Departments of Nutritional Sciences and Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA.
Nourish Global Nutrition, Vancouver, BC V6H 4A7, Canada.
Nutrients. 2019 Jun 13;11(6):1330. doi: 10.3390/nu11061330.
This study sought to elucidate the multi-level factors that influence behaviors underlying high childhood stunting and widespread micronutrient deficiencies in Kiribati. This two-phase formative research study had an emergent and iterative design using the socio-ecological model as the guiding theoretical framework. Phase 1 was exploratory while phase 2 was confirmatory. In phase 1, in-depth interviews, free lists, seasonal food availability calendar workshops, and household observations were conducted. In phase 2, focus group discussions, pile sorts, participatory workshops, and repeat observations of the same households were completed. Textual data were analyzed using NVivo software; ethnographic data were analyzed with Anthropac software for cultural domain analysis. We found a combination of interrelated structural, community, interpersonal, and individual-level factors contributing to the early child nutrition situation in Kiribati. Despite widespread knowledge of nutritious young child foods among community members, households make dietary decisions based not only on food availability and access, but also longstanding traditions and social norms. Diarrheal disease is the most salient young child illness, attributable to unsanitary environments and sub-optimal water, sanitation, and hygiene behaviors. This research underscores the importance of a multi-pronged approach to most effectively address the interrelated policy, community, interpersonal, and individual-level determinants of infant and young child nutrition in Kiribati.
本研究旨在阐明影响基里巴斯儿童发育迟缓率高和广泛存在微量营养素缺乏的多层次因素。这项两阶段形成性研究采用社会生态模型作为指导理论框架，具有突发和迭代设计。第一阶段是探索性的，第二阶段是验证性的。在第一阶段，进行了深入访谈、自由列表、季节性食物供应日历研讨会和家庭观察。在第二阶段，完成了焦点小组讨论、堆积分类、参与式研讨会以及对同一家庭的重复观察。使用 NVivo 软件对文本数据进行分析；使用 Anthropac 软件对民族志数据进行文化领域分析。我们发现，一系列相互关联的结构、社区、人际和个人层面的因素导致了基里巴斯儿童早期营养状况不佳。尽管社区成员普遍了解幼儿营养食品，但家庭做出饮食决策不仅取决于食物的可获得性和获取途径，还取决于长期的传统和社会规范。腹泻病是最突出的幼儿疾病，归因于不卫生的环境和不理想的水、环境卫生和个人卫生行为。这项研究强调了采取多管齐下的方法来有效应对基里巴斯婴儿和幼儿营养相关政策、社区、人际和个人层面决定因素的重要性。
