Assessing implementation fidelity of a community-based XXXX and young @entity1 feeding intervention in Ethiopia identifies delivery challenges that limit reach to communities: a mixed-method process evaluation study.

@entity1 @entity283
BACKGROUND: Program effectiveness is influenced by the degree and quality of implementation, thus requiring careful examination of delivery processes and how the program is or is not being implemented as intended. Implementation fidelity is defined by adherence to intervention design, exposure or dose, quality of delivery, and @entity1 responsiveness. As part of the process evaluation (PE) of Alive _ Thrive in Ethiopia, a large-scale initiative to improve @entity1 and young @entity1 feeding (IYCF), we assessed these four fidelity elements along three components of its community-based intervention: training of frontline workers (FLWs), delivery of program tools and messages, and supportive supervision. METHODS: Data from a qualitative study among three levels of FLWs (n   =   54), i.e. supervisors, @entity283 ( @entity283 ), and community volunteers, and among mothers with @entity1 under two years of age (n   =   60); and cross-sectional PE surveys with FLWs (n   =   504) and mothers (n   =   750) in two regions (Tigray and SNNPR) were analyzed to examine program fidelity. RESULTS: There was strong adherence to the intended cascading design (i.e. transfer of knowledge and information from higher to lower FLW levels) and high exposure to training (95% @entity283 and 94% volunteers in Tigray, 68% and 81% respectively in SNNPR). Training quality, assessed by IYCF knowledge and self-reported capacity, was high and increased since baseline. Job aids were used regularly by most supervisors and @entity283 , but only 54% of volunteers in Tigray and 39% in SNNPR received them. Quality of program message delivery was lower among volunteers, and aided recall of key messages among mothers was also low. Although FLW supervision exposure was high, content and frequency were irregular. CONCLUSIONS: There is evidence of strong fidelity in training and delivery of program tools and messages at higher FLW levels, but gaps in the reach of these to community volunteers and mothers and variability between regions could limit the potential for impact. Strengthening the linkages between @entity283 and volunteers further can help to reach the target households and deliver IYCF results at scale.
