1. An Iterative Process for Training Design and Implementation Increased Health Workers’ Knowledge for Taking Nutrition Behavior Change to Scale
- Author
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Mireya Vilar-Compte, Ana Lilia Lozada-Tequeanes, Wendy Gonzalez, Laura Quezada, Amira Hernandez, Alejandría Villa de la Vega, Anabelle Bonvecchio Arenas, Armando García-Guerra, and Cynthia Rosas
- Subjects
Evidence-based practice ,Process management ,Computer science ,Health Personnel ,Health Behavior ,evidence-based practice ,Medicine (miscellaneous) ,Context (language use) ,nutrition transition ,Humans ,Mexico ,Flexibility (engineering) ,Nutrition and Dietetics ,Primary Health Care ,scaling up nutrition ,Behavior change ,Infant ,Timeline ,Feeding Behavior ,Focus group ,systems strengthening ,Knowledge ,Child, Preschool ,Scale (social sciences) ,Supplement ,Situation analysis - Abstract
Background The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective The 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. Methods The 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. Results The 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. Conclusions The 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.
- Published
- 2019
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