The Program Assessment Guide: an approach for structuring contextual knowledge and experience to improve the design, delivery, and effectiveness of nutrition interventions.

As evidence from small-scale trials has accumulated concerning the efficacy of low-cost interventions to address undernutrition, the design, implementation, and strengthening of large-scale programs to deliver these interventions has become a high priority. This scaling up process involves a large number of technical, logistical, administrative, political, and social considerations and little research exists on how to address these in a systematic way. This paper introduces the Program Assessment Guide (PAG), a set of analysis and decision tools that seeks to fill this gap, and reports on its application in Kyrgyzstan and Bolivia. The PAG places a special focus on eliciting and systematizing contextual knowledge and experience through a structured, participatory workshop and is grounded in theory, principles, and experience from program planning, management, change management, and intervention planning. When applied in Kyrgyzstan and Bolivia, the PAG was successful in helping workshop participants identify key implementation bottlenecks, questionable assumptions in the program theory, and feasible ways to address some of the shortcomings. These experiences also identified the need for a number of modifications to the PAG related to the workshop design itself, the preparations prior to the workshop, and follow-up after the workshop. The PAG represents one approach for strengthening decisions related to the design and large-scale implementation of interventions. The development and full-scale testing of alternative methods such as these for strengthening program analysis and decision making is an important and intellectually challenging subject for further research.

A participatory assessment of dietary patterns and food behavior in Pohnpei, Federated States of Micronesia.

Non-communicable diseases are escalating rapidly within the Pacific region, including Pohnpei, Federated States of Micronesia. A shift in dietary patterns from indigenous, high fiber, healthy local food to energy-dense, imported food with low nutritional value, and increased sedentary lifestyles are expediting this process. Essential to counteract this trend is an understanding of how people make food decisions. This participatory assessment utilized a quantitative and qualitative approach to capture diet patterns and knowledge, attitudes, beliefs and practices of food consumption. A structured 7-day food frequency questionnaire (FFQ) was used to quantify the diets of 293 adult Pohnpeian women attending an island-wide education/disability screening program. An ethnographic approach, including in-depth interviews, informal focus groups and observations documented food behavior practices and contributed to the design of the FFQ. Of those responding to the FFQ, 96% reported eating rice frequently (3-7 days/week) whereas 75% reported eating locally grown carbohydrate foods frequently. Factors associated with culture change, including availability, affordability, convenience, and status of food items were found to determine food decisions. Food-based, culturally sensitive and innovative strategies that utilize existing resources are required to promote local food production and consumption. Prevention programs with an information, education and communication (IEC) approach are needed to provide accurate and available health and nutrition knowledge and to increase the demand for local foods. Behavior modification requires the continued collaboration of the national, state, and community organizations that partnered on this research to strategize programs in order to target individual food choices and to transform the environment to support these decisions.