Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Dec 13;16(24):4315.
doi: 10.3390/nu16244315.

Comparison of Methods to Assess Adherence to Infant and Young Child Feeding Practices and Provision of Low-Aflatoxin Porridge Flours in a Community-Based Intervention Trial

Erica Phillips  1   2 , Rosemary A Kayanda  3 , Neema Kassim  3 , Francis M Ngure  2 , Paul C Turner  4 , Rebecca J Stoltzfus  5
Affiliations
Randomized Controlled Trial

Comparison of Methods to Assess Adherence to Infant and Young Child Feeding Practices and Provision of Low-Aflatoxin Porridge Flours in a Community-Based Intervention Trial

Erica Phillips et al. Nutrients. .

Abstract

Background: Levels of adherence to recommended protocols in an intervention trial can affect outcomes and confound the results. To broaden the evidence about the selection and utility of adherence measures in varying contexts, we describe the level of adherence to the Mycotoxin Mitigation Trial (MMT) randomized intervention using caregiver-reported survey questions and compare inferences of adherence between multi-module surveys and interactive 24 h dietary recalls based on our program theory.

Methods: The MMT was a two-arm cluster-randomized trial conducted in 52 health facilities (clusters) in central Tanzania. Surveys were conducted with all trial participants at three time points and dietary recalls were conducted in a cohort at 12 mo.

Results: The 12 mo survey was conducted with 2112 caregivers and the 18 mo survey was conducted with 2527 caregivers. A cohort of participants (n = 282, 20 clusters) was selected for dietary recalls, balanced by arm. Reported feeding of blended porridge flours, whether MMT-provided or own-sourced, was high at 12 and 18 mo, between 73 and 95%, with only slight differences between the surveys and recalls. Inferences were similar for continuation of breastfeeding, feeding frequency, and dietary diversity. Only the amount of porridge fed the previous day differed statistically by method, with higher amounts reported in the recalls compared to the survey.

Conclusions: Detailed analysis of reported behaviors, based on the MMT program theory, supports high adherence to the recommended trial behaviors. Survey data and 24 h dietary recalls were convergent for almost all indicators, strengthening the trial's conclusions and allowing for either method to be selected for similar research.

Keywords: 24 h dietary recall; adherence; community survey; community-based intervention; infant and young child feeding.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Adherence section of Program Impact Pathway (PIP).
Figure 2
Figure 2
Maternal-reported sharing practices of MMT-provided porridge flours (intervention arm only).
See this image and copyright information in PMC

References

    1. Sharpe G. A Review of Program Theory and Theory-Based Evaluations. Am. Int. J. Contemp. Res. 2011;1:72–75.
    1. Habicht J.P., Lapp J., Pelto G.H. Methodologies to Evaluate the Impact of Large Scale Nutrition Programs. In: W.B. Group, editor. Doing Impact Evaluation Series. World Bank Group; Washington, DC, USA: 2008.
    1. Menon P., Rawat R., Ruel M. Bringing rigor to evaluations of large-scale programs to improve infant and young child feeding and nutrition: The evaluation designs for the Alive & Thrive initiative. Food Nutr. Bull. 2013;34((Suppl. S3)):S195–S211. - PubMed
    1. Rawat R., Nguyen P.H., Ali D., Saha K., Alayon S., Kim S.S., Ruel M., Menon P. Learning how programs achieve their impact: Embedding theory-driven process evaluation and other program learning mechanisms in alive & thrive. Food Nutr. Bull. 2013;34((Suppl. S3)):S212–S225. - PubMed
    1. Menon P., Covic N.M., Harrigan P.B., Horton S.E., Kazi N.M., Lamstein S., Neufeld L., Oakley E., Pelletier D. Strengthening implementation and utilization of nutrition interventions through research: A framework and research agenda. Ann. N. Y. Acad. Sci. 2014;1332:39–59. doi: 10.1111/nyas.12447. - DOI - PubMed

Publication types

LinkOut - more resources