Effective Transfer of Nutritional Messages to Caregivers by Health Service Providers Trained in Counseling in Two Poor Districts of the Lambayeque Region, Peru

Suboptimal infant and young child feeding practices contribute to poor nutrition outcomes. The 2015 Peru Demographic Health Survey reported that 49% of infants 6–8 months did not consume meats, poultry, fish, or eggs and 36% received fewer than three food categories. These inadequate feeding practices contribute to the high rates of anemia (43.5% of children 6 – 35 months). In response, the Lambayeque regional government funded a train‐the‐trainer initiative in the four poorest districts of the region to improve the skills of health service professionals (HP) in effective nutrition education counselling. The objectives of the present study were to evaluate how the training was currently applied in counselling by HP and to identify influential factors on effective transfer of improved nutrition practices to caregivers. Of particular interest was to examine interpersonal relationships between HP and caregivers. Data were collected in six health establishments in two of the four selected Lambayeque districts. We completed in‐depth interviews with 5 HP, and 34 exit interviews with caregivers, of whom 7 gave in‐depth interviews and 5 who also permitted home observations. In addition, 29 direct participant observations of visits to the child growth and development monitoring program were conducted to observe the counselling. Counselling messages focused on how to use multi‐micronutrient powders and increase consumption of iron‐rich foods (e.g., liver, sangrecita ). A majority of caregivers identified those same messages as the most important ones to assure their children's health. Interviews with caregivers and home observations indicated that nutritional messages (e.g., give more iron‐rich foods, give more legumes) were acceptable and feasible to achieve in the household. Learning materials (e.g., model plates) and group demonstration sessions facilitated caregiver comprehension, whereas caregivers' Quechua language was a barrier. Challenges that affected the continuity of good counselling in the health services were the frequent rotation of health service personnel and poor caregiver attendance. Lastly, beliefs or traditions prevented the adoption of some messages (e.g., duck is a cold meat, consuming animal blood ( sangrecita ) is comparable to consuming the animal's soul). Health professionals in the targeted districts used counselling skills demonstrated in the on‐going training and delivered the training's key nutrition messages. The HP made use of learning materials and used different delivery methods; caregivers understood the nutritional messages and applied them in their home. To conclude, HP also benefited from this on‐going initiative as they manifested a sense of satisfaction in what they had accomplished in improving children's health and nutritional status. Support or Funding Information McBurney Foundation

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