revisiting trials of improved practices methodology_schofield_5.10.11
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Trial of improved practices for an Urban IYCF program
Lilly Schofield
Evaluation and Research Advisor
Concern Worldwide Kenya
Core Spring Meeting, May 2011
Objective:
TIPs was used to investigate the feasibility and acceptability of the standard IYCF messages outlined by the MoH1 and method of delivery
1 See “National Strategy on Infant and Young Child feeding 2007-2010”, MoPHS, GoK and Infant and Young Child Feeding counseling: an integrated course. WHO and UNICEF.2006.
Implementation: Household trials
Project baseline identified 4 key groups to target in urban slums setting:
Caregivers of 6-23 months old, Mothers of <6 month olds-working outside the
home, Mothers of <6 month olds-not working outside the
home, Mothers of <6 months living with HIV and AIDS
STEP 1: Initial household visits
Community Health Workers trained in IYCF counseling and TIPs conducted initial visit with one caregiver from each group to collect data on current IYCF practices and child care.
Common feeding problems: 0-6 months-both working and non-working
mothers: Mixed feeding, reduced feeding during illness, poor position
and attachment leading to breast problems
6-23 months: Poor diversity-giving porridge only, low frequency of
feeding
HIV+ mothers 0-6 months: Mixed feeding (sugar water), reduced feeding during illness
STEP 2: Counseling Visit
CHWs returned and negotiated with caregivers to try a maximum of 3 new practices to address poor feeding practices for at least one week
STEP 3: Evaluation Visit
CHWs returned to HH one + weeks later and interviewed caregiver on changed practices, challenges, reactions, modifications, etc.
STEP 4: Verification
Verification of household visit findings and refinement of messages was done through focus groups with respondents falling into the same four categories
Recommendations for Program:
Discussion of motivators and barriers identified.
Led to seeking 2 tools that could address messages that had resistance to change (negative reactions to the recommended practice)
Modification of standard counseling approach Tools for expressing breastmilk-
Demonstration breast model for mothers, counseling care for secondary caregivers on importance of expression
Cost of diverse diet Common barrier given by mothers was that a
diverse diet was “too expensive”-card showing locally available foods purchased at local prices developed to highlight that more diverse
Conclusion:
TIPs was an effective approach for revising existing IYCF approaches for a urban slum setting
TIPs process also highlighted need for further emphasis on counseling skills in standard IYCF training for community workers
Thank You!
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