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Revisiting Trials of Improved Practices Methodology_Schofield_5.10.11


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Revisiting Trials of Improved Practices Methodology_Schofield_5.10.11

  1. 1. Trial of improved practices for an Urban IYCF program Lilly Schofield Evaluation and Research Advisor Concern Worldwide Kenya Core Spring Meeting, May 2011
  2. 2. Objective: <ul><li>TIPs was used to investigate the feasibility and acceptability of the standard IYCF messages outlined by the MoH 1 and method of delivery </li></ul><ul><li>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. </li></ul>
  3. 3. Implementation: Household trials <ul><li>Project baseline identified 4 key groups to target in urban slums setting: </li></ul><ul><ul><ul><li>Caregivers of 6-23 months old, </li></ul></ul></ul><ul><ul><ul><li>Mothers of <6 month olds-working outside the home, </li></ul></ul></ul><ul><ul><ul><li>Mothers of <6 month olds-not working outside the home, </li></ul></ul></ul><ul><ul><ul><li>Mothers of <6 months living with HIV and AIDS </li></ul></ul></ul>
  4. 4. STEP 1: Initial household visits <ul><li>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. </li></ul>
  5. 5. Common feeding problems: <ul><li>0-6 months-both working and non-working mothers: </li></ul><ul><ul><ul><li>Mixed feeding, reduced feeding during illness, poor position and attachment leading to breast problems </li></ul></ul></ul><ul><li>6-23 months: </li></ul><ul><ul><ul><li>Poor diversity-giving porridge only, low frequency of feeding </li></ul></ul></ul><ul><li>HIV+ mothers 0-6 months: </li></ul><ul><ul><ul><li>Mixed feeding (sugar water), reduced feeding during illness </li></ul></ul></ul>
  6. 6. STEP 2: Counseling Visit <ul><li>CHWs returned and negotiated with caregivers to try a maximum of 3 new practices to address poor feeding practices for at least one week </li></ul>
  7. 7. STEP 3: Evaluation Visit <ul><li>CHWs returned to HH one + weeks later and interviewed caregiver on changed practices, challenges, reactions, modifications, etc. </li></ul>
  8. 8. STEP 4: Verification <ul><li>Verification of household visit findings and refinement of messages was done through focus groups with respondents falling into the same four categories </li></ul>
  9. 9. Recommendations for Program: <ul><li>Discussion of motivators and barriers identified. </li></ul><ul><li>Led to seeking 2 tools that could address messages that had resistance to change (negative reactions to the recommended practice) </li></ul>
  10. 10. Modification of standard counseling approach <ul><li>Tools for expressing breastmilk- </li></ul><ul><ul><ul><li>Demonstration breast model for mothers, counseling care for secondary caregivers on importance of expression </li></ul></ul></ul><ul><li>Cost of diverse diet </li></ul><ul><ul><ul><li>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 </li></ul></ul></ul>
  11. 11. Reach Additional Target Groups: <ul><li>Secondary caregivers-targeted though daycare centers, men’s groups, women’s groups (merry-go-rounds and church groups) </li></ul><ul><ul><ul><li>Messages for these group focus on use of expressed breast milk + standard IYCF messages </li></ul></ul></ul>
  12. 12. Conclusion: <ul><li>TIPs was an effective approach for revising existing IYCF approaches for a urban slum setting </li></ul><ul><li>TIPs process also highlighted need for further emphasis on counseling skills in standard IYCF training for community workers </li></ul>
  13. 13. Thank You!