Integrated Child Nutrition, Parenting, and Health Intervention in Rural Liberia: a Mixed Methods Feasibility Study

• In Event: Using Qualitative Research to Optimize the Design of Parenting Interventions in the Global South

Abstract

Children living in resource-limited settings face multiple forms of adversity that can be detrimental to their growth and development. Important among these are lack of psychosocial stimulation, poor nutrition and feeding practices, and high incidence of infectious disease including diarrhea and malaria. These adverse conditions contribute to a high burden of unachieved developmental potential (Black et al., 2017). In Liberia specifically, 54% of children are at risk of poor development (UNICEF, 2020). In areas such as rural Liberia with high burdens of poor responsive stimulation, malnutrition, and infection, leaving one or more of these conditions unaddressed may be an impediment and a missed opportunity to achieving an intervention’s full impact on children’s development. Research is needed to examine the feasibility and benefits of integrated sets of interventions that can be incorporated into the existing health delivery programs to address these key determinants of poor child development simultaneously. This study used mixed methods to test the feasibility of an integrated intervention that promotes psychosocial stimulation, infection prevention practices, and improved child feeding by the provision of eggs and fish. Participants consisted of 30 female caregivers and their child 6-36 months of age randomly selected from two communities in rural Liberia. For four weeks, participants received fortnightly group parenting sessions (including modules on psychosocial stimulation, sanitation, hygiene, and nutrition) and weekly eggs and fish designated for child consumption. The intervention was delivered by trained community health workers (CHWs). Participants were assessed prior to the start of the intervention and after four weeks of intervention using quantitative surveys and qualitative interviews. At end-line only, qualitative interviews were conducted with CHWs. At baseline, we examined the home environment, and caregiver-child interactions, child discipline, food insecurity, feeding practices, and infection control practices. At end-line, we assessed the feasibility of the intervention. Descriptive analyses were conducted with quantitative data. Qualitative data were analyzed using a conventional approach to content analysis. Baseline qualitative and quantitative data indicated low levels of responsive parenting and early learning opportunities, and high use of violent discipline, food insecurity and child morbidity. Qualitative findings were used to select an appropriate time and location for the parenting sessions, and to adapt certain messages in the parenting session to the context, for instance around typical foods consumed by children. Mixed methods indicators of feasibility (i.e., adoption, fidelity, reach, adaptability, acceptability, feasibility, dose, self-efficacy) were high. For example, CHWs reported satisfaction with their training content and job aids, and effectiveness of the parenting sessions’ format which involved caregivers in play demonstrations, practice, encouragement, and problem solving with peers. Caregivers utilized the skills and activities learned and shared these with other community members. Qualitative data from this feasibility study informed several modifications to the program which may enhance its effectiveness: 1) engaging fathers in future parenting sessions; 2) complementing the group sessions with home visits by the CHW to review information and receive one-on-one feedback; and 3) opening the role of parenting session facilitator to other interested community members rather than exclusively relying on CHWs.

Authors

• Leila Margaret Larson, University of South Carolina
  Presenting Author

• Sejla Isanovic

• Musa Sanoe

• Shelbie Wooten

• Edward A Frongillo

• Aisha Khizar Yousafzai, Harvard TH School of Public Health

• Christine E Blake

• Mufaro Kanyangarara

• Melanie Swan

• Nicole Rodger

• Miriam Murray