALYSIS OF THE SWEET CHERRY SECTOR IN ARGENTINIAN SOUTH PATAGONIA

Sweet cherry production is a newly developed and promising activity in Argentinian South Patagonia. Together with a rapid increase in area (from 176 ha in 1997 to 635 ha in 2009), problems related to productivity and commercialization have threatened its sustainability. To gain a collective understanding of the complexity of the cherry sector, a participatory approach has been proposed for research. The steps followed and the contribution of this participatory methodology to a better understanding of the sector and the possible solutions to overcome un-sustainability are described. The methodology (Participatory Impact Pathways Analysis – PIPA) allowed different stakeholders to make explicit their assumptions and hypotheses about how the project will achieve its desired goals and changes. The first step was a problem tree analysis where participants identified the main problems of the sector and suggested main changes and outcomes as well as the vision expected from the project intervention. The most important constraints described by the different stake-holders’ group were: (a) inappropriate technology use at packinghouses and at farm level (requiring improvement of technology generation and transfer, and funding), (b) low profitability (less than 50% of the fruit is exportable and labour efficiency is low) and (c) commercialization (low prices, exchange rate, absence of contracts and unreliable brokers). The following step consisted of mapping the sector. Network maps were drawn by four groups of stakeholders: (1) packers and members of growers’ organizations, (2) researchers, (3) extension agents and growers and (4) politically important actors. Positive and negative influences and connections between stake-holders were described. Afterwards, an Outcome Logic Model of the project was constructed showing how project activities and inputs will lead to outputs, which in turn may lead to changes in knowledge, attitudes and skills, which in turn may lead to changes in behavior (outcomes) that over time will have impacts (reduced poverty for example). While implementing the project, reflection spaces were carried out in order to generate a collective process of reflection on the advances of the project (monitoring and evaluation).

A Program Impact Pathway Analysis Identifies Critical Steps in the Implementation and Utilization of a Behavior Change Communication Intervention Promoting Infant and Child Feeding Practices in Bangladesh

Mapping pathways of how interventions are implemented and utilized enables contextually grounded interpretation of results, differentiates poor design from poor implementation, and identifies factors that might influence the utilization of interventions. Few studies in nutrition have comprehensively examined the steps of implementation and utilization in behavior change communication (BCC) interventions, thus limiting the interpretation of variable impacts of BCC interventions. A program impact pathway (PIP) analysis was used to study a BCC intervention implemented in Bangladesh to improve infant and young child feeding (IYCF) practices. The PIP was developed through an iterative process with the program implementation team; the PIP then guided the choice of methods and tools. Using mixed methods, we reviewed the content of training materials for implementation staff, measured their IYCF knowledge (n = 100), observed their communication with mothers (n = 37), and examined factors influencing promotion of IYCF practices and their trial and adoption by mothers (n = 64). Implementation staff demonstrated good knowledge and maintained fidelity to the intervention to a large extent. Mothers identified them as their primary sources of information, and a majority of mothers tried recommended IYCF practices. Key facilitators included family support and availability of resources, whereas lack of time, maternal and family perceptions of age-appropriate feeding, and lack of resources were salient barriers to adopting recommended practices. Using a PIP analysis identified critical issues pertaining to implementation (e.g., the role of paid and volunteer staff) and utilization (e.g., resource and time constraints that require complementary interventions) and the need for further research and programmatic attention.

Participatory Impact Pathways Analysis: a practical method for project planning and evaluation

Participatory Impact Pathways Analysis (PIPA) is a practical approach to planning, monitoring and evaluation, developed for use with complex research-for-development projects. PIPA begins with a participatory workshop where stakeholders make explicit their assumptions about how their project will make an impact, and produce an ‘Outcomes logic model’ and an ‘Impact logic model’. These two logic models provide an ex-ante framework of predictions of impact that can also be used in priority setting and ex-post impact assessment. PIPA engages stakeholders in a structured participatory process, promoting learning and providing a framework for ‘action research’ on processes of change.