Utilizing innovative formative research techniques to decrease adolescent anaemia in Mozambique

AN Innovative Approach to DecreasE Adolescent Anaemia in Mozambique (Oct 2021 – Sept 2024)

In collaboration with the Ministry of Health (MoH), World Vision (WV) will compare the effectiveness, acceptability, and feasibility of Multiple Micronutrient Supplementation (MMS) among adolescent girls. The purpose of this implementation research is to inform future MoH decision-making and policies around best practices to prevent adolescent anaemia and scale these evidence-based approaches.

Funding: WV Canada, Every Girl Can project, funded by Global Affairs Canada

abstract:

Iron-deficiency anaemia is the leading cause of lost Disability-Adjusted Life Years (DALYs) globally among adolescent girls and young women aged 10 to 19 years (Canavan and Fawzi, 2019). In Mozambique, iron-deficiency anaemia is especially alarming, with 55.9% of girls aged 15 to 19 years with anaemia (Mozambique MoH, 2018). Malnutrition, especially anaemia, undermines adolescent girls’ aptitude for learning, capacity to generate income, and increases their risk for poor maternal and infant health outcomes. To better understand behavioural, social, political, and environmental determinants influencing adolescent dietary practices, especially iron-deficiency anaemia, WV Mozambique, in partnership with WV International, the Ministry of Health (MOH), and the Ministry of Education (MoE), will implement the Every Girl Can Improve Nutrition (ECG IN) study in Nampula Province, Mozambique. The ECG IN Study will utilise an Adolescent-Centred Design (ACD) that reflects the preferences of adolescent girls for how micronutrient supplements are delivered to them, and empowers adolescent girls to serve as lead consultants in the intervention design. The proposed theory of change for this study is: IF an ACD approach is utilised to design an adolescent MMS delivery model, THEN a significantly higher level of adoption of desired behaviours will occur resulting in decreased anaemia among adolescent girls in Monapo, Mozambique.  

While Human-Centred Design (HCD) has been increasingly utilised in global health (Human-Centered Design, 2021), there is a gap in the literature around how this methodology has been effectively applied to design the delivery of nutrition interventions. In particular, we could not find any specific reference to ACD in the literature as it relates to nutrition. An ACD approach could be an effective tool in designing an adolescent MMS delivery tool and warrants more consideration when designing adolescent health and interventions in general. There is also a need to explore the strengths and limitations of utilising HCD approaches in the design and implementation of adolescent nutrition programmes.  

Methodology 

While human-centred design (HCD) is well cited in the literature, to our best knowledge, the term adolescent-centred design (ACD) is innovative. With ACD, we will we follow the five-step process for people-centred design thinking related to designing a MMS delivery model: 1) understand the challenges and opportunities around school micronutrient supplementation (informed by Phase one); 2) define different scenarios of what an adolescent MMS delivery platform could look like; 3) ideate and select one or two preferred MMS delivery models; 4) make the platform tangible by sharing the preferred scenarios with key stakeholders; 5) iterate and revise the delivery model based upon feedback from key stakeholders and select one preferential MMS delivery model. The ACD workshop with follow the HCD methodology which allows the end users of a product or process to develop a new solution based on their lived experience.  

An ACD workshop will be conducted to determine a preferred MMS delivery model to help ensure the preferences and needs of adolescents are better served. With the assistance of teachers, we will use purposive sampling to recruit six adolescent girls 13 to 16 years of age and six adolescents 17 to 20 years of age (for a total of 12 girls) to ensure variation over the sample of characteristics of adolescent girls participating in IMPACT+ (and the study). The girls will be recruited from the four targeted schools in Monapo Province. To be eligible to participate in the ACD Workshop, participants must be between 13 and 20 years of age, be able to attend a four-hour workshop, obtain parental consent, and provide assent to participate. The first two hours of the workshop will include the adolescent girl participants, followed by another two hours with key stakeholders. Affinity mapping, rapid thematic content analysis, insight mapping, and visual analysis of the ACD MMS delivery model will be used to analyse the data collected during the workshop.  

References:  

4 Mozambique AH18052018.pdf. (n.d.). Retrieved April 24, 2022, from https://www.afro.who.int/sites/default/files/2019-04/4%20Mozambique%20AH18052018.pdf 

Canavan, C. R., & Fawzi, W. W. (2019). Addressing Knowledge Gaps in Adolescent Nutrition: Toward Advancing Public Health and Sustainable Development. Current Developments in Nutrition, 3(7), nzz062. https://doi.org/10.1093/cdn/nzz062 

Human-Centered Design. (2021, July 12). https://www.usaid.gov/cii/human-centered-design