Assessing Implementation Fidelity Of A Community-Based Infant And Young Child Feeding Intervention In Ethiopia Identifies Gaps In Delivery That Limit Reach To Communities

Implementation fidelity is defined by adherence to intervention design, exposure or dose, quality of delivery, and participant responsiveness. As part of the process evaluation (PE) of Alive & Thrive, a large-scale initiative to improve IYCF, our study assessed the four elements in training of frontline workers (FLWs), delivery of program tools and messages, and supervision and feedback. Data from a qualitative study among three levels of FLWs (n=54 in 2012), i.e. supervisors, health extension workers (HEWs), and community volunteers; and baseline and PE surveys with FLWs (n=225 in 2010, n=504 in 2013) and mothers (n=1,481 in 2010, n=750 in 2013) in two regions (Tigray and SNNPR) were analyzed to examine fidelity of key program components. There was strong adherence to intended cascading format (i.e. information transfer from higher to lower FLW levels) and high exposure to training (95% HEWs and 94% volunteers in Tigray, 68% and 81% respectively in SNNPR). Training quality, assessed by IYCF knowledge...