Poster Topical Area: Global Nutrition
Location: Hall D
Poster Board Number: 577
Objective: The impact of behavior change communication (BCC) programs relies not only on theory underlying an intervention, but on effective implementation. This mixed methods study examined the extent of implementation and associated influential factors of an ongoing nutrition and WASH school-based BCC program in Karnataka State, India, which consisted of 3 strategies: role models and cues to action, games and helper crews, and issues-based learning.
Methods: Only schools implementing at least two of the three BCC strategies, based on program facilitator reports, were considered for evaluation. Fifty-one of 2,316 grade schools were sampled in proportion to the number of schools in each of 4 sub-districts. Program fidelity, and perceptions of program appropriateness, acceptability, feasibility, cost, sustainability and participant responsiveness were collected through semi-structured teacher interviews and direct observations. Descriptive statistics were used to summarize the outcomes. Qualitative factors influential to implementation were deductively analyzed using initial a prior codes from the implementation outcomes and emergent secondary codes.
Results: Uptake of the three strategies differed, with cues to action and role models being the most widely used. Fidelity, defined as the number of core programmatic components implemented, was low across all strategies. The median fidelity scores and interquartile range were 2 out of 4 (1,3) in the cues to action, 3 out of 3 (2,3) for role models, 2 out of 5 (1,3) for the games, 2 out of 5 (2,3) for the helper crews and 1 out of 5 (1,2) for the issues-based learning. All strategies showed high levels of acceptability, appropriateness, feasibility and sustainability although the time requirements were too much. Facilitating factors derived from teacher interviews included headmaster support, communication amongst teachers, and a dedicated program facilitator. In contrast, competing demands, and lack of facilities hindered fidelity.
Conclusion: Program fidelity was low, which may limit effectiveness, despite positive perceptions of the intervention. Structural and political factors within the school environment were reported to influence fidelity. These findings indicate that school preparedness for the intervention is a critical element to be addressed before implementation.
Masters of Science in Public Health Candidate
Johns Hopkins Bloomberg School of Public Health