From research to program design: use of formative research in Haiti to develop a behavior change communication program to prevent malnutrition.

This paper summarizes findings from a formative research study conducted in Haiti to develop a behavior change communication (BCC) strategy to improve infant and child feeding practices and to reduce childhood malnutrition. It describes the methodology used and the tools developed to facilitate decisionmaking and effective use of formative research for program planning. The study is part of a larger research project carried out by the International Food Policy Research Institute (IFPRI) and Cornell University in collaboration with World Vision-Haiti, a private voluntary organization responsible for the implementation of integrated health and nutrition programs that include food donations. The study used formative research methods that included individual and group interviews, food-rating exercises, and participatory recipe trials. The aims of the study were to (1) study current infant and young child feeding practices in the Central Plateau of Haiti, (2) identify individual, household, and community factors that may facilitate or constrain adoption of recommended behaviors, and (3) use the information from the formative research to prioritize behaviors and design an effective BCC strategy. The study revealed some nonoptimal infant and young child feeding practices in this part of rural Haiti, such as low rates of exclusive breastfeeding, early introduction of nutrient-poor gruels, and the scarcity of nutrient-dense foods such as animal products in the diet. A number of constraints were also identified that may limit the ability of families to engage in optimal feeding practices. These include the early resumption of work outside the home by women, which is driven by economic necessity and results in frequent and sometimes long separations of the mother from her young infant. The lack of time to prepare special complementary foods for the child, the perception that 12month-old infants are ready to consume the family diet, and the low availability of micronutrient-rich foods (animal-source foods in particular) are additional constraints on poor families to achieving optimal child feeding practices.