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Environmental and behavioural factors influencing the effectiveness of counselling on the feeding of infants and young children in two extremely poor Peruvian districts

ABSTRACT Background Inadequate feeding practices contribute to poor nutrition among Peruvian children. In response, Peru’s Lambayeque Regional Government funded an initiative in its four poorest districts to improve nutrition counselling skills of health-service professionals (HP). The study aimed to identify factors associated with successful communication of optimal nutrition practices to caregivers. Method Counselling data were collected in six health establishments in two of the four poorest Lambayeque districts. A thematic content analysis was completed for 30 direct observations of counselling by staff in the national child growth and development monitoring programme, 26 exit interviews with caregivers, 12 in-depth interviews (5 HP and 7 caregivers), and 5 home observations. Results Type and training of HP influenced messages given. Nurses focussed on multi-micronutrient powders and iron-rich foods; nutritionists targeted dietary diversity, food consistency, and frequency of feedings. Caregivers reported feeling more comfortable when HP used positive verbal communication and non-verbal cues. Language was a barrier (non-Quechua speaking HP), as were high HP turnover, remoteness of villages, and limited attending hours, all of which reduced opportunities for nutrition education. Learning materials and group demonstrations facilitated comprehension, but cultural beliefs prevented the adoption of some messages. Conclusions Both HP and caregivers were invested in improving infant and young child feeding practices. Trained HP demonstrated skills for effective nutrition counselling. Inclusion of nutrition education and counselling training in all HP’s curriculum, as well as in-service refresher training, is recommended to ensure all HP possess the knowledge and communication skills needed in the health services.