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Part II. Creating the protocol

3. Theory and process: The methods

3. Theory and process: The methods

Harriet V. Kuhnlein, Pertti J. Pelto, Gretel H. Pelto, and Members of IUNS Committee II/6

The International Union of Nutritional Sciences, committee on nutrition and anthropology
Theory of the methodological approach
Overview of methods of data-collection described in the protocol manual
Testing the protocol

The International Union of Nutritional Sciences, committee on nutrition and anthropology

The International Union of Nutritional Sciences (IUNS) Committee II/6 on Nutrition and Anthropology was the conception point for this project. Committee II/6 convened from 1990 to 1994 with the mandate to facilitate solutions to food and nutrition problems through the application of anthropological knowledge and techniques. To this end, the committee identified its objectives to address vitamin A deficiency, and in particular the use of natural food sources of vitamin A in communities to prevent deficiency. A planning subcommittee met in Washington D.C. in November 1990, to define its goals, and to set the framework of the project described here, which became an activity of the committee.

The IUNS Committee II/6 was comprised of Isabel Nieves (Guatemala) and Harriet Kuhnlein (Canada) as co-chairs; Gretel Pelto (USA, WHO), Richard Young (Canada, IDRC), S. Abdel-Azim Wahba (Egypt), C. Santos-Acuin (Philippines), P. Pushpamma (Singapore), K. Kalumba (Zambia), N. Ngokwey (Benin), H. Creed-Kanashiro (Peru), and L.H. Martinez Salgado (Mexico). The planning subcommittee became Kuhnlein, Pelto, Nieves, and Young; other committee members who eventually participated in the project were Acuin, Pushpamma, and Creed-Kanashiro.

Several committee members had previous experience with rapid ethnographic assessments, and it was significant that the origins of the ideas for the project germinated at the RAP conference in 1990 in Washington (see Scrimshaw and Gleason, 1992). Committee member G. Pelto had substantial experience in the creation of ethnographic assessments in health programs, notably with the respiratory diseases manual in use with WHO (Pelto and Gove, 1992; Gove and Pelto, 1994; WHO, 1993a; 1994). It was therefore felt that sufficient experience in this area existed within the committee.

Objectives and Funding

The planning subcommittee proceeded to define the objectives and workplan of the project, with the first step being a literature review. With the financial assistance of the International Nutrition Foundation for Developing Countries (N. Scrimshaw), a literature review was completed and published through McGill University with the participation of S.L. Booth, T. Johns, H.V. Kuhnlein, and I. Nieves (Booth et al., 1992, Johns et al., 1992, Kuhnlein, 1992; Kuhnlein and Nieves, 1992).

A one-year project proposal was funded by IDRC through McGill University (H.V. Kuhnlein) to develop a community assessment protocol manual for the identification of locally-available food sources of vitamin A. The protocol was to identify food sources, describe current patterns of use, particularly in relation to infants, children, and pregnant and lactating women, and to elucidate the ecological, economic, and cultural factors that influence these patterns. It would identify community beliefs and practices related to the signs and symptoms of xerophthalmia and health care practices related to these. The protocol was to be tested in five diverse areas of culture and ecology/food system type to fine tune it and determine its generalizability. Field testing was used to identify useful information resulting from the protocol for implementing food-based vitamin A deficiency prevention programs.

The International Development Research Centre (IDRC) and the International Nutrition Foundation for Developing Countries (INFDC) agreed to jointly publish two volumes related to the project: Community Assessment of Natural Food Sources of Vitamin A: Guidelines for Ethnographic Studies and Culture, Environment and Food to Prevent Vitamin A Deficiency. Publication planning and finalization was coordinated through the Centre for Nutrition and the Environment of Indigenous Peoples of McGill University.

Persons Involved, Basic Activities and Timeline

With objectives and planning accomplished, funding was implemented in 1993-1994. The persons finally contributing to the project were as follows:

Planning: H.V. Kuhnlein, G. Pelto, R. Young, P. Pelto, I. Nieves

Initial field testing and creation of module sections to the protocol manual: L. Blum, G. Pelto, T. Johns, S. Booth, H.V. Kuhnlein

Literature review: S. Booth, T. Johns, H.V. Kuhnlein

Training workshop: P. Pelto, L. Blum

Field test site supervisors: L. Blum (Niger), H. Creed-Kanashiro (Peru), C. Santos-Acuin (Philippines), Li Wen Jun (China), P. Pushpamma (India). Site visits by P. Pelto, H.V. Kuhnlein

Revisions to protocol manual: P. Pelto, H. V. Kuhnlein, G. Pelto, L. Blum

Publications finalizing and submission: H.V. Kuhnlein

The timeline of activities was as follows:

• Communications with IUNS Committee II/6, identification of interested committee members, planning: 1990-1994

• Planning committee meetings in Washington, and by conference call: 1990-1993

• Training workshop, McGill University: May, 1993

• Commitment by field supervisors, budget distribution: May-August, 1993

• Field site testing: July, 1993-January, 1994

• Receipt of field test results: January, 1994

• Workshop on manual revisions: January, 1994

• Final revisions to manual received: January-June, 1994

• Submission of funding report and final draft of manual: June, 1994

• Reports to scientific meetings:

IUNS: August, 1993
Experimental Biology (FASEB): April, 1994
American Anthropology Association (AAA): November, 1994
IVACG: March, 1996

• Chapters to companion volume received: June-December, 1995

• Publications: March, 1996

Theory of the methodological approach

Positive dietary change is a gradual process initiated by education, food availability, and choice, and has been given low priority in most vitamin A intervention programs (Darnton-Hill, 1988; IVACG, 1989; Kuhnlein and Receveur, 1996). However, food-based programs for the prevention of vitamin A deficiency are recognized as essential components of the mix of interventions that will prevent mortality and morbidity related to the deficiency of this vitamin (Underwood, 1994). Effective positive dietary change that will prevent vitamin A deficiency requires identifying and quantifying natural food sources rich in vitamin A and provitamin A, in conjunction with foods rich in nutrients that impact on vitamin A uptake and bioavailability (Mejia, 1986). Ecological, cultural, and economic factors that influence food availability, cost, and consumption patterns, as well as attitudes and beliefs about food and feeding behaviors need to be defined and incorporated into programs, as these are often the underlying causes of the deficiency (Devadas, 1987; Kuhnlein, 1992).

It becomes increasingly clear that community data must be used to create locally effective programs for the prevention of vitamin A deficiency and improved health that will be sustainable for the long term. Such data include the availability of food; economic value of food; consumption patterns; values of and attitudes and beliefs toward food; feeding behaviors; and existing vitamin A deficiency (Kuhnlein and Nieves, 1992). Protocols are needed to assist community health, agriculture, education, and nutrition personnel and program planners in obtaining critical information for program planning and development aimed at the elimination of vitamin A deficiency as a public health problem.

Research methods grounded in nutrition and anthropology can be used to devise the needed protocols. As described in Chapter 1, the focused ethnographic study (FES) methodology has been developed and used to address the necessary community data in a series of predetermined questions, the answers to which will assist intervention planning. Similar to manuals developed in rapid assessment procedures (RAP) and other guidelines for ethnographic data-gathering, the manual for community assessment of vitamin A includes techniques used to gather both qualitative and quantitative information. The interviewing methods, including the use of in-depth interviewing, cognitive mapping techniques, and structured observation, are drawn from standard research procedures in the social sciences. Tools incorporated from nutrition research techniques include food frequency, 24-hour recall, market surveys, and food system data compilations. In common with other RAP approaches, but departing from the usual approaches in non-applied qualitative research, the manual sets forth very specific steps for data-collection to be followed by the field team. The provision of forms for data-recording, and instructions for data analysis, are further means of facilitating the goal of producing a programmatically useful report in a timely fashion.

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