Kate Reinsma, World Vision International (WVI)

1. DELIVERING FOR NUTRITION IN SOUTH ASIA
Implementation Research in the Context of COVID-19
December 1-2, 2021
Kate Reinsma, DrPH, MS
Program Impact Pathway of the
Positive Deviance/Hearth Interactive
Voice Calling Program in a Peri-Urban
Context of Cambodia

2. • Positive Deviance/Hearth (PDH) is an
internationally recognized nutrition
rehabilitation program
• Previous research suggests replacing
some of the in-person counselling visits
with interactive voice calls (IVC) is a
promising solution to reduce exposure to
COVID-19 while still achieving modest
reductions in underweight among
Cambodian children 6 to 23 months
• We did a Program Impact Pathway (PIP)
analysis to identify the essential activities
required for adapting of PDH to a PDH-
IVC program
Rationale/Objective

3. Methods: Study Overview
• Part of a longitudinal cluster-
randomized controlled trial
• 3 districts: Rolea Phaea, Samrong
Tong II, Boribour II in Kampong
Chnang and Kampong Speu
Provinces in Cambodia
• Purposively selected districts with
similar socio-demographic and
health characteristics, PDH start
dates, peri-urban settings, and
comparable living standards and
access to health care services

4. Intervention Implementation
Preparing for Hearth
sessions:
• Partnering with local
authorities and community
• Situational analysis and PDI
data collected and analyzed
• Key Hearth Messages and
Menus designed
• Linkages to H/N services
established (GMP,
deworming, VA,
immunization)
• PDH Volunteers identified
and selected
Inputs
Volunteers
supervised &
Data Monitored
(tools)
Process Outputs Outcomes Impact
Program Impact Pathway
Volunteer
Training/
Refresher
Training
Hearth
Sessions
Established
Hearth
Sessions
Conducted
Caregivers Improved
Knowledge in child
nutrition, hygiene
and caring practices
Improved
participant
confidence in
child nutrition,
hygiene and
caring practices
Improved
behaviours around
child nutrition,
hygiene, and caring
practices
Improved
nutritional status
(underweight) of
children 6-23 mo
Contextual
factors
Intervention Utilization
Intervention Design
HH follow-
up by
Phone and
F2F

5. Qualitative Data Collection
Process Evaluation
nTotal = 29
March 2018
Endline Evaluation
nTotal = 27
June 2020
12 In-depth
Interviews (IDIs)
PDH:
3 Caregivers: Top
3 Caregivers: Bottom
PDH-IVC:
3 Caregivers: Top
3 Caregivers: Bottom
20 In-Depth
Interviews (IDIs)
PDH:
6 Caregivers: Top
4 Caregivers: Bottom
PDH-IVC:
6 Caregivers: Top
4 Caregivers: Bottom
10 Key Informant
Interviews (KIIs)
3 WVI-C Staff
2 WVI Staff
PDH: 5 volunteers
PDH-IVC: 5
volunteers
(randomly selected)
9 Key Informant
Interviews (KIIs)
3 WVI-C
Staff PDH: 5 volunteers
PDH-IVC: 1 volunteers
(randomly selected)
WVI-C – World Vision International-Cambodia; WVI – World Vision International
5 Electronic
Surveys

6. Qualitative Data Analysis
All of the qualitative data was collected
by trained interviewers in the local
language, recorded, transcribed
verbatim at the end of each day, and
translated into English for analysis
Qualitative data transcripts in
English from the process and
endline evaluation were uploaded to
NVivo Version 12.0 and analyzed
using a mixture of deductive and
inductive coding techniques

7. Summary of Facilitators
• Quality training with immediate implementation afterwards
• Nutrition advisor support and tools to simplify menu design
• Community mobilization and linkage to existing health/nutrition services
• Volunteers retaining knowledge and skills after training
• Follow-up tools and guide
• Supervision and spot checks of volunteers
• Family Support for caregivers
• Availability of resources (food security, financial resources, time)
Summary of Barriers
• High work burden for volunteers and caregivers
• Poor phone network
• Lack of resources (financial and food)
• Low level of education and old age of primary caregivers
• Inconsistent phone use among grandmothers
Summary of Contextual Factors
• Frequent migration of mothers for work
• Primary caregiver role left to grandmothers, who feel stressed caring for multiple grandchildren and experience
depression and anxiety
Results

8. IVC is an innovative approach
that may be effective in
providing targeted nutrition
counseling while saving time,
reducing workload of frontline
health workers, and exposure
to COVID-19
When integrating IVC into
traditional nutrition programs
contextual factors, like mental
health of grandmothers, must
be considered during the
design phase, and quality
assurance tools adapted to fit
the new way of doing
counseling over the phone
Further research is needed to
determine if video calling or
other innovative approaches
using mobile phones may
effectively provide nutrition
counseling.
Policy Implications

9. Acknowledgements
• Melissa Young, Emory University (Co-PI)
• Lucas Gosdin, Emory University
• Hannah Paige Rogers, Emory University
• Hen Heang, WV Cambodia (Project Manager)
• Sopheap Ouk, WV Cambodia (MNCH Specialist)
• Chhea Chhorvann, National Institute of Public Health (NIPH) (Co-PI)
• Sreymom Oy, National Institute of Public Health (NIPH)
• Wuddhika Invong, National Institute of Public Health (NIPH)
Special thanks to the community volunteers and families who participated in PDH and the evaluation.
Funding provided by World Vision Hong Kong and World Vision International