[pronut-hiv] Translating global recommendations on HIV and infant feeding to the local context

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Translating global recommendations on HIV and infant feeding to the
local context: the development of culturally sensitive counselling tools
in the Kilimanjaro Region, Tanzania

Sebalda C Leshabari, Peggy Koniz-Booher. et al.

Implementation Science 2006, 1:22     

 http://www.implementationscience.com/content/1/1/22 

Background
This paper describes the process used to develop an integrated set of
culturally sensitive, evidence-based counselling tools (job aids) by
using qualitative participatory research. The aim of the intervention
was to contribute to improving infant feeding counselling services for
HIV positive women in the Kilimanjaro Region of Tanzania.
Methods
Formative research using a combination of qualitative methods preceded
the development of the intervention and mapped existing practices,
perceptions and attitudes towards HIV and infant feeding (HIV/IF) among
mothers, counsellors and community members. Intervention Mapping (IM)
protocol guided the development of the overall intervention strategy.
Theories of behaviour change, a review of the international HIV/IF
guidelines and formative research findings contributed to the definition
of performance and learning objectives. Key communication messages and
colourful graphic illustrations related to infant feeding in the context
of HIV were then developed and/or adapted from existing generic
materials. Draft materials were field tested with intended audiences and
subjected to stakeholder technical review.

Results
An integrated set of infant feeding counselling tools, referred to as
'job aids', was developed and included brochures on feeding methods that
were found to be socially and culturally acceptable, a Question and
Answer Guide for counsellors, a counselling card on the risk of
transmission of HIV, and an infant feeding toolbox for demonstration.
Each brochure describes the steps to ensure safer infant feeding using
simple language and images based on local ideas and resources. The
brochures are meant to serve as both a reference material during infant
feeding counselling in the ongoing prevention of mother to child
transmission (pMTCT) of HIV programme and as take home material for the
mother.

Conclusion
The study underscores the importance of formative research and a
systematic theory based approach to developing an intervention aimed at
improving counselling and changing customary feeding practices. The
identification of perceived barriers and facilitators for change
contributed to developing the key counselling messages and graphics,
reflecting the socio-economic reality, cultural beliefs and norms of
mothers and their significant others.