[Fidelity, acceptability, and suitability in the implementation of responsive food cards in Brazil]

The goal of responsive feeding (RF) cards is to encourage food autonomy and to boost cognitive, emotional and social development. It is becoming a critical tool to promote child nutrition in primary care. The aim of the present study is to (1) assess the accuracy of RF cards implementation by trained community health agents (CHA), (2) to investigate their acceptability and adequacy from the perspective of caregivers to 0 to 3-year old children in rural-riverside and urban Brazilian regions. Eight-hour training on using culturally appropriate RF cards was made available to 45 CHAs. Observations on how to conduct the sessions were based on using a checklist applied to four group-education sessions. The opinion of caregivers was collected through deductive coding based on recordings that were transcribed by a professional. The aforementioned training ensured accuracy to delivery RF messages. Caregivers highlighted the messages' adequacy and acceptability over the group-education sessions. The study highlights a viable strategy to achieve RF cards use accuracy in primary care, besides stressing the relevance of culturally adapted materials developed for different populations.