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Research article
Roselyter Monchari Riang'a
Moi University School of Arts and Social Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0688-5244
License:
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Background Implementation fidelity which is defined as the degree to which programmes are implemented as intended is one of the factors that affect programme outcome, thus requiring careful examination. This study aims to acquire insight into the degree to which nutritional counselling and Iron and Folic Acid supplementation (IFAs) policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity.
Methods Data were collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among intervention recipients (n=188) and semi-structured interviews with programme implementers (n=6). Data collection and analysis were guided by an implementation fidelity framework. We specifically evaluated adherence to intervention design (content, frequency, duration and coverage), exposure or dosage quality of delivery and participant responsiveness.
Results Coverage of nutritional counselling and IFAs policy is widespread. However, partial provision was reported in all the intervention components. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 28% reported receiving nutritional counselling, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills and issuing of many pills at one go, were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to comply to instructions were established to be motivations for adherence to nutritional counselling and IFAs guidelines.
Conclusions Implementation fidelity of nutritional counselling and IFAs policy in Kenya is generally weak. There is need for approaches to enhance early access to interventions, enhance stock availability, provide mitigation measures for the side effects, as well as intensify nutritional counselling to promote the consumption of micronutrient-rich food sources available in the local environment to substitute for the shortage of nutritional supplements and low compliance to IFAs.
Keywords
Maternal nutrition, pregnancy, programme evaluation, implementation fidelity, nutrition interventions, iron and folic acid supplementation, Kalenjin, Kenya
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CURRENT STATUS: Published
View the published article at BMC Nutrition.
No community comments so far
Submission checks complete
On 04 Dec, 2020
Editorial decision: Accept
On 29 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 23 Nov, 2020
Editor assigned
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 21 Nov, 2020
Version 3
Posted 16 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 10 Nov, 2020
Review #1 received
Received 03 Nov, 2020
Reviewer #1 agreed
On 06 Oct, 2020
Reviewers invited
Invitations sent on 01 Oct, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Major revision
On 21 Aug, 2020
Review #1 received
Received 08 Aug, 2020
Reviewer #2 agreed
On 30 Jul, 2020
Review #2 received
Received 30 Jul, 2020
Reviewer #1 agreed
On 16 Jul, 2020
Reviewers invited
Invitations sent on 13 Jul, 2020
Editor assigned
On 08 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
No comments provided
Editorial decision: Major revision
On 27 May, 2020
Review #2 received
Received 23 May, 2020
Review #1 received
Received 17 May, 2020
Reviewer #1 agreed
On 25 Apr, 2020
Reviewer #2 agreed
On 25 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Editor assigned
On 16 Apr, 2020
Submission checks complete
On 07 Apr, 2020
Editor invited
On 07 Apr, 2020
First submitted
On 31 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nutrition & Dietetics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Nutrition.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Roselyter Monchari Riang'a
Moi University School of Arts and Social Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0688-5244
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Nutrition.
No community comments so far
Submission checks complete
On 04 Dec, 2020
Editorial decision: Accept
On 29 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 23 Nov, 2020
Editor assigned
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 21 Nov, 2020
Version 3
Posted 16 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 10 Nov, 2020
Review #1 received
Received 03 Nov, 2020
Reviewer #1 agreed
On 06 Oct, 2020
Reviewers invited
Invitations sent on 01 Oct, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
No comments provided
Editorial decision: Major revision
On 21 Aug, 2020
Review #1 received
Received 08 Aug, 2020
Reviewer #2 agreed
On 30 Jul, 2020
Review #2 received
Received 30 Jul, 2020
Reviewer #1 agreed
On 16 Jul, 2020
Reviewers invited
Invitations sent on 13 Jul, 2020
Editor assigned
On 08 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
No comments provided
Editorial decision: Major revision
On 27 May, 2020
Review #2 received
Received 23 May, 2020
Review #1 received
Received 17 May, 2020
Reviewer #1 agreed
On 25 Apr, 2020
Reviewer #2 agreed
On 25 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Editor assigned
On 16 Apr, 2020
Submission checks complete
On 07 Apr, 2020
Editor invited
On 07 Apr, 2020
First submitted
On 31 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Nutrition & Dietetics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Nutrition.
Background Implementation fidelity which is defined as the degree to which programmes are implemented as intended is one of the factors that affect programme outcome, thus requiring careful examination. This study aims to acquire insight into the degree to which nutritional counselling and Iron and Folic Acid supplementation (IFAs) policy guidelines during pregnancy have been implemented as intended and the challenges to implementation fidelity.
Methods Data were collected in rural Uasin Gishu County in the western part of Kenya through document analysis, questionnaires among intervention recipients (n=188) and semi-structured interviews with programme implementers (n=6). Data collection and analysis were guided by an implementation fidelity framework. We specifically evaluated adherence to intervention design (content, frequency, duration and coverage), exposure or dosage quality of delivery and participant responsiveness.
Results Coverage of nutritional counselling and IFAs policy is widespread. However, partial provision was reported in all the intervention components. Only 10% accessed intervention within the first trimester as recommended by policy guidelines, only 28% reported receiving nutritional counselling, only 18% and 15% of the respondents received 90 or more iron and folic acid pills respectively during their entire pregnancy period, and 66% completed taking the IFAs pills that were issued to them. Late initial bookings to antenatal care, drug stock shortage, staff shortage and long queues, confusing dosage instructions, side effects of the pills and issuing of many pills at one go, were established to be the main challenges to effective implementation fidelity. Anticipated health consequences and emphasis by the health officer to comply to instructions were established to be motivations for adherence to nutritional counselling and IFAs guidelines.
Conclusions Implementation fidelity of nutritional counselling and IFAs policy in Kenya is generally weak. There is need for approaches to enhance early access to interventions, enhance stock availability, provide mitigation measures for the side effects, as well as intensify nutritional counselling to promote the consumption of micronutrient-rich food sources available in the local environment to substitute for the shortage of nutritional supplements and low compliance to IFAs.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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