An Iterative Process for Training Design and Implementation Increased Health Workers’ Knowledge for Taking Nutrition Behavior Change to Scale

Abstract

BackgroundThe shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services.ObjectiveThe objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context.MethodsThe design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge.ResultsThe initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers’ routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points.ConclusionsThe EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions.

How much can Mexican healthcare providers learn about breastfeeding through a semi-virtual training? A propensity score matching analysis

“…those who had not been trained), the analytical design complies with the PSM assumptions. Finally, another potential issue may have been caused by implementation issues linked to the training such as a weak face-to-face relationship with mentors from the first cascade, slow uptake of the virtual training, which have been reported in prior studies [8]. However, even considering these implementation challenges, improvements in breastfeeding knowledge were significant and large.…”

“…The training followed a cascade model in which the National Institute of Health (INSP for its acronym in Spanish) trained health educators from the states (n = 32), who then trained primary physicians, registered nurses (RNs), and nurse technicians based at public primary healthcare clinics. The training was based on a semi-virtual approach involving initial face-to-face contact followed by electronic-based modules, and was designed on prior formative research [8].…”

Breastfeeding practices in Mexico: Results from the National Demographic Dynamic Survey 2006–2018

“…In general, the poor promo- In the same period, a behaviour change strategy to promote EB < 6mo and complementary feeding was implemented as part of the ESIAN strategy, which aims to prevent the double burden of malnutrition (undernutrition, micronutrient deficiencies and obesity) as part of Prospera, one of the largest conditional cash transfer programmes in the world (Bonvecchio Arenas et al, 2019). The strategy included a nutrition training programme for more than 100,000 health service providers nationwide (Gonzalez et al, 2019). The evaluation of the nutrition training programme showed significant formulas and food and beverages for infants and young children (NOM-131-SSA1-2012, 2012) must also be considered so that plain packaging, or instead front-of-pack warning labels, can be used for these products, because they are currently exempt from the recent modification to the food labelling regulation, NOM-051-SCFI/ SSA1-2010 (White & Barquera, 2020).…”

Evaluación de procesos de una intervención: actividad física durante el embarazo y postparto

“…Entre las pocas intervenciones existentes que incorporan la PAF durante el embarazo y posparto (3) , la mayoría se encuentra en países desarrollados. No obstante, su implementación y evaluación, nos muestra lecciones valiosas en torno a sus estrategias educativas efectivas o deficientes, formas para contactar con las participantes (4) y ventajas de la capacitación a los PSS para incrementar conocimientos (5) a favor de su recomendación entre las mujeres que atienden.…”