Environmental and behavioural factors influencing the effectiveness of counselling on the feeding of infants and young children in two extremely poor Peruvian districts

ABSTRACT

Background

Inadequate feeding practices contribute to poor nutrition among Peruvian children. In response, Peru’s Lambayeque Regional Government funded an initiative in its four poorest districts to improve nutrition counselling skills of health-service professionals (HP). The study aimed to identify factors associated with successful communication of optimal nutrition practices to caregivers.

Method

Counselling data were collected in six health establishments in two of the four poorest Lambayeque districts. A thematic content analysis was completed for 30 direct observations of counselling by staff in the national child growth and development monitoring programme, 26 exit interviews with caregivers, 12 in-depth interviews (5 HP and 7 caregivers), and 5 home observations.

Results

Type and training of HP influenced messages given. Nurses focussed on multi-micronutrient powders and iron-rich foods; nutritionists targeted dietary diversity, food consistency, and frequency of feedings. Caregivers reported feeling more comfortable when HP used positive verbal communication and non-verbal cues. Language was a barrier (non-Quechua speaking HP), as were high HP turnover, remoteness of villages, and limited attending hours, all of which reduced opportunities for nutrition education. Learning materials and group demonstrations facilitated comprehension, but cultural beliefs prevented the adoption of some messages.

Conclusions

Both HP and caregivers were invested in improving infant and young child feeding practices. Trained HP demonstrated skills for effective nutrition counselling. Inclusion of nutrition education and counselling training in all HP’s curriculum, as well as in-service refresher training, is recommended to ensure all HP possess the knowledge and communication skills needed in the health services.

KEYWORDS:

• Health services
• nutrition education
• nutrition counselling
• complementary feeding
• infant and young child feeding
• behavioural factors
• environmental factors
• Peru

Acknowledgements

This paper and the research presented within would not have been possible without the invaluable contribution of Cindy Castro-Sernaqué to the data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Ethical approval was obtained for all data collection from McGill University’s Research Ethics Review Board and the Instituto de Investigación Nutricional (Nutrition Research Institute) Ethics Committee in Lima, Peru. Informed verbal consent was obtained prior to conducting exit interviews and informed written consent before in-depth interviews and observations for all participants prior to any study activity.

Additional information

Notes on contributors

M. B. Charron

M. B. Charron is currently a medical student at University College Cork in Ireland. She previously completed her bachelor’s and master’s degrees at McGill University. Her interests lie in maternal and child health and more specifically in infant feeding and the benefits of optimal feeding on child health and development.

G. S. Marquis

G. S. Marquis, PhD, LLD, is Associate Professor at McGill University and Associate Professor/Collaborator at Iowa State University. Her research career began in Peru at the Instituto de Investigación Nutricional. In 1999, her research group started working in Ghana. These long-term collaborations continue today. The work in Ghana is primarily through the Nutrition Research and Training Centre, a permanent research site which she built in the Eastern Region in collaboration with faculty at the University of Ghana (https://mcgill.ca/cine/research/building-capacity-sustainable-livelihoods-and-health-ghana). Her community-based research examines how many social, cultural, biological, and environmental factors interact and the mechanisms by which they alter a household’s ability to provide optimal feeding and caregiving for young children. Based on acquired knowledge, her research group develops alternative strategies that will support child health and growth and are feasible for families in poverty. Dr. Marquis is Associate Editor for Advances in Nutrition. She received a Doctorate of Laws, honoris causa, for contribution to tertiary education from the University of Ghana in 2013.

R. Bartolini

R. Bartolini is a principal investigador at the Instituto de Investigacion Nutricional (Nutrition Research Institute) in Lima, Peru. With a Masters of Anthropoly from the Pontificia Universidad Católica del Perú (Pontifical Catholic University of Peru), she specializes in the design, management, and implementation of health research projects from medical anthropology and public health perspectives. Her research projects focus on nutrition, hygiene, infectious diseases, and quality care. She has substantial experience working in different environments from peri-urban to rural regions in Peru and Latin America.

H. Creed-Kanashiro

H. Creed-Kanashiro, MPhil, is a principal investigator at the Instituto de Investigación Nutricional (Nutrition Research Institute) in Lima, Peru. Graduated with a Master of Philosophy from University College London, she has led and participated in numerous research projects in Peru and other regions of the world. Her interests lie principally in breastfeeding, complementary feeding, responsive feeding and health service counselling in these areas.