Participatory nutrition research dissemination at national and sub-national levels of Guinea
Teresa Schwendler PhD Candidate at the Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
Ramatou Hermine Sankhon Consultant based in Conakry, Guinea
Mohamed Lamine Fofana Regional Vitamin A Supplementation Program Officer at Helen Keller International, Conakry, Guinea
Mamady Daffe Head of the Alimentation & Nutrition Division, Ministry of Health and Public Hygiene, Conakry, Guinea
Stephen Kodish Associate Professor at Departments of Nutritional Sciences and Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
A special thank you to all the stakeholders who shared their time and technical knowledge with our research team. This work would not have been possible without the support of the Guinean Ministry of Health, the U.S. Student Fulbright Award, and Helen Keller International. Funds to support this research were provided by the Society for Research in Child Development and specifically the Patrice L. Engle Dissertation Grant in Global Early Child Development.
What we know: Multisectoral approaches can have more positive effects on improving maternal, infant, and young child nutrition (MIYCN) than single-sector interventions. Since the inception of Guinea’s National Multisectoral Nutrition Policy and Strategic Plan in 2019, understanding of the extent of its operationalisation to improve MIYCN has been limited.
What this article adds: This article explores how a participatory nutrition research dissemination approach was used to increase stakeholder engagement in identifying obstacles and strategies to improve MIYCN in Guinea. Community-generated research findings were shared in participatory workshops with national and sub-national stakeholders in a position to implement more targeted programming across sectors. The approach supported cross-sectoral collaboration, as well as the prioritisation of context-specific intervention strategies.
The prevalence of stunting among children under the age of five years has remained above 30% in Guinea for the past decade (Global Nutrition Report, 2023). Given that the risk for stunted growth is greatest within the first 1,000 days of life, from conception to a child’s second birthday, enacting health and nutrition strategies within this timeframe is important for healthy growth and development (Victora et al, 2010).
Multisectoral approaches (Figure 1) have been found to have a more substantial positive impact on MIYCN outcomes than approaches delivered through one sector alone (UNICEF, 2020). However, such approaches have not traditionally been the norm in public health nutrition. Facilitated learning exchanges and partnership opportunities among professionals representing various sectors may enhance collaboration potential in any country that has the political will to improve its nutrition situation.
Figure 1: UNICEF Action Frameworka
In 2019, the Guinean government developed a National Multisectoral Nutrition Policy and corresponding Strategic Plan. This outlined the expected roles and responsibilities of both government and non-government organisations working across sectors to improve MIYCN (Ministère de la Santé et de l'hygiène Publique, 2019). In the three years since inception, there is some anecdotal evidence of how the implementation of aligned interventions has impacted operational understanding.
In 2023, we conducted a systematic narrative review to highlight how programmes and policies operationalised evidence for multisectoral programmes to improve MIYCN in Guinea. This article describes the participatory process conducted in December 2023, which formed a part of that research effort. We presented findings to national and sub-national stakeholders for their input, and to develop recommendations for strategies to improve MIYCN in Guinea.
Methods
Study design
This participatory study encompassed the final phase of a larger multi-phase, iterative, and mixed-methods study conducted from April 2022 to December 2023 (Creswell, 2008). Phases 1-3 were carried out at the community level in peri-urban Guinea. Over a nine-month period, we investigated what and how infants aged 6-9 months were being fed, and the factors that shaped infant dietary diversity. In phase 4, we systematically reviewed national policy and programme documents across sectors (food, health, water, sanitation, and hygiene (WASH), and social protection) to understand how these target MIYCN. Then, we purposefully sampled and interviewed stakeholders across sectors from both the national and sub-national levels to help contextualise findings from our review of literature (Figure 2).
Figure 2: Multiphase, iterative study design, and methodological framework
Finally, phase 5 was designed to disseminate findings from phases 1-4 with national and sub-national stakeholders and to build consensus on strategies for improving MIYCN through participatory workshops.
Participant sampling
Stakeholders from the food, health, WASH, and social protection sectors were purposefully sampled with the support of Guinea’s Ministry of Health to take part in either a national or sub-national participatory workshop. The final sample consisted of a mix of phase 4 participants and new participants. A criterion-based approach was used to purposefully sample an equal number of stakeholders representing each sector and government and non-governmental entities. The overall sample size for each workshop was determined based on the number of workshop participants that we felt would be manageable. We also considered optimal group sizing so that everyone would feel comfortable voicing their perspectives (Kodish et al, 2019).
Data collection methods
Each participatory workshop consisted of two parts. The first part included a presentation of findings stemming from phases 1-4. Summarised findings presented in part 1, from phases 1-4 of this research, are listed in Figure 3.
Figure 3: Key findings from phases 1-4 presented as stimulus prompts in workshops
1. Most caregivers were classified as moderately or severely food insecure using the Food Insecurity Experience Scale. 2. Infants consumed an average of two food groups per day using the standard infant and young child feeding indicators (WHO & UNICEF, 2021). 3. Food taboos were identified as a significant risk factor for infant dietary diversity score. 4. Imported infant foods were reported to be preferred by caregivers but only contained one food group. 5. The majority of caregivers fed their infants responsively (responding to their infant’s hunger and satiety cues) but did not achieve a significantly higher dietary diversity score. 6. Policies and programmes were multisectoral but stakeholders reported that financing and planning challenges limited their implementation. 7. Health sector programming aimed to educate caregivers on healthy diets but did not offer corresponding food or cash aid, regardless of food security status. 8. Agricultural programming often included women’s empowerment but did not target the first 1,000 days of life. 9. WASH programming targeted the first 1,000 days of life. 10. Social protection programmes often targeted farmers and women but not specifically the first 1,000 days of life. |
The second part used the Nominal Group Technique to build consensus among stakeholders on the greatest perceived obstacles and suggested strategies to improve MIYCN throughout Guinea (Rushton et al, 2021). Two prompts were posed to stakeholders during each workshop. First, “brainstorm the main obstacles to MIYCN, based on the presentation of study findings and your knowledge of the current programme environment in Guinea”. Second, “determine how the top-voted obstacles can be addressed to improve MIYCN across sectors over the next five years in Guinea using available resources.”
Each workshop used a multi-step process following the Nominal Group Technique (Dunham, 1998). Step 1: participants silently generated ideas in response to the two prompts provided. Step 2: in small groups comprised of 4-5 participants from different sectors, the top three obstacles to improving MIYCN were identified. Step 3: a session was conducted where each small group shared the three top obstacles with the larger group. From this, a master list of obstacles was then created for everyone to see projected at the front of the room. Step 4: each participant privately voted on what they perceived to be the top three greatest obstacles to improving MIYCN in Guinea. The same four-step process was followed to elicit and build consensus on suggested strategies to overcome those top-voted obstacles.
Data analysis
The discussion and voting that occurred during each stakeholder workshop were recorded in real time by a note-taker. Participant votes were summarised using simple descriptive statistics and stratified by national and sub-national units.
Results
Participant demographics
Most participants who attended the workshops were male professionals, with representation across multiple sectors (Table 1).
Table 1: Participant demographics
National-level workshop findings
Obstacles
At the national workshop, stakeholder inputs generated a list of 10 distinct obstacles to optimal MIYCN (Table 2).
Table 2: Top-voted obstacles to optimal MIYCN at national level
Strategies
Seven distinct strategies were recommended for addressing the top-voted obstacle to MIYCN at the national level (poor sensitisation of community members on proper dietary practices) (Table 3).
Table 3: Intervention strategies to improve MIYCN identified at the national level
Sub-national workshop findings
Obstacles
At the sub-national workshop, six distinct obstacles to optimal MIYCN were identified (Table 4).
Table 4: Top-voted obstacles to optimal MIYCN at sub-national level
Strategies
Six distinct strategies were recommended for overcoming the top-voted barrier at the sub-national level (lack of caregiver knowledge of optimal feeding practices) (Table 5).
Table 5: Intervention strategies to improve MIYCN identified at the sub-national level
Lessons learned
Three key lessons were learned from conducting this participatory research dissemination work in Guinea.
First, future research seeking to develop strategies for improving MIYCN using a participatory approach may benefit from a more structured workshop approach. While our research generated rich findings, more comprehensive intervention approaches may have been developed if a more structured approach to brainstorming was adhered to. Providing workshop participants with an open-ended guide to facilitate the silent generation of ideas around strategies to improve MIYCN could be one strategy to improve the workshop structure. The open-ended guide could include key planning components such as target areas, population, number of beneficiaries, how the intervention will be carried out, what type of intervention will be provided, and for how long (WFP, 2018).
Second, during the workshops, and particularly at the sub-national level, it was clear that cross-sectoral communication about the shared responsibility for nutrition programming was not regularly occurring. In addition to generating intervention strategies, the meetings served as an opportunity for stakeholders to build shared responsibility, to exchange ideas, and to forge new professional connections across sectors.
Third, the Nominal Group Technique provided a structured approach for sharing community-generated obstacles to MIYCN with stakeholders who can implement more targeted programming across each sector. Although bottom-up approaches to develop intervention strategies are frequently recommended, they are not always put into practice. The Nominal Group Technique can be employed in participatory stakeholder workshops to facilitate the sharing of community members' lived experiences. This can promote the development of context-specific intervention strategies, even when working with stakeholders who express diverse opinions. In our case, the Nominal Group Technique also allowed for national and sub-national-level stakeholders to take findings back to their respective entities across sectors. This helped to disseminate our findings more widely.
Conclusions
Participatory stakeholder workshops are a useful tool that researchers can use to disseminate community-level findings amongst those in positions to enact national and sub-national change. Since the completion of our study in December 2023, the Guinean government has been working to evaluate the implementation of the National Multisectoral Nutrition Policy. They are also developing a new five-year Strategic Plan for Reproductive, Maternal, Neonatal, Infant-Juvenile, and Adolescent Health and Nutrition (SRMNIA-N) (Ministère de la Santé, 2019). The SRMNIA-N initiative brings together national-level actors across sectors. Alongside the National Multisectoral Committee on the Food and Nutrition System, these platforms provide an ideal opportunity to integrate multisectoral approaches for improving MIYCN.
For more information, please contact Teresa Schwendler at teresarose199@gmail.com
References
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Global Nutrition Report (2023) Guinea country nutrition profile. globalnutritionreport.org
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Ministère de la Santé et de l'hygiène Publique (2019) Plan Stratégique National Multisectoriel de Nutrition (PSNMN) 2019-2024. faolex.fao.org
Ministère de la Santé (2019) Plan strategique SRMNIA-N. Direction Nationale de la Santé Familiale et de la Nutrition. portail.sante.gov.gn
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WFP (2018) Food and Nutrition Handbook. emergency.unhcr.org
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Teresa Schwendler, Ramatou Hermine Sankhon, Mohamed Lamine Fofana, Mamady Daffe and Stephen Kodish (2024). Participatory nutrition research dissemination at national and sub-national levels of Guinea. Field Exchange 74. https://doi.org/10.71744/2ckt-hh69