From Research to Program Design: Use of Formative Research in Haiti to Develop a Behavior change Communication Program to Prevent Malnutrition

This paper summarizes findings from a formative research study conducted in Haiti to develop a behavior change communication (BCC) strategy to improve infant and child feeding practices and to reduce childhood malnutrition. It describes the methodology used and the tools developed to facilitate decisionmaking and effective use of formative research for program planning. The study is part of a larger research project carried out by the International Food Policy Research Institute (IFPRI) and Cornell University in collaboration with World Vision-Haiti, a private voluntary organization responsible for the implementation of integrated health and nutrition programs that include food donations. The study used formative research methods that included individual and group interviews, food-rating exercises, and participatory recipe trials. The aims of the study were to (1) study current infant and young child feeding practices in the Central Plateau of Haiti, (2) identify individual, household, and community factors that may facilitate or constrain adoption of recommended behaviors, and (3) use the information from the formative research to prioritize behaviors and design an effective BCC strategy. The study revealed some nonoptimal infant and young child feeding practices in this part of rural Haiti, such as low rates of exclusive breastfeeding, early introduction of nutrient-poor gruels, and the scarcity of nutrient-dense foods such as animal products in the diet. A number of constraints were also identified that may limit the ability of families to engage in optimal feeding practices. These include the early resumption of work outside the home by women, which is driven by economic necessity and results in frequent and sometimes long separations of the mother from her young infant. The lack of time to prepare special complementary foods for the child, the perception that 12- month-old infants are ready to consume the family diet, and the low availability of micronutrient-rich foods (animal-source foods in particular) are additional constraints on poor families to achieving optimal child feeding practices. The data also highlighted some facilitating factors that could be used to design locally relevant and powerful communication messages. The few mothers who reported having exclusively breastfed their infants, for example, emphasized that this practice improved their infants health and reduced health-care costs. Similarly, the absence of cultural restrictions regarding feeding animal-source foods to infants and young children, and the knowledge among some mothers that these foods are good for children, are positive factors likely to facilitate behavior change related to these practices. The recipe trials also provided valuable insights regarding feasible, affordable, and acceptable recipes for enriched complementary foods that could be promoted through the BCC intervention. To simplify interpretation of the findings, we organized the information gathered into a decision tool. This tool consists of a matrix containing the following elements: 1. goal to achieve, 2. practices to promote to achieve this goal, 3. current practices in the population studied, 4. facilitating conditions for behavior change, and 5. issues that may affect the capacity for behavior change (e.g., potential constraints). A second, complementary matrix summarizes the constraints and facilitating factors identified for the different practices and includes columns to identify programmatic options (either within or outside of the current program context) to alleviate some of these constraints or to optimize use of facilitating factors in promoting behavior change. The decision tool was useful, because it helped structure the large amount of information gathered and permitted its presentation in a systematic, clear, easy-to-grasp manner. The tool also proved valuable in discussions related to program planning with World Vision-Haiti staff at all levels, in developing programmatic options within the current program structure, and providing suggestions for additional supporting program activities.