Implementation fidelity of a pilot group-based nutrition intervention for pregnant women (Nutri Pou Ti' Moun 2): a...

In the context of an overseas territory of a high-income country characterized by high fertility rates, cultural diversity, and food insecurity, a small-scale collective intervention with a focus on nutrition was implemented among pregnant women. Inspired by centering-based group care, without the health care component and with a food aid component, the interactive group sessions were co-facilitated by an expert on the session's topic and a peer-facilitator. The objective of the study was to assess the implementation fidelity to determine whether upcoming intervention outcomes are driven by the innovation or its implementation, and identify opportunities for improvement.

The study employed a mixed-methods design and was guided by the Conceptual Framework for Implementation Fidelity. Quantitative data regarding the intervention recipients were collected through questionnaires, intervention worksheets and medical records. Semi-structured interviews were used to collect qualitative information about the experience of the intervention recipients. Data among deliverers and other stakeholders were collected quantitatively through self-administered questionnaires and qualitatively through semi-structured interviews. Descriptive, bivariate, and multivariate analyses were performed using Stata 19.5 software to determine the sociodemographic characteristics of intervention recipients and the determinants of relative assiduity.

Overall, implementation was aligned with the original plan, with only a few minor adaptations. Despite contextual barriers and competing survival priorities, 77% of the 122 intervention recipients attended at least half of the sessions, indicating a satisfactory participation rate. The profile of recipients showed that marginal exclusion of the most socioeconomically disadvantaged women appears to have been limited, and bivariate analysis revealed that women who reported suffering from social isolation actually showed greater commitment. Conversely, educational attainment was associated with higher assiduity in nutrition-focused sessions, as opposed to living in a single-adult household. Although the intervention demonstrated high appropriateness and was well-received from recipients and all stakeholders, opportunities for improvement were identified regarding intervention clarity, organizational processes, and the scope of the mediation role.

These findings inform the subsequent impact evaluation and its mechanisms of action. They also shed light on the potential transferability of a group-based intervention that addresses determinants of food insecurity during the first 1,000 days.

Clinicaltrials.gov number: NCT06528535. Release date: 07/23/2024.