Setting global research priorities for private sector child health service delivery: Results from a CHNRI exercise.

BACKGROUND: The private health sector is an important source of sick child care, yet evidence gaps persist in best practices for integrated management of private sector child health services. Further, there is no prioritized research agenda to address these gaps. We used a Child Health and Nutrition Research Initiative (CHNRI) process to identify priority research questions in response to these evidence gaps. CHNRI is a consultative approach that entails prioritizing research questions by evaluating them against standardized criteria. METHODS: We engaged geographically and occupationally diverse experts in the private health sector and child health. Eighty-nine experts agreed to participate and provided 150 priority research questions. We consolidated submitted questions to reduce duplication into a final list of 50. We asked participants to complete an online survey to rank each question against 11 pre-determined criteria in four categories: (i) answerability, (ii) research feasibility, (iii) sustainability/equity, and (iv) importance/potential impact. Statistical data analysis was conducted in SAS 9.4 (SAS Institute Inc, Cary NC, USA). We weighted all 11 evaluation criteria equally to calculate the research priority score and average expert agreement for each question. We disaggregated results by location in high-income vs low- and middle-income countries. RESULTS: Forty-nine participants (55.1%) completed the online survey, including 33 high-income and 16 low- and middle-income country respondents. The top, prioritized research question asks whether accreditation or regulation of private clinical and non-clinical sources of care would improve integrated management of childhood illness services. Four of the top ten research priorities were related to adherence to case management protocols. Other top research priorities were related to training and supportive supervision, digital health, and infant and newborn care. Research priorities among high-income and low- and middle-income country respondents were highly correlated. CONCLUSION: To our knowledge, this is the first systematic exercise conducted to define research priorities for the management of childhood illness in the private sector. The research priorities put forth in this CHNRI exercise aim to stimulate interest from policy makers, program managers, researchers, and donors to respond to and help close evidence gaps hindering the acceleration of reductions in child mortality through private sector approaches.

A pilot food store intervention in the Republic of the Marshall Islands.

To improve diet and reduce risk for obesity and chronic disease, we developed, implemented and evaluated a pilot intervention trial with 23 large and small food stores in the Republic of the Marshall Islands (12 intervention, 11 control). The intervention included both mass media (radio announcements, newspaper ads, video) and in-store (cooking demonstrations, taste tests, shelf labeling) components. Consumer exposure to the mass media components was high (65% had heard half or more of the radio announcements, 74% had seen at least one of the newspaper ads). Consumer exposure to the in-store components of the intervention was moderate (61% attended at least one cooking demonstrations, 59% received at least one recipe card). After adjustment for age, sex and education level, increased exposure to the intervention was associated with higher diabetes knowledge (p<0.05) and label reading knowledge (p<0.05), but not with increased self-efficacy for performing promoted healthy behaviors. The intervention was associated with increased purchasing of certain promoted foods (p<0.005), including oatmeal, turkey chili, fish, canned fruit and local vegetables. It was also associated with improvements in healthiness of cooking methods (p<0.05). Food store centered interventions have great potential for changing cognitive and behavioral factors relating to food choice and preparation, and may contribute to lessening the burden of diet-related chronic disease worldwide.

Development and implementation of a food store-based intervention to improve diet in the Republic of the Marshall Islands.

Effective approaches for the prevention and reduction of obesity and obesity-related chronic diseases are urgently needed. Food store-centered programs represent one approach that may be both effective and sustainable. The authors developed a food store-based intervention in the Marshall Islands using qualitative and quantitative formative research methods, including a store usage survey (n = 184) and in-depth interviews with large-store managers (n = 13), small-store managers (n = 7), customers (n = 10), and community leaders (n = 4). This process was followed up by development and piloting of specific intervention components and workshops to finalize materials. The final intervention combined mass media (newspaper articles, video, radio announcements) and in-store components (shelf labels, cooking demonstrations, posters, recipe cards) and had high store-owner support and participation. High levels of exposure to the intervention were achieved during the 10-week period of implementation. This model for developing food store-based interventions is applicable to other settings.