Theory-Driven Process Evaluation of the SHINE Trial Using a Program Impact Pathway Approach

Abstract

Two reasons for the lack of success of programs or interventions are poor alignment of interventions with the causes of the problem targeted by the intervention, leading to poor efficacy (theory failure), and failure to implement interventions as designed (program failure). These failures are important for both public health programs and randomized trials. In the Sanitation Hygiene and Infant Nutrition Efficacy (SHINE) Trial, we utilize the program impact pathway (PIP) approach to track intervention implementation and behavior uptake. In this article, we present the SHINE PIP including definitions and measurements of key mediating domains, and discuss the implications of this approach for randomized trials. Operationally, the PIP can be used for monitoring and strengthening intervention delivery, facilitating course-correction at various stages of implementation. Analytically, the PIP can facilitate a richer understanding of the mediating and modifying determinants of intervention impact than would be possible from an intention-to-treat analysis alone.

Suaahara in Nepal: An at‐scale, multi‐sectoral nutrition program influences knowledge and practices while enhancing equity

“…This examination of several steps along Suaahara's implementation pathways, and the equity analysis, exemplifies the possibilities of using detailed PE studies to assess programs (Mbuya et al, 2015). Finally, the gaps between DAG and non-DAG households were significantly smaller in Suaahara areas than in comparison areas for many of the same exposure, knowledge, and practice indicators.…”

“…Few nutrition programs globally have attempted to operate with such wide geographic coverage, and even fewer have explicitly focused on equity, but there is an increasing call for large-scale nutrition programs to close equity gaps for vulnerable populations (Aguayo & Menon, 2016). Nepal's successful vitamin A distribution was also at scale and with explicit attention to coverage barriers related to equity (Thapa, 2014 the design of complex programs and meaningful findings on program implementation and uptake (Mbuya et al, 2015;Menon, Rawat, & Ruel, 2013). Other data also suggest that rapid increases in program coverage accompanied by purposeful targetting can reduce inequalities (Victora et al, 2003).…”

“…Consistent with other PE studies of nutrition interventions, this mixedmethods PE was theory-driven, carried out after a few years of implementation in all target areas, and aimed to assess program delivery and utilization (Mbuya et al, 2015;Robert et al, 2006;Robert et al, 2007). A baseline study was conducted in 2012; however, due to differences in sampling methodology at the household-level, we will not compare our findings to the baseline results.…”

Process evaluation improves delivery of a nutrition‐sensitive agriculture programme in Burkina Faso

“…Our study contributes to a growing body of implementation research using varied and rigorous methods to assess how well nutrition programmes are delivered and utilized compared to plans (Avula et al, ; Kim et al, ; M. N. N. Mbuya et al, ; Menon, Rawat, & Ruel, ; Rajaraman et al, ), how to optimize programme implementation (Olney, Vicheka, et al, ; Winch et al, ) and to provide confirmatory evidence of the posited causal pathways (Loechl et al, ; Robert et al, ). Like ours, other studies have identified breakdowns in the pathway between training and effective application of its contents, including the volume of content to be absorbed, the skills and attributes of trainers, logistical and human challenges to adequate supervision, and the considerable and perhaps unrealistic demands placed on community agents (Kim et al, ; Mbuya, Menon, Habicht, Pelto, & Ruel, ).…”

Experiences and lessons learned for programme improvement of micronutrient powders interventions

“…Evaluation activities were led by a detailed PIP model, linking various data sources, relating evaluation with programme implementation timelines, and engaging with the programme implementation and management teams (Rawat et al, 2013). The PIP approach to guiding process evaluation was also used to inform nutrition and WASH interventions (Mbuya et al, 2015). …”