A Mixed Methods Exploration of the Role of Participation in a Nutrition-Sensitive Agroecology Intervention in Rural Tanzania

Overview

Journal Curr Dev Nutr

Specialty Nutritional Sciences

Date 2023 Jul 3

PMID 37396961

Authors

Marianne Victoria Santoso

Halle Claire Petrie

Rachel Bezner Kerr

Charlotte Lane

Neema Kassim

Haikael Martin

Elias Mtinda

Esther Lupafya

Sera Young

Affiliations

Soon will be listed here.

Abstract

Background: Participation is key to the successful implementation of nutrition-related interventions, but it has been relatively overlooked.

Objective: We sought to describe participation intensity among smallholder farmers in a randomized nutrition-sensitive agroecology study in rural Tanzania. We explored the association between baseline characteristics and overall participation intensity (quantitatively at the individual level and qualitatively at the group level), the association of participation intensity with 2 process indicators, and the association between participation intensity and key study outcomes.

Methods: Data came from 7 rounds of surveys with 295 women and 267 men across 29 months and 2 rounds of semi-structured interviews with the 20 "mentor farmers" who delivered the intervention. Participation intensity was based on the number of months of attendance at village-level project meetings or household visits (range: 0-29). Multivariable models of participation were built.

Results: Women and men participated for 17.5 ± 7.2 and 13.6 ± 8.3 months, respectively. Participation intensity followed 1 latent trajectory: initially low, with a sharp increase after month 7, and plateaued after the first year. At baseline, higher participation intensity was associated with older age, higher education, level of women's empowerment, being in the middle quintile of wealth, and qualitatively, village residence. Higher participation intensity was associated with 2 process indicators - better recall of topics discussed during meetings and greater knowledge about key agroecological methods. High participation intensity was positively associated with increased use of sustainable agricultural practices among all participants, and among women, with husband's involvement in household tasks and child's dietary diversity score.

Conclusions: Participation intensity covaried with key study outcomes, suggesting the value of increased attention to implementation in nutrition-related programs for providing insights into drivers of impact. We hope that investigations of participation, including participation intensity, will become more widespread so that intervention impacts, or lack thereof, can be better understood.

References

Lane A, Murphy N, Bauman A . An effort to 'leverage' the effect of participation in a mass event on physical activity. Health Promot Int. 2013; 30(3):542-51. DOI: 10.1093/heapro/dat077. View

Khanal S, Choi L, Innes-Hughes C, Rissel C . Dose response relationship between program attendance and children's outcomes in a community based weight management program for children and their families. BMC Public Health. 2019; 19(1):716. PMC: 6558714. DOI: 10.1186/s12889-019-7094-5. View

Bezner Kerr R, Berti P, Shumba L . Effects of a participatory agriculture and nutrition education project on child growth in northern Malawi. Public Health Nutr. 2010; 14(8):1466-72. DOI: 10.1017/S1368980010002545. View

Tumilowicz A, Neufeld L, Pelto G . Using ethnography in implementation research to improve nutrition interventions in populations. Matern Child Nutr. 2016; 11 Suppl 3:55-72. PMC: 5019237. DOI: 10.1111/mcn.12246. View

Kuchenbecker J, Reinbott A, Mtimuni B, Krawinkel M, Jordan I . Nutrition education improves dietary diversity of children 6-23 months at community-level: Results from a cluster randomized controlled trial in Malawi. PLoS One. 2017; 12(4):e0175216. PMC: 5398527. DOI: 10.1371/journal.pone.0175216. View

Natamba B, Achan J, Arbach A, Oyok T, Ghosh S, Mehta S . Reliability and validity of the center for epidemiologic studies-depression scale in screening for depression among HIV-infected and -uninfected pregnant women attending antenatal services in northern Uganda: a cross-sectional study. BMC Psychiatry. 2014; 14:303. PMC: 4260190. DOI: 10.1186/s12888-014-0303-y. View

Bezner Kerr R, Chilanga E, Nyantakyi-Frimpong H, Luginaah I, Lupafya E . Integrated agriculture programs to address malnutrition in northern Malawi. BMC Public Health. 2016; 16(1):1197. PMC: 5126822. DOI: 10.1186/s12889-016-3840-0. View

Angeles-Agdeppa I, Monville-Oro E, Gonsalves J, Capanzana M . Integrated school based nutrition programme improved the knowledge of mother and schoolchildren. Matern Child Nutr. 2019; 15 Suppl 3:e12794. PMC: 6593821. DOI: 10.1111/mcn.12794. View

Shekar M, Condo J, Pate M, Nishtar S . Maternal and child undernutrition: progress hinges on supporting women and more implementation research. Lancet. 2021; 397(10282):1329-1331. DOI: 10.1016/S0140-6736(21)00577-8. View

10.

Vu A, Tran N, Pham K, Ahmed S . Reliability of the Marlowe-Crowne social desirability scale in Ethiopia, Kenya, Mozambique, and Uganda. BMC Med Res Methodol. 2011; 11:162. PMC: 3259072. DOI: 10.1186/1471-2288-11-162. View

11.

Dulal B, Mundy G, Sawal R, Rana P, Cunningham K . Homestead Food Production and Maternal and Child Dietary Diversity in Nepal: Variations in Association by Season and Agroecological Zone. Food Nutr Bull. 2017; 38(3):338-353. DOI: 10.1177/0379572117703264. View

12.

Nordhagen S, Nielsen J, van Mourik T, Smith E, Klemm R . Fostering CHANGE: Lessons from implementing a multi-country, multi-sector nutrition-sensitive agriculture project. Eval Program Plann. 2019; 77:101695. DOI: 10.1016/j.evalprogplan.2019.101695. View

13.

Olney D, Vicheka S, Kro M, Chakriya C, Kroeun H, Sok Hoing L . Using program impact pathways to understand and improve program delivery, utilization, and potential for impact of Helen Keller International's homestead food production program in Cambodia. Food Nutr Bull. 2013; 34(2):169-84. DOI: 10.1177/156482651303400206. View

14.

Santoso M, Bezner Kerr R, Kassim N, Martin H, Mtinda E, Njau P . A Nutrition-Sensitive Agroecology Intervention in Rural Tanzania Increases Children's Dietary Diversity and Household Food Security But Does Not Change Child Anthropometry: Results from a Cluster-Randomized Trial. J Nutr. 2021; 151(7):2010-2021. PMC: 8245885. DOI: 10.1093/jn/nxab052. View

15.

Jones K, Specio S, Shrestha P, Brown K, Allen L . Nutrition knowledge and practices, and consumption of vitamin A--rich plants by rural Nepali participants and nonparticipants in a kitchen-garden program. Food Nutr Bull. 2005; 26(2):198-208. DOI: 10.1177/156482650502600204. View

16.

Reinbott A, Schelling A, Kuchenbecker J, Jeremias T, Russell I, Kevanna O . Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia. Br J Nutr. 2016; 116(8):1457-1468. PMC: 5082286. DOI: 10.1017/S0007114516003433. View

17.

Tumilowicz A, Ruel M, Pelto G, Pelletier D, Monterrosa E, Lapping K . Implementation Science in Nutrition: Concepts and Frameworks for an Emerging Field of Science and Practice. Curr Dev Nutr. 2019; 3(3):nzy080. PMC: 6400593. DOI: 10.1093/cdn/nzy080. View

18.

Perez-Escamilla R, Bermudez O, Buccini G, Kumanyika S, Lutter C, Monsivais P . Nutrition disparities and the global burden of malnutrition. BMJ. 2018; 361:k2252. PMC: 5996967. DOI: 10.1136/bmj.k2252. View

19.

Heidkamp R, Piwoz E, Gillespie S, Keats E, DAlimonte M, Menon P . Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: an agenda for action. Lancet. 2021; 397(10282):1400-1418. DOI: 10.1016/S0140-6736(21)00568-7. View

20.

Webb Girard A, Grant F, Watkinson M, Okuku H, Wanjala R, Cole D . Promotion of Orange-Fleshed Sweet Potato Increased Vitamin A Intakes and Reduced the Odds of Low Retinol-Binding Protein among Postpartum Kenyan Women. J Nutr. 2017; 147(5):955-963. PMC: 5404208. DOI: 10.3945/jn.116.236406. View