A program impact pathway analysis identifies critical steps in the implementation and utilization of a behavior change communication intervention promoting infant and child feeding practices in Bangladesh

Abstract

Mapping pathways of how interventions are implemented and utilized enables contextually grounded interpretation ofresults, differentiates poor design from poor implementation, and identifies factors that might influence the utilization ofinterventions. Few studies in nutrition have comprehensively examined the steps of implementation and utilization inbehavior change communication (BCC) interventions, thus limiting the interpretation of variable impacts of BCCinterventions. A program impact pathway (PIP) analysis was used to study a BCC intervention implemented in Bangladeshto improve infant and young child feeding (IYCF) practices. The PIP was developed through an iterative process with theprogram implementation team; the PIP then guided the choice of methods and tools. Using mixed methods, we reviewedthe content of training materials for implementation staff, measured their IYCF knowledge (n = 100), observed theircommunication with mothers (n = 37), and examined factors influencing promotion of IYCF practices and their trial andadoption by mothers (n = 64). Implementation staffdemonstrated good knowledge and maintained fidelity to theintervention to a large extent. Mothers identified them as their primary sources of information, and a majority of motherstried recommended IYCF practices. Key facilitators included family support and availability of resources, whereas lack oftime, maternal and family perceptions of age-appropriate feeding, and lack of resources were salient barriers to adoptingrecommended practices. Using a PIP analysis identified critical issues pertaining to implementation (e.g., the role ofpaid and volunteer staff) and utilization (e.g., resource and time constraints that require complementary interventions)and the need for further research and programmatic attention. © 2013 American Society for Nutrition.